Social norms around the Arab world are changing. According to Rehab Gomaon, education and awareness-raising on the prevention of sexually transmitted diseases should be continued1
Arab societies often follow a strong religious commitment and have relatively conservative sexual behavior compared to other cultures.2 Historically, the prevalence of sexually transmitted infections (including HPV) in this geographical area is low compared to the rest of the world. .3 But with the rapid changes in lifestyles resulting from globalization, sexual behavior patterns, especially among younger generations, have become more liberal. This phenomenon is expected to increase the spread of sexually transmitted diseases and associated cancers, such as cervical cancer, in the Arab region.2
Despite efforts over the past two decades, cervical cancer screening tests in the Middle East and North Africa region are relatively low. The World Health Organization (WHO) and other institutions and health experts are trying to defend the HPV vaccine as an effective intervention method to overcome obstacles to accessing health services and eliminate most of the HPV-related cancers that can be prevented. However, religious and conservative traditions throughout the MENA region have prevented HPV vaccine from being included in national immunization programs for health policy makers, waiting for the people to react.
Evaluation of behavior in research
To investigate this, a systematic review recently published by EMHJ at the official WHO Regional Office for the Mediterranean in the Mediterranean explored the awareness of HPV infection and adopted a vaccine between several subgroups in Arab countries. 4 The results revealed the average and high acceptance of HPV vaccine – despite low or moderate knowledge of HPV infection – and openness to the general public and healthcare providers to learn more about the virus and its prevention.
Another recent study was conducted in Tunisia involving 452 women and 55 gynecologists5 And studied HPV vaccine acceptance. The aim of this work was to complete the successful level of a possible national HPV vaccination program in Tunisia, based on the responses of women and healthcare workers involved in the Cervical Cancer Prevention Program (the role of gynecologists in Tunisia).
The results revealed a very high level of HPV vaccine acceptance and a clear interest in learning more about cervical cancer prevention methods for Tunisian women. More than 80% of women surveyed reported their desire to receive HPV vaccine if they were advised by doctors. They also expressed their willingness to pay for their daughter's future vaccination against HPV, even if the costs are relatively high. More than 90% of women surveyed supported the introduction of HPV vaccine in a national immunization program to make it available to all Tunisian girls.
Despite limited knowledge of the women involved in HPV and cervical cancer, a significant level of HPV vaccine acceptance was found. Only 38.7% of women understood the causal relationship between HPV infection and cervical cancer, and only 38.9% were aware of the recommended frequency of Pap smear testing.
These findings confirm the general public support for the HPV vaccine and that the cultural causes often cited by the health authority as the main barrier to the HPV vaccination program are not evidence. This trend is not limited to Tunisia. Other studies have indicated that the HPV vaccine has a medium to high tolerance for women in other countries in the Middle East and North Africa.4 ,6 .
Educate health care professionals
It is interesting to note that the study found less evidence of HPV vaccine acceptance among the gynecologists surveyed. Most of the surveyed obstetricians / gynecologists reported extensive knowledge of cervical cancer and Pap smear, but their knowledge of HPV vaccine was relatively smaller. Doctors pointed to the high cost of vaccination as a determining factor for the wide spread of HPV vaccine. For example, the current dose of Bivalent vaccine at the Tunisian pharmacy is about $ 45.77 Although the wholesale price can reach $ 9.50 per dose if the vaccine is included in the vaccination program8 .
Other factors mentioned included a cultural barrier associated with the introduction of a vaccine against sexually transmitted infections in Arab societies that prevent sexual relationships outside marriage, limit HPV awareness of women, relatively limited knowledge of immunization specialists, their effectiveness, and possible side effects.
There is growing evidence that there is an urgent need for rapid cooperation between the countries of the MENA region to develop further education for HPV healthcare workers involved in the prevention of cervical cancer. This will ensure that healthcare workers are familiar with vaccination and encourage patients to accept it. Intervention strategies in the field of education and awareness, whether directed at health care workers or Arab women, will undoubtedly improve the knowledge of HPV and its complications and the potential success of national HPV vaccination programs in the MENA countries.