title: Perceptions and Experiences of Human Papillomavirus (HPV) Infection and Testing among Low-Income Mexican Women.
abstract: HPV infection causes cervical cancer, a major contributor to morbidity and mortality among low-income Mexican women. Human papillomavirus (HPV) DNA testing is now a primary screening strategy in Mexico's early cervical cancer detection program (ECDP). Research on Mexican women's perceptions of HPV and testing is necessary for establishing culturally appropriate protocols and educational materials. Here, we explore perceptions about HPV and HPV-related risk factors among low-income Mexican ECDP participants.
  
  
  
  We conducted semi-structured interviews with 24 ECDP participants from two primary care health clinics in Michoacán state, Mexico. Interviews addressed women's understandings of and experiences with HPV and HPV testing. Analysis was inductive and guided by the Health Belief Model with a focus on gender.
  
  
  
  Women's confusion about HPV and HPV screening caused emotional distress. They understood HPV to be a serious disease that would always cause severe symptoms, often characterizing it as analogous to HIV or inevitably carcinogenic. Women also attributed it to men's sexual behaviors, specifically infidelity and poor hygiene. Women described both sexes' desire for sex as natural but understood men's negative practices of masculinity, like infidelity, as the causes of women's HPV infection. Some women believed dirty public bathrooms or heredity could also cause HPV transmission.
  
  
  
  These results are consistent with prior findings that geographically and economically diverse populations lack clear understandings of the nature, causes, or symptoms of HPV, even among those receiving HPV testing. Our findings also reveal that local cultural discourse relating to masculinity, along with failure to provide sufficient education to low-income and indigenous-language speaking patients, exacerbate women's negative emotions surrounding HPV testing. While negative emotions did not deter women from seeking testing, they could be ameliorated with better health education and communication.
authors.affiliation: CONACYT, Instituto Nacional de Cancerología, Ciudad de México, México.|Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Leith
authors.initials: L
authors.lastname: León-Maldonado
authors.affiliation: Department of Anthropology, The University of Iowa, Iowa City, IA, United States of America.
authors.forename: Emily
authors.initials: E
authors.lastname: Wentzell
authors.affiliation: Department of Social Medicine and Population Health, School of Medicine, University of California, Riverside, CA, United States of America.
authors.forename: Brandon
authors.initials: B
authors.lastname: Brown
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Betania
authors.initials: B
authors.lastname: Allen-Leigh
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Leticia
authors.initials: L
authors.lastname: Torres-Ibarra
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.|Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salmerón
authors.affiliation: Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Billings
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.|Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lazcano-Ponce
mesh_terms: D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears