Disclaimer: This article contains references to sexual trauma, which may be distressing. Reader discretion is advised.

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Despite how common it is, human papillomavirus (HPV) remains a stigmatized health issue. Guidance around HPV prevention has focused on encouraging people to manage their sexual practices (e.g., monogamy, protected sex). While safe and consensual sex is important for many reasons, over the years, this emphasis on sexual habits has created a sense of stigma around HPV and blame toward women who test positive for this virus. 

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Aisha, a 40-year-old mother of three, and metastatic cervical cancer survivor describes how this stigma impacted her when she was diagnosed: 

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“Cervical cancer is so taboo. In hindsight, when I was diagnosed, I didn't want to tell anybody I had cervical cancer. I was like ‘Gross, I have a STD.’ I was so misinformed. [...] But I just sat with myself and realized this is actually part of the problem.” 

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Like so many others, stigma added to Aisha’s emotional distress when she was diagnosed. She felt embarrassed and soon realized that this stigma was making it even more challenging to find the information she needed to understand her diagnosis and manage her treatment: 

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“People look at cervical cancer like this (taboo), and this is why nobody talks about it. This is why I'm spending hours trying to find resources and information, having to piecemeal all this because it's not talked about.”

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Almost all cervical cancers are caused by persistent and untreated high-risk HPV infections. According to the Centers for Disease Control, nearly all sexually active adults will get HPV at some point in their lives, making it the most common sexually transmitted infection. In fact, 80% of women will have had an HPV infection by age 50. For 90% of women, HPV clears up on its own within 2 years. However, some HPV infections can persist, and if left untreated may progress into cancerous cell changes. 

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The American Cancer Society notes that certain genetic predispositions, smoking tobacco, and a weakened immune system are among the factors that can make it more likely that an HPV infection persists and progresses. But emerging research is also showing that key social factors can shape the risk for HPV persistence:

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1. Dealing with chronic stress and high-risk coping behaviors
2. Healthcare impacts of living in poverty 
3. Ongoing challenges that sexual trauma or violence has on one’s body and health. 

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These socially driven risk factors are not as uncommon as one may think. Most of us can probably relate to one of the most significant factors – chronic stress. 

• Research shows that among those aged 35-44, long-term sustained stress increased from 48% in 2019 (when the COVID-19 pandemic began) to 58% in 2023. 
• This group also faced the highest increase in mental health diagnoses during these 4 years – from 31% to 45%. 
• When it comes to cervical cancer risk, we also find that this is most frequently diagnosed among women who are between 35-44 years of age.

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Chronic Stress and Related Lifestyle Coping Practices 

Chronic stress (through increased cortisol levels) suppresses one’s immune functions, which compromises the body's ability to clear HPV infections. Stress creates a vicious cycle, leading to an inflammatory response that in turn intensifies stress. This stress cycle compromises immunity, increases DNA damage, and heightens the risk of HPV persisting and progressing into possibly cancerous changes. 

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The accompanying coping behaviors that people at times use to manage stress and mental health (e.g., smoking tobacco, substance use) also damage DNA and weaken one’s immune response, similarly increasing the likelihood that HPV progresses into cervical cancer. 

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Poverty and Healthcare 

Those who are low-income, especially if they also live in residentially segregated spaces, often face healthcare barriers, including limited resources, provider shortages, and less access to preventive care. These barriers contribute to why cervical cancer is steadily increasing, including among those who are low-income in urban and rural areas, where access to the HPV vaccine and routine screening can be challenging. 

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Poverty can also bring overlapping challenges, such as longer or irregular working hours, inconsistent paychecks, immigration hurdles, unsteady housing, and racial and ethnic discrimination. These challenges can lead to chronic stress, making one’s immune system more vulnerable to persistent HPV. 

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Experiences of Trauma and Violence

There is a significant link between experiences of violence or trauma and increased risk of contracting HPV with the infection progressing into cervical cancer. In the United States, over half of all women have experienced sexual violence, and those who are low-income are often continually victimized by intimate partners as they struggle to find the finances to change their living situations. 

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Survivors of sexual violence continually process these experiences psychologically and physically. This represents extreme stress and trauma, which hurts one’s long-term immune response while also increasing vulnerability to social circumstances and behaviors that escalate the risk for persistent HPV infections. 

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A Fuller Framework Around HPV Risk

Today, Aisha is a proud advocate for those going through cervical cancer and has created a platform to support women in a similar position as she was in. But, as Aisha describes, she needed to unlearn the stigma and shame around HPV and cervical cancer before she could move forward: 

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“(The HPV stigma), that's what started me trying to get comfortable because I was uncomfortable.”

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Declining cervical cancer screening rates and rising diagnoses are widespread issues. Shedding light on social determinants behind HPV and cervical cancer risk gives us a fuller framework of how to address this common virus and eliminate a highly preventable cancer – one that goes beyond stigmatizing sexual behavior. With social context in mind, we need more strategies and alternatives that engage people in routine HPV screening, which is the most effective way to eliminate cervical cancer.