By SAMUEL ANYULA
As Kenya approaches
World AIDS Day 2024 with its focus on promoting the health and well-being of
men and boys, it is crucial to address a silent epidemic that has been largely overlooked—human
papillomavirus (HPV) outbreaks among men. Although many variances of HPV are cleared by a
healthy immune system, a number of HPV genotypes found to be prevalent in
African contexts (including Kenya) can cause ano-genital warts
and cancers.
As an HIV clinician with more than 5 years of experience working in a community-led men’s clinic, I have encountered men presenting with severe, advanced HPV-related symptoms that are both physically and emotionally distressing. Some patients arrive with massive, cauliflower-like anogenital warts that obstruct normal bodily functions, causing intense pain, bleeding, and difficulty in sitting or walking. These conditions are often accompanied by a foul odor due to secondary infections, leaving patients feeling stigmatized and isolated. Many expressed a deep sense of shame, admitting that they delay seeking care due to stigma and a lack of knowledge and fear of judgment [9]. These experiences underscore the urgent need for increased awareness, comprehensive education, and a supportive men-centered HPV care—both with respect to prevention and treatment.
For a long time, HPV has been mischaracterized as solely a women's health issue. Consequently, men, particularly those at increased risk and living with HIV, have been left out of HPV prevention campaigns. These include awareness creation, screening and early detection, vaccination, and even treatment within the frameworks of HIV programs. This exclusion has led many men to seek care only when they present with advanced stages of HPV-related diseases, which increases the risk of malignancies and the potential progression to various forms of cancer, such as anal, penile, and throat cancer.
For too long, men's health has been sidelined in the HIV response, leading to missed opportunities for early intervention and holistic care. The high correlation between HPV and HIV in men, especially men living with or at heightened risk for HIV, demands urgent attention. If strides are to be made in HIV prevention, care, and treatment, as well as STI programs, integrating comprehensive HPV screening and vaccination into both HIV programs and general health services for young men must become a priority.
A 2023 research study conducted in Nairobi County highlighted the high risk of HPV infection among men living with HIV, male sex workers, and other key populations [8]. Half were found to have an HPV infection. Among those infected, 84% had an HIV-positive status. HPV samples revealed the presence of high-risk strains, such as HPV-16, which is highly associated with penile, anal, throat, and cervical cancers. Importantly, many of the carcinogenic HPV variances are preventable with the vaccines currently available in the country. However, in our public facilities these vaccines are freely available, and therefore largely accessible only to adolescent girls and young women (AGYW).
According to the Anal Cancer Foundation, HPV causes 5% of all cancers worldwide, including a majority of anal (91%), cervical (91%), mouth and throat (70%), vaginal (75%), vulva (69%), and penile cancers (63%). However, early detection and vaccination programs can ameliorate these preventable cancers. Since the HPV vaccine's global introduction in 2006, there have been significant reductions in HPV-related cancers. Australia's gender-neutral vaccination program, which included both boys and girls, resulted in a sharp decline in HPV infections. A Swedish study also showed a reduced genital warts with a more than 25% reduction among females age 17 to 18 years. Additionally, a meta-analysis of 65 papers across 14 countries found decreases in anal and genital warts by almost half in boys aged 15–19, and 32% in men aged 20–24 within five to eight years of the vaccine rollout. These statistics underscore the vaccine's impact in averting millions of HPV-related cancers globally.
Some may argue that including men and boys in HPV screening and vaccination programs would strain already limited resources and divert vaccines currently targeting AGYW. On the contrary, investing in these preventive measures now can reduce long-term healthcare costs associated with treating advanced HPV-related conditions. For example, between 2016 and 2019, a total of 239 men in Nairobi underwent surgery at the clinic where I work, with 72 experiencing a recurrence that required additional surgical intervention. These procedures cost the clinic more than £60,000 over the four-year period. Also investing in awareness raising, demand creation, and provider training can educate men on HPV risks, increase vaccine and screening uptake, and equip healthcare workers with necessary skills. These efforts can prevent advanced HPV-related conditions, saving lives and reducing long-term healthcare costs.
This year even after the World AIDS Day, we must emphasize men's health; we must push for a more inclusive
HIV response that recognizes the critical intersection of HPV and HIV.
Policymakers, healthcare providers, and funding agencies must work together to
ensure HPV screenings and vaccination become standard components of HIV care
for men and boys at heightened risk. Let’s make some noise and
finally expose and confront the silent epidemic of HPV among men.
Samuel Anyula Gorigo is an AVAC Fellow and healthcare provider based at HOYMAS medical center in Nairobi, Kenya