Examining stigma associated with human papillomavirus (HPV) and cervical cancer screening and treatment in Africa: a scoping review.

Cervical cancer, primarily caused by human papillomavirus (HPV), is the most common cancer in women in sub-Saharan Africa and the most common cause of cancer fatalities among women on the continent. While both prevention and early detection are possible through HPV vaccination and cervical cancer screening, health system capacity is inadequate for screening and there are pervasive negative attitudes and beliefs. A major, modifiable but understudied barrier is cancer stigma, which underlies suboptimal vaccination efforts as well as cancer screening. Adhering to the PRISMA, ScR guidelines, we conducted a scoping review exploring HPV and cervical cancer stigma in Africa. We included studies that described stigma in relation to HPV or cervical cancer in Africa or among people of African descent. Forty-three studies described HPV and cervical cancer stigma in a dozen countries in sub-Saharan Africa and none in North Africa. Internalized, enacted and anticipated forms of stigma occurred at the individual, family and community levels. The four main themes that emerged include (1) how lack of knowledge and false perception hinders screening and vaccine uptake; (2) stigma in the context of practical barriers to care; (3) acceptability of education and interventions to reduce stigma and (4) stigma as a contributor to psychological distress and treatment outcomes. Only two studies described interventions focused on eliminating stigma through promoting cervical cancer and HPV-related knowledge, targeting misinformation and incorporating patient navigation. Addressing stigma is essential, as it is a key barrier to HPV vaccination, cervical cancer screening and timely treatment. We call for future studies to develop culturally informed interventions to reduce stigma and improve cervical cancer outcomes across all regions in Africa.