Here is my mom’s reaction to my persistent requests for a PAP test (فحص المسح المهبلي او فحص القزازة): “I am not comfortable on the exam table with that thing shoved down there.” Well, who is? I would start to worry if she actually liked it!

Two years ago, I gave a seminar about sexually transmissible infections to a group of women belonging to human rights organization in Beirut. Their awareness about HIV, Chlamydia, Gonorrhea, Herpes and the other culprits was optimal. Little did they know about HPV. Eyebrows were raised when I spoke about how common it is, how easily transmissible and how it can cause cervical cancer.

Social media campaigns in Lebanon have tackled breast cancer, diabetes and other diseases. Little has been done to raise awareness about the Human Papilloma Virus or HPV (فيروس الورم الحليمي البشري) and cancer of the cervix (سرطان عنق الرحم), options for early detection and prevention.

The Lebanese Ministry of Health website has awareness campaigns for Breast cancer, diabetes and Hepatitis, prevention campaigns for smoking and HIV, surveillance sections for different infections and cancers. A search for HPV returns 0 results. Even on a page dedicated for vaccination, there is no mention of the cervical cancer vaccine.

So why is HPV awareness suboptimal in Lebanon?

No research has addressed this issue and I do not claim to have the answers. I welcome your feedback and comments. Feel free to add theories that you believe might be a factor. Here are few that I could think of:

Is it lack of interest by the medical field in Lebanon?

Very little research is done on HPV disease in Lebanon. A quick PubMed search using “HPV” and “Lebanon” brings up only a handful of articles. The questions remains: Why is there lack of interest?

Is it lack of interest by pharmaceutical companies?

Unfortunately, most of the current health awareness campaigns in Lebanon, like anywhere in the world, can be driven by pharmaceutical and medical equipment companies. Does cervical cancer sell less? Will having the new vaccines on board change that?

Is HPV less prevalent in Lebanon as compared to western countries?

A study by Dr. Adnan Mroueh published in 2002 showed that up to 5% of Lebanese women between ages 18 to 76 carry the virus. This is similar to Arab countries but significantly less western countries (40 – 60%). This might be a valid reason. However, the study by Mroueh tested for only few types of HPV which might explain the low prevalence.

Is it the social taboo of sexuality?

HPV is sexually transmitted and many would like to believe or claim that extramarital or premarital sexuality do not exist in Lebanese communities. In October 2007, Al-Akhbar publishes “Who remains silent about HPV disease is a mute devil” or “H.P.V: الساكت عن المرض شيطان أخرس”. This very interesting and rare article in the Lebanese media addresses the lack of awareness and invites people to discuss HPV and cervical cancer more openly. It includes true stories of how societal prejudice can ostracize some Lebanese womyn diagnosed with HPV.

"Media attention to HIV vs. HPV"

Is it the social fear from and ignorance about cancer?

The further you go away from Beirut and big cities the weirder the alternative names for cancer get. You reach my village and there they call it “The Evil Disease” or “المرض الخبيث” and “The one whose name we shall not say” or “هيدا يلي ما بيتسمى”. But then why breast cancer awareness is at its peak?

Is cervical cancer less disfiguring to “female prototype”?

I feel appalled by even typing that. You might feel it is a remote possibility especially if you are not familiar with the Lebanese societal dynamics. Before you proceed here are two facts about Lebanon:

1. Lebanese banks offer plastic surgery loans. Read “Nip’n’tuck loans offer in Lebanon” by BBC news. AFP took it a step further and described the situation as ‘a national duty for women to look the best‘ in their article “Sea, sun and scalpel.”
2. Lebanon tops the world’s charts for plastic surgeries performed per capita. “Official estimates place the number of cosmetic surgeries carried out annually in the country at 1.5 million”.

Here is an eye-opening perspective from a Lebanese woman who wrote “HPV: Is it Really Worth the Shot?” for Bekhsoos, the queer arab online magazine. She writes: “I for one refuse for health workers to tell me that my breasts are much more important than my uterus. Both forms of cancer are dangerous and can lead to death, yes…. However one can be prevented but is associated with sexual conduct and therefore isn’t accepted. While the other deals with aesthetics- and therefore gains more sympathy.”

Lebanon has a Chauvinistic framework but could it be that bad? Does she make a valid point?

Food for the thought,

Categories: Health

Tags: cancer, cervical cancer, health awareness, HPV, Lebanon, Ministry of Health, STD, STI, vaccine