Malaysian Doctors Stigmatising HPV Patients As Promiscuous Women: UMMC Study

UMMC’s Prof Woo Yin Ling says a study of 578 doctors in Malaysia found that 1 in 5 believe women with HPV deserve their condition, 29% think HPV-positive women have multiple sexual partners, 39% think HPV-positive women started having sex at an early age.

PETALING JAYA, July 11 — A recent local study has revealed concerning levels of stigma among health care professionals towards women with human papillomavirus (HPV), with one in five doctors believing that women with HPV deserve their condition.

The study – involving 578 obstetricians, gynaecologists, and primary care physicians – showed that one in six doctors felt women with multiple partners did not deserve sympathy, said Prof Dr Woo Yin Ling, a consultant gynaecological oncologist at University Malaya Medical Centre (UMMC). 

Additionally, one in eight doctors blamed promiscuous behaviour for HPV-related cancers. The study was modelled after a similar survey on HIV-related stigma among health care providers.

“When we asked obstetricians and primary care doctors what they think about HPV, one in five doctors think women deserve what they get,” said Dr Woo, who is also founder and trustee of the ROSE Foundation, at the National Cancer Congress Malaysia 2024 at Sunway University last June 22.

It was further revealed that 29 per cent of doctors think that HPV-positive women have multiple sexual partners, and 39 per cent think that most HPV-positive women started having sex at an early age, further compounding the stigma.

Dr Woo said such stigmatisation can severely affect patient relationships and even marriages, creating barriers to effective communication and simple screening tests. 

She called for better educational initiatives to address these misconceptions and improve education among health care professionals to eliminate such biases. 

“It is really quite worrying to think that health care professionals hold such views – things like sharing a toilet can spread the virus,” she said. “There is a need to tackle those educational issues.”

Woo added that some Malaysian doctors, when they take the history of a patient with cervical cancer, the second question they ask is, “When did you start having sex?” and “Do you have multiple sexual partners?”.

“That is the most insensitive thing doctors can ask a patient with cervical cancer. It still happens on the ground and we do need to address it.”

Insurance Denies Reimbursement for HPV Positive Test Results

In addition to stigma from health care providers, Dr Woo also highlighted financial barriers in HPV testing rollout. She criticised Malaysian insurance policies that still classify HPV tests as part of sexually transmitted disease (STD) screening, leading to denial of reimbursement for follow-up plans when tests are positive.

“So if you do the right thing, you screen with an HPV test and not a pap smear, and it’s positive, the insurance company will not reimburse you for the follow-up plan. That’s something that we have to deal with,” Dr Woo said.

“The wider picture is you cannot work alone. This is tackling a financial institution which is something we need to look at.”

HPV is so common that most sexually active people will be infected at some point in their life, as HPV is spread through genital skin-to-skin contact during sex. It is estimated that up to 90 per cent of sexually active individuals will contract HPV in their lifetime.

Insurance usually pays for pap smears performed in medical offices, but only a few insurers cover the expense of at-home HPV PCR tests. 

These HPV tests, utilising self-sampling swabs, offer a 90 per cent sensitivity in detecting cervical cancer risk, compared to 50 per cent for pap smears. Additionally, a single HPV test is necessary only twice in a lifetime, costing approximately RM600, whereas 15 pap smears over a lifetime can total RM3,600.

Dr Woo explained that HPV testing represents the current best method for detecting cervical cancer due to advances in molecular technology.

“Just like how you might buy an iPhone 4, and then 10 years later, there’s an iPhone 16 where you don’t even need a camera. Similarly, when I started studying, the pap smear was the best available option at that time. It served its purpose then,” Dr Woo said.

“Now, with molecular technology and HPV tests, we can offer women a more advanced option. Communication about these advancements is crucial. You don’t need to have the test every year or every three years anymore; it’s only necessary twice in a lifetime or, if affordable, once every five years,” she added.

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