How Kenya can step up fight against HPV-related cancers

In an article published by Healthy Nation on July 22, my colleague, Dr Nelly Bosire, made a strong case for expanding the scope of Human Papilloma Virus (HPV) vaccination to young boys to prevent penile and anal cancers. The senior gynaecologist argued that this intervention should build on the success achieved in the rollout of HPV vaccination among young girls to prevent cervical cancer.

 Around the same time Dr Bosire penned her well-argued article, I was among the faculty members in a Surgical Society of Kenya-sponsored training on laser treatment of haemorrhoids. Haemorrhoids are a swelling of the veins or blood vessels in and around the anus and lower rectum. This happens when there is extra pressure on these veins. In one of the sessions, the audience was taken through a refresher on common non-cancerous lesions of the anus and perianal skin.

As surgeons went through common diseases in the perianal skin slide by slide, the presenter projected an image of a skin afflicted by anal warts. Anal warts are caused by the Human Papilloma Virus, the same virus that causes cervical cancer. When the session was opened for discussion, surgeon after surgeon reiterated an observation that the incidence of perianal warts has been rising in recent days. This has been observed mostly among college students and young men having sexual intercourse with men. One colleague reported how he challenged one such patient about his sexual behaviour. It is then that the patient admitted he had been practising homosexuality.

It is important to put a few statistics into perspective, having dispensed with the opening gambit that HPV causes anal warts. First, HPV is the most common sexually transmitted infection (STI) worldwide. Secondly, anal HPV prevalence among homosexuals is high, affecting six out of every 10 men having sex with men (MSM). This figure rises to nine out of every 10 MSM who are HIV-positive.

Thirdly, early sexual debut, multiple sexual partners, concurrent STIs and unprotected sex are contributors to HPV infection. Fourth, over time, anal warts progress to precancerous masses and ultimately anal cancer.

 The discussion about ratification of laws legalising homosexuality has been fraught with controversy and resistance in our society. This makes some patients who identify as LQBTQ shy away from seeking medical attention. What this means is that we have such Kenyans, but they may not outrightly come forth for medical check-up or treatment for fear of societal judgement or reprimand.

Looking back, we all recall that stigma was the main hindrance to adoption of testing and treatment when HIV/Aids knocked on our doors at the turn of the century. We can learn a thing or two from how we have handled it.

As Dr Bosire opined, here is a virus that attacks almost all regions of the body, often leading to deleterious outcomes. Having a nationwide vaccination for all young people irrespective of gender will go a long way in prevention against HPV-related cancers like anal and penile, besides cervical cancer.

A non-selective rollout that incorporates young men carries the advantage of blinding to the gender orientation and possible concomitant stigma that may keep Kenyans away from seeking care early. After all, males play a crucial role in transmission of HPV that causes the cervical cancer we are vaccinating girls against.

High income countries have already introduced a gender-neutral rollout of HPV vaccination. It is just a matter of time before WHO recommendation comes directing countries to include boys in their vaccine schedule. Kenya should move with the times and include the boy child in the vaccine strategy.

As scientists have observed in a landmark research, universal HPV vaccination is likely to be more effective and efficient in reducing HPV virus circulation in the general population even at lower levels of vaccine uptake.

 Dr Aruyaru is a consultant general surgeon, chief  medical officer at PCEA Kikuyu Hospital and the secretary-general of the Surgical Society of Kenya