3 de Abril: Mejor que un huevito de chocolate

This week, the La Paz daily, La Razón, reported on an upcoming campaign to vaccinate 30,000 Bolivian girls between the ages of 9-13 against the Human Papillomavirus (HPV), one of the leading causes of cervical cancer.  The campaign, which will vaccinate girls in five cities and one rural community in Bolivia between April 6-10, is being carried out by the Centro de Información, Educación, y Servicios en Salud Sexual y Reproductiva (CIES) in cooperation with the Ministry of Health.  The vaccinations will be provided without cost, and will be distributed at schools and in public health centers in the areas of highest cervical cancer incidence in the country–El Alto, Oruro, Potosí, Trinidad, Sucre, and in rural areas outside of the city of Sucre.  According to Wilma Pérez, the author of the article, “Bolivia has one of the highest rates of mortality due to uterine cancer in the world,” with “five women dying daily from the disease.”  The World Health Organization reports that cervical cancer is the leading cancer affecting women in Bolivia.

A graffiti penned by El Alto youth at a CIES health and community center, reading, “Let’s prevent STIs.”

According to EhealthMD, poverty and failing to get regular pap test screenings are among the leading risk factors for cervical cancer.  Since women who suffer from cervical cancer generally show few symptoms until the disease is quite advanced, a yearly pap test–which detects changes in the cells of the cervix that can be related to cervical cancer–is the best way to catch the disease early on.  Women who are poor generally know less about the causes of cervical cancer and the importance of yearly screenings, have less access to sexual and reproductive health services, and are frequently malnourished–a condition which also increases the risk of cervical cancer.   Since Bolivia is the poorest country in Latin America apart from Haiti, it is not surprising that it also displays one of the highest rates of death from uterine cancer in the world–according to the WHO study cited above, only 28% of women in Bolivia report ever having had a pap exam.

“Youth Program, ‘You…Decide,’ CIES.”

Although I am as yet unable to provide concrete statistical data on these themes, my own research seems to support the conclusions of the articles cited above.  Since beginning research in Bolivia, I have examined thousands of gynecological and obstetrical records from prominent La Paz and El Alto hospitals stretching from the mid-1950s to 2009.  Anecdotally, I can attest to the fact that the majority of women seen at these facilities across these years report never having had a pap test.  A smaller majority report having had perhaps one or two pap tests across their entire reproductive lives, rather than the yearly test that is recommended.  The number of patients that report to hospitals with advanced cervical cancer seems astounding; many of these women die during their hospital stays.

Another fact that I have noticed in these records, which you can interpret how you like, is this: those women who report having had more than three pap smears in their lives are also more likely to report having used some method of birth control (including the rhythm method), and are more likely to report having had an abortion.

It seems very unlikely that any one of these factors–birth control use, pap tests, or abortions–causes in any direct way any of the other two factors.  Instead, it seems to me that each one of these factors corresponds to a degree of control that women are exercising over their own sexual and reproductive lives.  Women who get yearly pap tests or who use birth control to limit or to space their births are, through these actions, declaring a sense of autonomy over their bodies, sex lives, and reproductive choices.  And women who have abortions, I would argue, are also exercising this autonomy.  Although few women actually want to experience an unwanted pregnancy or to have an abortion, many women who do choose abortion–particularly young women–report that the experience made them more mature, responsible adults, since for many, it was the first time they were forced to make a truly autonomous decision about their lives.  So, perhaps it should not surprise us that women who have had abortions in Bolivia also get pap tests and use birth control.  The conditions of these women’s lives have allowed them access to information and services in sexual and reproductive health, which have given them the tools to exercise control over their own bodies–something that many Bolivian women lack.

A final note: it seems sort of ironic to me that the HPV vaccination campaign has been timed so close to Easter, a holiday that is widely celebrated in the largely Catholic country of Bolivia.  The HPV vaccine has drawn criticism from right-wing and religious elements in other countries due to the belief that girls who are vaccinated–like girls who have access to birth control–will have sex earlier than girls who are not (or do not).  Instead, opponents of the vaccine believe that young people should not be taught about sex, have access to birth control, or be protected from HPV, and that this will simply prevent adolescents from having sex.  This profoundly sex-negative message–which was institutionalized in the U.S. through abstinence-only education in many schools during the Bush years–has proven to only increase rates of adolescent pregnancy and STI infection.  Fortunately, right-wing forces have not derailed the HPV vaccination campaign in Bolivia.  So, during the week following Easter, 30,000 Bolivian girls will receive something much more valuable, though perhaps less tasty, than chocolate eggs.

4 Responses to “3 de Abril: Mejor que un huevito de chocolate”

  1. locojhon Says:

    Felicidades por un artículo muy informativo y el esfuerzo!
    Para obtener más información así: http://en.wikipedia.org/wiki/HPV_vaccine
    La necesidad de seguimiento y las inyecciones de refuerzo a través del tiempo es, obviamente, muy importante.
    Lo que se perdió aquí, es el uso de las vacunas para la población de sexo masculino que son igualmente responsables de la propagación de la enfermedad, ya que están por ser realizados por él. Los hombres son como vectores de la enfermedad tanto como las mujeres, y por el bien de todos, deberían ser considerados para el tratamiento preventivo adecuado. De lo contrario, sólo la mitad se solucione el problema, y es garantizada para continuar.
    Esto desde el punto de vista gringo – uno que está a corregir – con gracias a Google de traducción del texto original a continuación.
    Respetuosamente,,, locoto

    Congratulations for a very informative article and effort!
    For more information this: http://en.wikipedia.org/wiki/HPV_vaccine
    The need for follow-ups and booster shots over time is obviously very important.
    What I missed here, is the use of the vaccines for the male population who are equally responsible for spreading the disease, as they are for being effected by it. Men are as much vectors of the disease as the women, and for the sake of all, should be considered for appropriate preventive treatment. Otherwise, only half the problem is addressed, and is guaranteed to continue.
    This from a gringo’s point of view–one who stands to be corrected–with thanks to Google translation from the original text below.
    Respectfully,,,locoto

  2. Thanks very much, Locoto, for your comment. You are obviously right on both counts–booster shots of the HPV vaccine are essential, and vaccinating men is also clearly important. A point I neglected to mention from the La Razón article is that those 30,000 girls who will be vaccinated in the coming week will indeed receive boosters in June and again in October (a total of 3 doses per girl). I imagine that the vaccination has not yet been offered to men and boys because it was so recently approved for use in those populations, at least in the USA. But let’s hope that soon, boys and men will be vaccinated in Bolivia!

    Muchas gracias, Locoto, por sus comentarios. Estoy completamente de acuerdo con usted con respecto a ambos puntos, o sea, en cuanto a las inyecciones de refuerzo y la necesidad de vacunar a la población masculina. Un punto que dejé de mencionar del artículo de La Razón es que estas niñas que se van a vacunar durante la próxima semana recibirán inyecciones de refuerzo en Junio y otra vez en Octubre de este año (o sea, que cada niña recibirá tres dosis de la vacuna). Me imagino que la vacuna no se ha ofrecido hasta ahora a la población masculina porque hasta hace poco, no había sido aprobada para estas poblaciones, por lo menos en los EEUU. Pero, ojalá que pronto se la ofrezca a la población masculina también!

  3. locojhon Says:

    Gracias por la cálida bienvenida.
    En realidad, yo no estaba pensando en la serie inicial de vacunas – todos ellos importantes – pero además, un tratamiento preventivo en el camino como la protección inicial se reduce con el tiempo.
    Aquí es donde me sugieren los seguimientos son los más necesarios – a la derecha sobre el momento de su vida, cuando son más activos sexualmente.
    Gracias de nuevo por su gran trabajo en nombre del pueblo.
    Saludos,,, locoto

    Thank you for the warm welcome.
    Actually, I was not thinking about the initial series of shots–all of them important–but additional preventive treatments down the road as the initial protection is reduced over time.
    This is where I suggest follow-ups are most necessary–right about the time in their lives when they are most sexually active.
    Thanks again for your great work on behalf of the people.
    Regards,,,locoto

  4. Brooke Harlowe Says:

    Another fine article. You might want to check out a thesis completed by Maruja Aliaga at the university in Carmen Pampa, who examined STD incidences in the Caranavi region. She also looked into pap tests. The best contact is Dr. Hugh Smeltekop, Vice Director of the University boliviahugh@gmail.com Hugh is an agronomist but can direct you to Lic. Lidia Cuevas, head of the nursing program, who may be of some help, too.

    Of course, the issue in rural areas is that puestos de salud and even centros de salud are not equipped to do pap smears. Women have to go to the hospital. I am a bit surprised by your numbers for the cities, however, since SUMI (and its previous iterations) have covered pap tests for almost 15 years now.

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