title: The application of Kingdon's Multiple Streams Theory for human papillomavirus-related anal intraepithelial neoplasia.
abstract: OBJECTIVE
  This paper presents a discussion of the advantages and disadvantages of redefining human papillomavirus-related anal intraepithelial neoplasia as a problem of sexually active people by using Kingdon's Multiple Streams Theory to examine possible policy solutions for increasing anal cancer screening.
  
  
  BACKGROUND
  Human papillomavirus is the most common sexually transmitted infection worldwide. Anal cancer associated with human papillomavirus infections is increasing in incidence in both men and women. The prevalence of anal cancer does not decrease with age.
  
  
  METHODS
  Pubmed was searched for articles and internet references from 1995-2012.
  
  
  CONCLUSIONS
  Although a large body of literature suggests that human papillomavirus-related anal intraepithelial neoplasia is a problem, no effective policy solutions have emerged. However, as almost the entire sexually active population is exposed to human papillomavirus, it should be thought of as every person's problem. This suggests that human papillomavirus-related anal intraepithelial neoplasia calls for different types of problem definitions and policy solutions to address the disease. The issue of anal cancer is typically defined as a problem of HIV-positive individuals.
  
  
  CONCLUSIONS
  Nurses are focused on improving patient outcomes. We play a key role in helping to identify problems, moving problems onto policymaker's agendas, and influencing the creation of new healthcare policies.
  
  
  CONCLUSIONS
  Human papillomavirus-related anal intraepithelial neoplasia demands attention and the development of national level policies to ensure public health and safety. Kingdon's Multiple Streams Theory has provided a pragmatic framework to evaluate the problem.
authors: University of California San Francisco - School of Nursing, Community Health Systems, California, USA.
authors: Tara
authors: T
authors: Walhart
mesh_terms: D001005:Anus Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008962:Models, Theoretical; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control; D011050:Policy Making
keywords: HIV; HPV; HRA; Nursing practice; anal cancer; policy