Understanding Men's Perceptions of Human Papillomavirus and Cervical Cancer Screening in Kampala, Uganda

"Findings from this study provide some evidence of the need for enhanced methods to engage and educate men to encourage men's involvement in reproductive screening programs."

In low- and middle-income countries (LMICs) such as Uganda, the lack of population-level implementation of cervical cancer screening and human papillomavirus (HPV) vaccination has led to high rates of morbidity and mortality. The World Health Organization (WHO) has called for an increase in male involvement in the prevention of cervical cancer in LMICs. Yet issues including stigma, cultural taboos, and a general lack of knowledge have been described as barriers to supportive male engagement in women's health care. This study explored men's knowledge and attitudes toward HPV and cervical cancer and intention to support partners to attend screening in Kisenyi, a densely populated urban community in Kampala, Uganda. The hope is that this research could inform the design and development of future public health education strategies.

Established in 2006, the international women's health initiative Advances in Screening and Prevention in Reproductive Cancers (ASPIRE) has drawn centrally on community mobilisation and engagement to improve acceptability and uptake of cervical cancer screening. In prior ASPIRE research on community engagement and education leading up to a cervical cancer clinical trial, women in the Kisenyi district indicated male involvement was central to the success of any cervical cancer screening intervention.

For the present ASPIRE study, in June 2015, outreach workers recruited 63 men between the ages of 18 and 69 years in the area of the Kisenyi Health Centre to participate in an education session. Run by the centre's medical director, the 2-hour presentation focused on HPV, cervical cancer, prevention methods, and screening options for women. Before the session, knowledge and awareness of cervical cancer was more than twice as high (n = 36; 59%) as knowledge of HPV (n = 15; 24.6%; Table 2). Of the men who had heard of HPV, only 6 (9.5%) believed that it was transmitted through sexual intercourse. In total, 43 men (70%) indicated that their partner had never been screened for cervical cancer, and 57 (93%) would support their partner to be screened if screening was available in the community.

Of the 62 men who completed the education session, 55 completed the posteducation survey. Fifty-four men (98.2%) indicated they would want their partners to be screened for cervical cancer, and 55 (100%) would want their daughters to be vaccinated with the HPV vaccine if available. Forty-nine men (89.2%) understood that you could have HPV without knowing it, and 53 (96.4%) believed HPV was spread through sexual contact.

Despite indication of some improvements in knowledge after the session, some misconceptions about HPV remained: 30 men (54.5%) believed that only women could get HPV, 9 (16.4%) believed that HPV causes HIV, and 18 (32.7%) believed that antibiotics could cure HPV. These findings highlight that a one-time didactic education session may not be sufficient for knowledge translation. They also suggest the need for ongoing culturally appropriate education programmes for both men and women about cervical cancer and HPV. Previously published data suggest that cultural beliefs and limited education were a barrier to HPV vaccination in some LMICs but that these can be mitigated through community sensitisation and education.

In conclusion, cervical cancer is a leading cause of death for women in countries such as Uganda, and a lack of partner support is a barrier to screening. Men's knowledge of cervical cancer and HPV remain low in many LMICs; however, men in this study expressed a high level of interest in reproductive health education and the desire to support their partner to be screened for cervical cancer. Future studies could explore male partners' perceived barriers to their involvement in their partners' screening as well as the impact of ongoing education on their partners' reproductive health.