Academic journal article Central European Journal of Public Health

Knowledge and Awareness of Female Sex Workers towards Human Papillomavirus Infection in Turkey

Academic journal article Central European Journal of Public Health

Knowledge and Awareness of Female Sex Workers towards Human Papillomavirus Infection in Turkey

Article excerpt


Objective: The aim of this study was to determine the knowledge and awareness of female sex workers (FSWs) about human papillomavirus (HPV) infection in Turkey.

Methods: 239 brothel-based FSWs were recruited for an interview. A questionnaire was completed by face to face interview. The demographic features, the level of knowledge, and awareness about HPV infection of the participants were recorded.

Results: A total of 152 (63.6%) were over 30 years of age, and 210 (87.9%) completed primary education. 122 FSWs (50.9%) were using condom, and about one third had high frequency of sexual contacts. Knowledge scores were ≤4 in 181 (75.7%) FSWs. Low education and higher age group were not significant predictors of low knowledge scores. Low education was not an independent risk factor for awareness but higher age group participants were significantly less aware of risks associated with HPV infection (p = 0.019) although overall score was very poor (0.60 ± 0.68).

Conclusions: The knowledge and awareness about HPV infection and its possible consequences (cervical cancer) as well as the utility of screening methods among FSWs in Turkey are extremely poor. HPV-focused educational programmes for targeted populations, e.g. FSWs and young adults prior to their sexual activity, should be launched urgently to increase awareness of the risks associated with HPV infection and thus reducing the incidence of cervical cancer in Turkey in the future.

Key words: human papilloma virus, sex workers, knowledge


Cervical cancer, the second most common cancer in women in developing regions, is the 1 Oth most common cancer in developed regions worldwide (1-3). Approximately 9,000 women develop cervical cancer and about 4,600 die from the disease each year in Southeast Europe (4). It ranks the ninth most common cancer among women in Turkey (5).

Cervical cancer is one of the most preventable cancers. Elucidation of the casual role of oncogenic HPV types in cervical cancer has led to rapid advances in HPV testing and vaccination to improve cervical cancer prevention (4). Genital HPV types have been subdivided into low-risk types, which are found mainly in genital warts, and high-risk types (HR-HPV), which are frequently associated with invasive cervical cancer (1). Based on HPV type-specific odds ratios and HPV prevalence among patients and controls, Munoz et al. identified 1 5 HPV types as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82) (1). Types 16 and 18 are the most dangerous ones and together account for over 70% of cervical cancer cases (2). The most common types were types 16, 45, 18, and 31 among Turkish females living in south-eastern region (6).

Sex workers represent the high risk group for all sexually transmitted diseases and especially HPV infection is significantly more prevalent among FSWs than control groups (7). HR-HPV types are high in FSWs than in women from the general population. Therefore, they comprise the priority group for active surveillance against HPV infection and cervical cancer (7-10).

A quadrivalent vaccine against HPV types 6,11,16 and 1 8 was approved by the United States (US) Food and Drug Administration (FDA) on June, 2006, and a bivalent vaccine against types 1 6 and 1 8 was approved by the European Commission in September, 2007 (11,12). Previous studies demonstrated that the knowledge and awareness about HPV infection and its consequences, and about screening methods for cervical cancer and attitudes toward vaccination were generally low (13-15). Onan et al. from Turkey demonstrated also that women in general population required more information about both HPV infection and vaccine-related issues (16).

An effective preventive programme assumes widespread use of Pap smear and/or HPV DNA testing, use of barrier methods, increasing the public understanding about HPV, implementation of vaccination programmes for a naive population, and for females who are not yet sexually active, because the vaccines have the potential to improve cervical cancer control through primary prevention (13,17). …

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