HIV Educators Conference 2008
Living with HIV & Human Papillomavirus related cancer – double jeopardy <ul><li>Max Niggl </li></ul><ul><li>Speakers Burea...
My HIV & HPV personal fears <ul><li>Diagnosed HIV positive 1987 </li></ul><ul><li>Diagnosed with AIDS defining illnesses 1...
My HIV & HPV personal fears <ul><li>Diagnosed with recurring anal skin cancer 2004 </li></ul><ul><li>Undergoing extensive ...
HPV 101 <ul><li>HPV causes genital warts </li></ul><ul><li>HPV infection can remain dormant for many years – more than 70%...
HPV 101 <ul><li>Anal cancer is more common in gay or MSM populations </li></ul><ul><li>Gay HIV positive men are at greater...
What do Gay men know about HPV? <ul><li>Only 45% had even heard of HPV </li></ul><ul><li>62% did not know whether it had s...
What do Gay men know about Anal dysplasia and testing? <ul><li>Knowledge of risk and prevention </li></ul><ul><li>59% didn...
What sources have you relied upon for information on anal pap smears? <ul><li>55.1% had never heard of anal pap smears </l...
Testing for HPV <ul><li>Anal pap smears (“chap smears”) same as cervical pap smears are easy to do in doctor’s surgery  </...
Screening for HPV –  the case for it <ul><li>“ It is well established that localised early-stage anal cancer is more likel...
Screening for HPV –  the case for it <ul><li>Routine screening every 3 years among gay men has been shown to be an economi...
Screening for HPV –  the case against it <ul><li>“ Screening should not be instituted outside clinical trials until there ...
Screening for HPV –  the case against it <ul><li>“…  screening programmes, similar to those for cervical cancer prevention...
Prevalence of abnormal cells <ul><li>84% were infected with high risk HPV </li></ul><ul><li>14% no high risk HPV </li></ul...
Cervical cancer screening in Australia <ul><li>61% of women are screened bi-yearly </li></ul><ul><li>Due to screening Aust...
Treatment progress to date <ul><li>Early screening & detection = early surgical removal of pre cancerous areas to avoid re...
Elements of change required to address low knowledge & fear of HPV <ul><li>Medical community </li></ul><ul><li>Counselling...
HPV Health belief model  <ul><li>Primary target group – gay pos men </li></ul><ul><li>Health related problem – Ignorance a...
HPV vaccine <ul><li>HPV female cervical cancer vaccine is highly effective  </li></ul><ul><li>Likely to protect against an...
Elements for the future <ul><li>Proof of efficacy for HPV screening for gay men – an advocacy issue </li></ul><ul><li>Male...
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Living with HIV & Human Papillomavirus related cancer – double jeopardy

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Max Niggl from People Living With HIV/AIDS Victoria discusses gay men's lack of knowledge of HPV and anal cancer, and the need for screening and education. This presentation was given at the AFAO HIV Educators' Conference 2008.

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  • Living with HIV & Human Papillomavirus related cancer – double jeopardy

    1. 1. HIV Educators Conference 2008
    2. 2. Living with HIV & Human Papillomavirus related cancer – double jeopardy <ul><li>Max Niggl </li></ul><ul><li>Speakers Bureau Coordinator </li></ul><ul><li>People Living With HIV/AIDS Victoria </li></ul>
    3. 3. My HIV & HPV personal fears <ul><li>Diagnosed HIV positive 1987 </li></ul><ul><li>Diagnosed with AIDS defining illnesses 1988, 1992 </li></ul><ul><li>Diagnosed with HPV related pre cancerous related changes 1991 - surgery </li></ul><ul><li>Diagnosed with HPV related cancer </li></ul><ul><li>(in sit’ u) 1995 - surgery </li></ul><ul><li>Diagnosed with HPV related anal skin cancer 1996 - radiotherapy </li></ul>
    4. 4. My HIV & HPV personal fears <ul><li>Diagnosed with recurring anal skin cancer 2004 </li></ul><ul><li>Undergoing extensive surgery, skin grafts and a temporary colostomy 2004 </li></ul><ul><li>Skin graft surgery failed 2004 </li></ul><ul><li>Being in hospital for five weeks 2004 </li></ul><ul><li>Skin graft surgery attempted again 2004 </li></ul><ul><li>Temporary colostomy reversal 2006 </li></ul>
    5. 5. HPV 101 <ul><li>HPV causes genital warts </li></ul><ul><li>HPV infection can remain dormant for many years – more than 70% of the population have HPV infection </li></ul><ul><li>HIV subtypes 16 & 18 cause cervical cancer </li></ul><ul><li>HPV subtypes 16 & 18 cause anal cancer </li></ul><ul><li>Anal cancer is still rare </li></ul>
    6. 6. HPV 101 <ul><li>Anal cancer is more common in gay or MSM populations </li></ul><ul><li>Gay HIV positive men are at greater risk of developing anal cancer </li></ul><ul><li>Gay HIV positive men who smoke are at an even greater risk of developing anal cancer </li></ul>
    7. 7. What do Gay men know about HPV? <ul><li>Only 45% had even heard of HPV </li></ul><ul><li>62% did not know whether it had symptoms or not </li></ul><ul><li>56% did not know whether affected men, women or both </li></ul><ul><li>PITTS ET AL 2006 Australian Gay Men’s Knowledge & Experience of Anal Cancer Screening & HPV 2006 </li></ul>
    8. 8. What do Gay men know about Anal dysplasia and testing? <ul><li>Knowledge of risk and prevention </li></ul><ul><li>59% didn’t know about anal Pap smears </li></ul><ul><li>68% didn’t know smoking increases risk of anal cancer </li></ul><ul><li>Only 1 in 5 knew that being an anal receptive partner increased risk of anal cancer </li></ul><ul><li>71% didn’t know an abnormal Pap smear indicates low risk of disease </li></ul><ul><li>PITTS ET AL 2006 Australian Gay Men’s Knowledge & Experience of Anal Cancer Screening & HPV 2006 </li></ul>
    9. 9. What sources have you relied upon for information on anal pap smears? <ul><li>55.1% had never heard of anal pap smears </li></ul><ul><li>19.2% sourced that information at their Doctors </li></ul><ul><li>No difference in age , sexuality or smoking </li></ul><ul><li>HPV knowledge was significantly different according to higher levels of education. However knowledge in that group was still low </li></ul><ul><li>PITTS ET AL 2006 Australian Gay Men’s Knowledge & Experience of Anal Cancer Screening & HPV 2006 </li></ul>
    10. 10. Testing for HPV <ul><li>Anal pap smears (“chap smears”) same as cervical pap smears are easy to do in doctor’s surgery </li></ul><ul><li>If abnormal pap smear: </li></ul><ul><li>Skin biopsy performed under general anaesthetic </li></ul>
    11. 11. Screening for HPV – the case for it <ul><li>“ It is well established that localised early-stage anal cancer is more likely to respond to treatment than more advanced anal cancer and some clinicians and treatment advocates have therefore suggested that gay men should have screens ... to check for abnormal cells in the anus” </li></ul><ul><li>Anderson J et al. Abnormal anal cells & high risk HPV common in HIV positive Australians April 2008 edition Sexually Transmitted Infections </li></ul>
    12. 12. Screening for HPV – the case for it <ul><li>Routine screening every 3 years among gay men has been shown to be an economic model with an acceptable level of cost effectiveness similar to many other public health programs compared to no screening (Pitts et al, 2006)‏ </li></ul><ul><li>Goldie et al suggest that anal screening would be particularly beneficial & cost effective for HIV Positive men </li></ul><ul><li>PITTS ET AL 2006 Australian Gay Men’s Knowledge & Experience of Anal Cancer Screening & HPV 2006 </li></ul>
    13. 13. Screening for HPV – the case against it <ul><li>“ Screening should not be instituted outside clinical trials until there is clearer evidence of effective treatments for anal neoplasia and better information on natural history” </li></ul><ul><li>PITTS ET AL 2006 Australian Gay Men’s Knowledge & Experience of Anal Cancer Screening & HPV 2006 </li></ul>
    14. 14. Screening for HPV – the case against it <ul><li>“… screening programmes, similar to those for cervical cancer prevention, may benefit patients with abnormal anal cell changes. However before such programmes are introduced, greater understanding is required of the natural history and the role of intervention in this condition” </li></ul><ul><li>Anderson J et al. Abnormal anal cells & high risk HPV common in HIV positive Australians </li></ul><ul><li>April 2008 edition Sexually Transmitted Infections </li></ul>
    15. 15. Prevalence of abnormal cells <ul><li>84% were infected with high risk HPV </li></ul><ul><li>14% no high risk HPV </li></ul><ul><li>Two thirds of patients had abnormal cells in the anus </li></ul><ul><li>Findings showed infection with high risk HPV was associated with the presence of high grade and potentially high grade pre cancerous cells </li></ul><ul><li>Anderson J et al. Abnormal anal cells & high risk HPV common in HIV positive Australians April 2008 edition Sexually Transmitted Infections </li></ul>
    16. 16. Cervical cancer screening in Australia <ul><li>61% of women are screened bi-yearly </li></ul><ul><li>Due to screening Australia now has one of the lowest rates of cervical cancer </li></ul><ul><li>Mortality rate has been halved </li></ul>
    17. 17. Treatment progress to date <ul><li>Early screening & detection = early surgical removal of pre cancerous areas to avoid recurrence </li></ul><ul><li>HPV anal cancer = chemotherapy or radiotherapy – vast treatment improvements since 1996 </li></ul><ul><li>Anal skin grafts – impossible in 1996, possible in 2004 </li></ul>
    18. 18. Elements of change required to address low knowledge & fear of HPV <ul><li>Medical community </li></ul><ul><li>Counselling community </li></ul><ul><li>HIV educators </li></ul><ul><li>PLWHA Organisations - Genesis style of workshop </li></ul><ul><li>HPV peer support </li></ul><ul><li>HPV information through www.treataware.info </li></ul>
    19. 19. HPV Health belief model <ul><li>Primary target group – gay pos men </li></ul><ul><li>Health related problem – Ignorance about HPV-related cancer </li></ul><ul><li>Perceived susceptibility – very low: people connect HPV with genital warts, not cancer </li></ul><ul><li>Perceived barriers – shame about the anus, long time frame enables avoidance tactics </li></ul><ul><li>Perceived benefits – avoiding cancer/surgery </li></ul><ul><li>Cues to action – 3 year screening: prompting by doctors, automated screening reminders </li></ul><ul><li>Preventive health action – attending screening </li></ul>
    20. 20. HPV vaccine <ul><li>HPV female cervical cancer vaccine is highly effective </li></ul><ul><li>Likely to protect against anal cancer (same strains) although no mention of this when the vaccine was Medicare funded </li></ul><ul><li>Good public health policy </li></ul>
    21. 21. Elements for the future <ul><li>Proof of efficacy for HPV screening for gay men – an advocacy issue </li></ul><ul><li>Male HPV vaccine – general population </li></ul><ul><li>Proof of efficacy of surgical interventions </li></ul><ul><li>Decreased rates of anal cancer in gay men </li></ul>

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