Around 50% of counties in the United States, most being rural counties, do not have OBGYNs. This makes women’s healthcare particularly hard to access based on where you live. When it comes to cervical cancer, this lack of access can mean missing out on critical routine screenings – a Pap smear or HPV test – that can save lives. 

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Women across the United States face several relatable barriers to getting into a clinic for cervical cancer screenings. They report not having enough time, struggling to take time off work or find childcare, and avoiding the speculum exam because it is uncomfortable. These challenges are often especially felt in rural areas, where fewer than half of all women live within a 30-minute drive of an OBGYN.

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In Teal’s national clinical study, SELF-CERV, 24% of participants came from rural (agricultural or remote) areas and small cities and towns, largely from around Louisiana, Alabama, New England, and North Carolina. Within this group, over 1 in 4 had delayed or avoided their routine cervical cancer screening. They told us this was mostly because they could not find the time to get into a clinic. They also avoided the screening because they found the in-clinic speculum exam uncomfortable. 

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Recent research shows these patterns resonate broadly with women living outside urban areas. Nationwide, we have seen a sharp decline in cervical cancer screenings among women in rural areas since the pandemic. In 2022, only 49% of rural residents received a routine cervical cancer screening, compared to 64% of urban residents.

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Lack of access to healthcare not only means these women often delay routine screenings that can prevent cervical cancer, but they also do not receive timely diagnoses and treatments that can address cervical dysplasia at early stages, before it progresses to cancer. As a result, health inequalities between women living in rural and urban areas are widening. 

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Another recent study revealed that women in rural areas, particularly white women, are being diagnosed with cervical cancer more often than before. Moreover, the cervical cancer mortality rate is significantly higher across women of all racial and ethnic groups in rural areas compared to those in urban areas. Given that cervical cancer is preventable and can be eliminated with routine screening and preventive care, any increase in deaths from this disease is unacceptable. 

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Allowing women the option to screen for cervical cancer at home could make all the difference in rural counties. A large U.S. study found that offering at-home self-collection tripled cervical cancer screening engagement in rural regions. 

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Similarly, women in Teal’s national clinical trial overwhelmingly preferred at-home self-collection with the Teal Wand. This was true for our participants from rural and small town or city areas too: 84% found their Teal screening to be as or more comfortable than the speculum exam, and 85% said they would be more likely to stay up to date on their routine screening if they could screen at home using the Wand. 

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Here’s what our participants from rural areas and small cities or towns across the country had to say: 

“Having it shipped to me would be super convenient versus having to find transportation to the clinic that's an hour and a half drive away. That would save on gas, that would save on having to figure out a plan.”

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“For people that don't have transportation or time, they can do this in the comfort of their home.”

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“It was very quick and easy, and I like that I don’t have to go all the way to the doctor's office.”

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“I would recommend it as a great option if you do not want to, or cannot, come in person to a clinic for a Pap. I liked the privacy, and I felt empowered.”

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“The procedure is simple and can be done in the comfort of my home on my schedule. No need to plan a full day around an uncomfortable appointment.”

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“I think about women with limited access to healthcare. This could mean access to screenings that many women do not have.”

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While the Teal Wand is being reviewed by the FDA, we encourage you to schedule your routine cervical screening and join our waitlist to be among the first to know when we are available in your state.

Too Busy. No Childcare. It’s Uncomfortable. I’ll Do it Later.

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Mae is 39 years old and a full-time working mom who lives with her young son and husband in Connecticut. Her experience with cervical cancer screenings – especially struggling to make time in her busy schedule to get to the clinic – can resonate with most of us.

After participating in the Teal Health clinical trial, Mae tells us how an at-home cervical cancer screening would help her stay on top of her preventive healthcare. 

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When it comes to cervical cancer, routine screening saves lives. This is one of the only cancers where screening can mean disease prevention, or allow an early enough diagnosis for a high cure rate of 91%. However, over 4000 women still die from this disease each year in the United States, where screening engagement is declining. Cervical cancer particularly affects young women – of those aged 20 to 39 years, around 10 die each week from cervical cancer, which is the second leading cause of cancer death in this age group. 

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Like so many of us, Mae describes knowing the importance of this screening and wanting to stay up-to-date. But, she finds herself putting it off for a myriad of reasons. We’ve all been there before. Childcare. Work is busy. It’s uncomfortable, I’ll do it another day. In fact, over 1 in 4 women are currently behind on their cervical cancer screening in the United States.

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“(Cervical cancer screening) was just not top of my priority list. I kind of kept pushing it off and pushing it off. It's not fun. Going and having a Pap smear done is not my favorite doctor's appointment. So, it’s one that I can pretty easily be like, ‘Oh, I'll get to it. I'll get to it.’” 

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For Mae, delaying her cervical cancer screenings also stems from birthing trauma, which makes these intimate exams using a speculum in a clinic setting feel all the more distressing. She describes how these speculum exams usually feel for her: 

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“They’ll always be like, ‘It's going to be a little pressure’ And I’m like, ‘It’s not pressure, it’s pain!’ It's uncomfortable and I am pretty nervous, so I am tensing and that isn't going to help the process at all. [...] It’s physically painful, and sometimes I can't believe how open they make (the speculum)!”

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When she agreed to participate in the Teal Health clinical study, she was already behind on her screenings and thought an at-home self-collection option would be worth a try. Mae describes how easy it was for her to self-collect using the Teal Wand, and was shocked at how simple and comfortable this screening process could be. 

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“(Using the Wand) was easier than a COVID test. I was shocked at how easy it was. The instructions were really clear and it all worked out really well. [...] The device itself is really easy to use. It's literally a Wand. It's not some cumbersome, weird apparatus. It was a very simple device. It was really quick, [...] and the Wand didn’t hurt.” 

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Using the Wand, Mae also found that the emotional challenges that she and many others feel with tolerating the speculum were resolved. She describes how the Wand made her feel in control, allowing her to collect at her own speed with the privacy she needed. 

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While Mae reflects on how much tougher it has become to stay on top of her preventive screenings since becoming a mom and balancing work demands, she emphasizes that being able to screen at home would mean that she can prioritize her health needs. 

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“I have a very, very busy job. I serve on 2 boards. I have a lot going on. [...] The prospect of an at-home test is so cool because you can literally do it at your own home. You don't need to schedule something, drive somewhere, or have an appointment. [...] A hundred percent, absolutely, I would stay on top of this screening with an at-home option.” 

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We know that Mae is far from alone in her experience – more than 94% of our clinical study participants would prefer a trusted at-home option for their cervical cancer screenings. And, like Mae, 86% tell us that an at-home option would mean they could stay on top of their recommended cervical cancer screenings, 

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As we spend this month continuing to build awareness around cervical cancer, we encourage you to schedule your routine screening if you have not already. While the (many) barriers to cervical cancer screening may be relatable and challenging, there is no better time to prioritize your health and well-being than now. 

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In the meantime, Teal Health is working on an at-home screening option. Join our waitlist to be the first to know when you can screen with the Teal Wand. 

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Thank you, Mae, for generously sharing your story. Teal Health is incredibly grateful to all our study participants, with a special acknowledgment for those who shared their personal stories about cervical cancer screening with us.

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*The Teal Health Cervical Cancer Screening device is an Investigational Device and is under review by the US FDA.

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Aisha was first diagnosed with cervical cancer around 8 years ago when she was 32 years old. Her three children, to whom she is a single parent, were all under the age of 10. At the time, she did not have health insurance. She was experiencing bleeding after sex, a common symptom of cervical cancer, and went to the Health Department to get checked. 

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“You probably have some sort of STI,” they told her without screening, “so we're going to give you some antibiotics and it'll clear it up.” 

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Hesitant, she began the course of antibiotics but felt her body worsening. 

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“I started noticing other things that felt off. I was really tired, and my friends said I looked a little gray. My energy levels were low, and my back was hurting.” 

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Aisha knew there was something more going on.

She went back to the Health Department. Once again, they sent her home without an examination, telling her she had to wait until her antibiotics had run their course. Seeing no improvement, on her third visit to the Health Department she insisted she needed to be examined. Finally, a provider conducted an exam and found what Aisha had suspected. 

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“Your cervix looks angry. I can't diagnose you with anything, but I definitely see something that could be a mass. You'll want to get a biopsy, but we can’t biopsy here. So, you're going to have to find somebody to give you a biopsy.”

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She left the Health Department with nothing more than the knowledge that she might have cancer, without any resources to navigate how to obtain a biopsy. She spent the next days calling nearby clinics until she found a doctor who would conduct a biopsy as an out-of-pocket procedure, as she did not have health insurance. At age 32, Aisha was diagnosed with stage 2b cervical cancer. 

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Aisha should have never developed cervical cancer.

She was up-to-date on her screenings, knowing that she had a history of abnormal results and colposcopies. Still, she fell through the cracks because her providers were not testing her for high-risk Human Papillomavirus (hrHPV), which causes almost all cervical cancers. 

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“They missed it because (the tumor) was towards the back, and they didn't get back far enough. They just did a Pap so they didn’t catch HPV.” 

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Just 9 months before she was diagnosed, Aisha had a Pap Smear, which is a cytology test where cervical cells are visually analyzed under a microscope for cancerous cell changes. However, Pap Smears alone do not test for the presence of hrHPV that causes cervical cancer and are far less sensitive than HPV tests. On the other hand, HPV tests look for the presence of high-risk HPV and are highly sensitive, which means they almost always find disease when it is present. 

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In FDA clinical trials, Pap smears, or cytology, have a sensitivity of around 53% for detecting abnormal cell changes (i.e., CIN3+). This means they miss almost half of all cases where cancerous abnormalities exist, which is why they were recommended annually. HPV tests are far more sensitive. In FDA clinical trials, Primary HPV tests show 92% sensitivity, at least, when detecting abnormal cell changes (i.e., CIN3+).

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Aisha’s treatment began immediately. Six rounds of chemotherapy, 25 rounds of radiation, and 5 rounds of brachytherapy (internal radiation). She describes feeling very unprepared and uninformed about what her treatment would entail and didn’t have time to ask questions. For example, it was not explained that the radiation regime she was signing onto would mean that she would lose her fertility, and she was not given options to preserve her fertility. 

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“Pretty immediately, I went into early menopause at age 32. It wasn't explained to me that was going to happen. I was frustrated by that. Maybe they assumed that I had 3 children, so I didn’t want to have another kid. But I wasn’t necessarily ruling that out. I thought maybe I would have one more, one day.” 

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Fertility preservation is a common challenge for women undergoing cervical cancer treatment that includes radiation. Most women are diagnosed young – cervical cancer is most frequently diagnosed in women aged 35 to 44 years – and may want treatments that include options for future family-building. 

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After her treatment, which she was told went well, Aisha was asked to return for a follow-up in three months. She thought she had beaten the cancer and was looking forward to moving on. But, the news was far from what she expected.

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 “It’s just that you’re so young,” the resident doctor told Aisha. 

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“Your cancer has spread to your lungs and liver. It’s metastasized now. I can't promise you any more than two years right now. And if you don't get treatment, you're looking at maybe three months.”

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The doctor described that two years of treatment would be incredibly challenging, and asked her to instead consider three “good months” with her children. Aisha recalls spending the next few hours crying beside an oncology nurse, fixated on who would take care of her children if the worst were to happen. But, as she made her way to school pick-up after receiving this devastating news, her attitude shifted as soon as she saw her children – Aisha decided to fight. 

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Aisha now had health insurance and had started working at a hospital-affiliated institution. She emailed every oncologist requesting a second opinion. Finally, one oncologist (who remains a doctor she relies on) gave her more options. This oncologist believed that Aisha, being young, could tolerate aggressive treatment – and being a mother who was desperate to live, deserved that chance to try. 

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“That's all I needed to hear. The same diagnosis, same finding, same everything, but just, ‘let's try.’”  

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This time, Aisha took the time she needed to do her research and ask questions.

After three months, she began her second treatment to address metastatic cervical cancer. She points out that according to her first doctor, she should not have been alive, but here she was, persevering. 

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She underwent chemotherapy requiring her to be hospitalized overnight each time, due to anaphylactic shock (a side effect, as she built a tolerance to the medication). When she was discharged at 8AM, she would take her children to school and bring herself to work, all while enduring treatment. She did her best to keep herself healthy and maintain a smooth life for her children, protecting them from the weight of her diagnosis. 

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“I had a very traumatic childhood, so my goal has always been to make my kids' lives as easy and trauma-free as possible. So, I faked it. I kept doing all the usual things. I was exhausted. I was sick. But I wanted to create a sense of normalcy for my children. And I feel by doing that, I was saving myself in the meantime.” 

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In July 2017, Aisha completed her chemotherapy and went into the clinic to undergo scans in preparation for CyberKnife treatment (highly targeted radiation) for the small amount of cancer that the doctor thought remained in her lungs. Again, her doctor had unexpected news.

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“I've been doing these 25 years,” her oncologist said, “And I've never in my life seen this, but you had a complete response to treatment. What we saw on your scan was just calcified tissue, it’s not even an active disease.” 

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Against all odds, Aisha has been in remission since August 2017. Now, looking back at her earlier scans, Aisha knows that her cancer was metastatic from the very beginning. Her first scan after being diagnosed showed spots on her lungs with notes indicating, “Cannot rule out metastatic disease.” Aisha describes feeling betrayed at many points, from being screened with only a Pap Smear despite her HPV history, to being treated with antibiotics and denied examinations, losing her fertility, and being dismissed when she wanted to fight. 

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Today, Aisha knows that she needs to ask for what she wants in her healthcare, and encourages others to do the same. She believes in the power of patient self-advocacy and uses her experience to help others. 

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“If you feel dismissed, if you feel uneasy, or if a symptom is persistent and you don't feel comfortable with the outcome, then you keep going back until you feel comfortable. [...] Keep being a squeaky wheel. [...] I saved my life by being a squeaky wheel.”

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Not only does she emphasize the importance of getting screened routinely to enable diagnoses and treatment as early as possible, but she is also a proud and vocal advocate against the stigma around HPV. 

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“HPV is something that can affect anybody who's ever had sex in life, ever! Why are we not talking about it? It (leads to) the only cancer that can be eradicated.”

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“Don’t be afraid to talk about (cervical cancer) because there are so many people who have had to navigate this. So many people have had HPV. So many people have had abnormal Pap smears. I need people to understand, it's so much more common than they think it is. And outcomes for cervical cancer are improving every day.”

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We couldn’t agree more. With January being Cervical Cancer Awareness Month, we urge you to schedule your routine screening if you have not already. Cervical cancer can be prevented (and eliminated), but it takes everyone screening routinely so that persistent HPV infections can be identified and treated before they progress into cancer. If you would like to learn more about HPV and the risks around cervical cancer, check out Teal’s resource center for more blogs and research deep dives. 

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Thank you, Aisha, for telling us your inspiring cervical cancer survivor story. We are incredibly grateful to be able to share your experience with our Teal community.

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Robelle recalls her mother, Bellina Del Rosario, who passed away from cervical cancer almost 20 years ago, a few days after her 47th birthday. When she lost her mother, Robelle was a 20-year-old carefree college student – she had never heard of cervical cancer.

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Her mother’s story is all too familiar.

“As a mom you are so busy taking care of everyone else around you that you forget to take care of yourself. Same with my mom. She was a full-time, working mom, and a single mom to three children on top of it. She never got to take care of herself.”

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Bellina was not alone in these challenges. Recent national data shows that 63% of women, including 75% who have children, struggle to prioritize their own health. Now a mother to a 3-year-old daughter herself, Robelle understands how women – especially mothers – tend to put themselves at the bottom of their to-do list. 

Robelle’s mother immigrated to the United States from the Philippines when she was in her early twenties. Not only did she struggle with access to healthcare due to her non-citizen status, but she was accustomed to a different cultural norm in the Philippines, where healthcare was less accessible and regular preventive screenings were unheard of at the time. In the United States, Bellina continued to feel as though this preventive healthcare was not readily available to her while struggling to find time to prioritize herself. Robelle also tells me that women’s healthcare was almost never discussed in her house growing up, as these topics were culturally taboo in generations past.

After giving birth to her youngest child, Bellina stopped going to the doctor for herself (yet she was diligent with taking her children to all their appointments). As the years went on, she started experiencing vaginal bleeding. She initially dismissed this concern, assuming it was menopause. But as the bleeding worsened, Bellina finally sought a doctor’s appointment. 

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Robelle’s mother was diagnosed with stage 4 cervical cancer at age 46.

Initially, Robelle tells me she did not understand the seriousness of her mother’s situation because her family lacked awareness around cervical cancer at the time.

“If I would have known a little bit more, I could have asked the questions. I would have asked my mom and even pushed her, pushed us together as women, to get screened.”

Unfortunately, Bellina’s condition deteriorated quickly as the cancer spread. While Robelle tried to stay optimistic, she witnessed the toll that the chemotherapy and radiation treatments were taking on her mother. Robelle tells me, “It happened very quickly. She passed away within a year of being diagnosed. This was back in 2006. I had never even heard of cervical cancer, nor did I know anything about it.”

As she coped with her mother’s passing, Robelle stepped in as her younger sister’s caretaker and built her awareness around women’s health. Coincidentally, Bellina passed the same year that the Gardasil shot – a vaccine that protects against high-risk HPV types that cause cervical cancer – was released. Without hesitation, Robelle took herself and her sister to get this shot. “I did not know enough about the vaccine, but I knew enough from the experience that we had with my mom that I was trying to do anything preventive. At 20 years old I was trying to be a mother to a 10-year-old.” 

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Now, Robelle is very informed about preventive care surrounding cervical cancer and other women’s health needs – a concern she has translated to her family in the Philippines. In fact, her mother’s passing prompted Robelle’s aunts in the Philippines to get screened. All three of her aunts were found to have cancer – but, because they were screened and diagnosed early, their treatments were successful.

She tells me that she holds onto her mother’s experience but tries to do things differently now that she is a parent.

“It’s like when the masks fall down in the airplane. You should put the mask on yourself first and then your kid. As a mom you're always coming up with so many excuses as to why you're not taking care of yourself.”

Today, Robelle is particular about attending her annual appointments, women’s wellness visits, and preventive cancer screenings. She stays aware of her body and health needs, advocating for herself to get the care and attention she wants from her providers. Robelle tells me that she often finds herself “trying to break down walls of doctors,” while trying to get providers to take her seriously. In addition to her mother’s struggle, Robelle has also undergone cervical cryosurgery herself after an abnormal Pap smear. Based on her medical history, she insists – despite pushback – on regular preventive care and yearly cervical cancer screenings.

Robelle highlights that the Teal Wand and telehealth platform could fill critical gaps in women’s healthcare. She describes her continued discomfort with the speculum exam. “I always dread it and I always think to myself, ‘you've given birth, you'll be fine.’ It’s quick but it’s not comfortable. And they have that thing (speculum) in you. It kind of sucks.” Beyond the clinical encounter, Robelle notes that scheduling her appointments is painstaking. While she has a good relationship with her ObGyn, it can be frustrating when her appointments are canceled or rescheduled due to her provider’s busy schedule. “Teal would be beneficial because now, I'm rescheduling and canceling a year later. You just lose track of time.” 

Reflecting on how her mother’s story could have been different, Robelle tells me, “I always wonder, if Teal existed back in 2006, would my mom have done it? She wouldn’t have had to make an appointment and sit on hold.” Robelle hopes that people take advantage of the ease and preventive care that Teal’s at-home cervical cancer screening will offer. “Knowing that Teal will be available, women should definitely embrace it. Why not? It’s there for you.”

In Robelle’s words, put your oxygen mask on first.

At Teal, we want to help make sure that happens, starting with your at-home cervical cancer screenings and virtual women’s health providers dedicated to you.

Thank you, Robelle, for generously sharing your experience and your mother’s story. We at Teal Health are incredibly grateful to those who have shared their personal stories about cervical cancer screening with us.

This week, the U.S. moved one step closer to making at-home self-collection cervical cancer screening a reality. The United States Preventive Services Task Force (USPSTF), which is a panel of experts who develop the medical guidelines that providers, insurers, and consumers follow, announced a recommended update to the cervical cancer screening guidelines. 

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The update includes two important changes from the previous published guidelines:

• Primary HPV testing is now the recommended screening test, moving co-test and Pap smear to alternative options:
  From USPSTF proposal: For women 30-65 years, self-collected or clinician-collected HPV testing alone (primary HPV testing) every 5 years provides the optimal balance of benefits and harms. 
• Self-collection was added to the guidelines and stated to have similar accuracy to clinician-collected tests:
  From USPSTF proposal: Self-collection of HPV tests for screening has similar accuracy to clinician-collected tests and is associated with increased screening in underscreened individuals and in historically underscreened populations. The accuracy does not appear to show a difference between home or clinic setting for self-collection. However, most of the evidence for increased rates of screening was for home self-collection of HPV.

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There were no recommended changes to the screening age and screening intervals. For more details, see the current screening guidelines. 

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These recommended updates are currently under review and are open for public comment. Once they are finalized, they will update the 2018 USPSTF screening guidelines. You can see the draft cervical cancer screening recommendation on the USPSTF website.

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How this update supports at-home screening

At Teal Health, we are thrilled to see the USPSTF make these recommended updates to the cervical cancer screening guidelines, acknowledging the accuracy of self-collected samples and following the American Cancer Society’s lead in officially endorsing Primary HPV testing as the recommended screening test. Both of these updates align with the work we have been doing to develop, test, and validate our at-home self-collection device for cervical cancer screening. 

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The Pap smear was revolutionary for its time, but with the overwhelming evidence that HPV causes nearly all cervical cancers, HPV testing is shown to be the most effective screening. Through Primary HPV screening, we can introduce a more comfortable and private at-home self-collection option like the Teal Wand^TM, unlocking access to this critical screening. These updated guidelines will ensure we can get more people screened for cervical cancer - using a preferred method that women want.

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Teal Health, through the FDA Breakthrough Device Designation is on the fast track to be the first FDA approved at-home self-collection kit for Primary HPV testing. We were granted this designation based on the ability of the Teal Wand at-home collection to address a public health need. The USPSTF’s inclusion of this language is another sign of the importance of offering more accessible options to women in the U.S. We are excited by the progress, and honored to play our role in making it a reality in the near term. Our at-home collection kit is currently under review by the FDA.

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Cervical cancer screening guidelines are developed by organizations like the USPSTF as well as other leading organizations, such as the American Cancer Society (ACS), American Society for Colposcopy and Cervical Pathology (ASCCP), and the American College of Obstetricians and Gynecologists. 

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Disclaimer: This article contains references to sexual trauma, which may be distressing. Reader discretion is advised.

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Despite how common it is, human papillomavirus (HPV) remains a stigmatized health issue. Guidance around HPV prevention has focused on encouraging people to manage their sexual practices (e.g., monogamy, protected sex). While safe and consensual sex is important for many reasons, over the years, this emphasis on sexual habits has created a sense of stigma around HPV and blame toward women who test positive for this virus. 

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Aisha, a 40-year-old mother of three, and metastatic cervical cancer survivor describes how this stigma impacted her when she was diagnosed: 

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“Cervical cancer is so taboo. In hindsight, when I was diagnosed, I didn't want to tell anybody I had cervical cancer. I was like ‘Gross, I have a STD.’ I was so misinformed. [...] But I just sat with myself and realized this is actually part of the problem.” 

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Like so many others, stigma added to Aisha’s emotional distress when she was diagnosed. She felt embarrassed and soon realized that this stigma was making it even more challenging to find the information she needed to understand her diagnosis and manage her treatment: 

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“People look at cervical cancer like this (taboo), and this is why nobody talks about it. This is why I'm spending hours trying to find resources and information, having to piecemeal all this because it's not talked about.”

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Almost all cervical cancers are caused by persistent and untreated high-risk HPV infections. According to the Centers for Disease Control, nearly all sexually active adults will get HPV at some point in their lives, making it the most common sexually transmitted infection. In fact, 80% of women will have had an HPV infection by age 50. For 90% of women, HPV clears up on its own within 2 years. However, some HPV infections can persist, and if left untreated may progress into cancerous cell changes. 

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The American Cancer Society notes that certain genetic predispositions, smoking tobacco, and a weakened immune system are among the factors that can make it more likely that an HPV infection persists and progresses. But emerging research is also showing that key social factors can shape the risk for HPV persistence:

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1. Dealing with chronic stress and high-risk coping behaviors
2. Healthcare impacts of living in poverty 
3. Ongoing challenges that sexual trauma or violence has on one’s body and health. 

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These socially driven risk factors are not as uncommon as one may think. Most of us can probably relate to one of the most significant factors – chronic stress. 

• Research shows that among those aged 35-44, long-term sustained stress increased from 48% in 2019 (when the COVID-19 pandemic began) to 58% in 2023. 
• This group also faced the highest increase in mental health diagnoses during these 4 years – from 31% to 45%. 
• When it comes to cervical cancer risk, we also find that this is most frequently diagnosed among women who are between 35-44 years of age.

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Chronic Stress and Related Lifestyle Coping Practices 

Chronic stress (through increased cortisol levels) suppresses one’s immune functions, which compromises the body's ability to clear HPV infections. Stress creates a vicious cycle, leading to an inflammatory response that in turn intensifies stress. This stress cycle compromises immunity, increases DNA damage, and heightens the risk of HPV persisting and progressing into possibly cancerous changes. 

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The accompanying coping behaviors that people at times use to manage stress and mental health (e.g., smoking tobacco, substance use) also damage DNA and weaken one’s immune response, similarly increasing the likelihood that HPV progresses into cervical cancer. 

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Poverty and Healthcare 

Those who are low-income, especially if they also live in residentially segregated spaces, often face healthcare barriers, including limited resources, provider shortages, and less access to preventive care. These barriers contribute to why cervical cancer is steadily increasing, including among those who are low-income in urban and rural areas, where access to the HPV vaccine and routine screening can be challenging. 

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Poverty can also bring overlapping challenges, such as longer or irregular working hours, inconsistent paychecks, immigration hurdles, unsteady housing, and racial and ethnic discrimination. These challenges can lead to chronic stress, making one’s immune system more vulnerable to persistent HPV. 

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Experiences of Trauma and Violence

There is a significant link between experiences of violence or trauma and increased risk of contracting HPV with the infection progressing into cervical cancer. In the United States, over half of all women have experienced sexual violence, and those who are low-income are often continually victimized by intimate partners as they struggle to find the finances to change their living situations. 

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Survivors of sexual violence continually process these experiences psychologically and physically. This represents extreme stress and trauma, which hurts one’s long-term immune response while also increasing vulnerability to social circumstances and behaviors that escalate the risk for persistent HPV infections. 

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A Fuller Framework Around HPV Risk

Today, Aisha is a proud advocate for those going through cervical cancer and has created a platform to support women in a similar position as she was in. But, as Aisha describes, she needed to unlearn the stigma and shame around HPV and cervical cancer before she could move forward: 

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“(The HPV stigma), that's what started me trying to get comfortable because I was uncomfortable.”

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Declining cervical cancer screening rates and rising diagnoses are widespread issues. Shedding light on social determinants behind HPV and cervical cancer risk gives us a fuller framework of how to address this common virus and eliminate a highly preventable cancer – one that goes beyond stigmatizing sexual behavior. With social context in mind, we need more strategies and alternatives that engage people in routine HPV screening, which is the most effective way to eliminate cervical cancer.