Include Males Too In Addressing Human Papilloma Virus And Related Cancers

Human Papilloma Virus (HPV) is a common sexually transmitted infection. Since an effective HPV vaccine exists and HPV screening and treatment of pre-cancer lesions can save lives, no one should be suffering from any of the HPV related cancer or had to die of it.

According to the World Health Organization (WHO), HPV do not cause health concerns in most infected people (of all genders), but persistent HPV infection with some high-risk genotypes is common and can cause genital warts or cancer. For example, almost all cervical cancer, which is the 4th top cancers among women worldwide, is caused by HPV. HPV also causes cancers of vulva, vagina, mouth/throat (oropharyngeal), penis and anus.

Despite cervical cancer being preventable and curable (if detected early and managed effectively), more than 660,000 women developed cervical cancer in 2022. Over 350,000 women died of cervical cancer in 2022.

In 2019, HPV caused over 70,000 cancer cases in men too.

HPV screening must be done with DNA test, not pap smear or VIA

“We have a large burden of cervical cancer in India - one woman dies every 8 minutes due to this preventable cancer. All women above the age of 30 years, must undergo cervical cancer screening with an HPV DNA molecular test (and not by pap smear or visual inspection with acetic acid – VIA),” said Dr Smita Joshi, a noted scientist who has made a significant contribution to advancing HPV vaccine and screening research and science-backed interventions in the past two decades.

National Family Health Survey (NFHS) of India 2019-2021 shows that among women age 15-49, only 1.2% ever got a screening for cervical cancer in India. WHO Cervical Cancer Elimination Initiative (adopted in 2021) sets the goal of at least 70% of the eligible women to get screened. “There is a large gap in HPV screening of eligible women in India,” points out Dr Joshi. Dr Joshi leads the Department of Preventive Oncology, Prayas (a non-profit). Dr Joshi has been a principal investigator for HPV vaccine and cervical cancer related research studies of WHO’s IARC (International Agency for Research on Cancer) since 2009. She also serves as Programme Director at Jahangir Clinical Development Centre (JCDC) in Pune, India.

Connect the dots: HPV, HIV and all genders

Women living with HIV are at 6 times higher risk of HPV-related cervical cancer compared to those without HIV. HPV also infects men. For example, studies show that rates of HPV have shown to be alarmingly high among men who have sex with men.

Mumbai-based microbiologist and researcher Dr Prapti Gilada-Toshinwal presented an important study at 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025) in Japan. This study was done to determine the prevalence of HPV anal infection among 105 men who have sex with men who were seeking care at Unison Medicare and Research Centre (a comprehensive infectious diseases centre) between August 2022 and December 2024. It is important to note that Unison Medicare and Research Centre has been serving around 10,000 people living with HIV since last 35 years.

Around 80% study participants came from Mumbai and rest of them were from other cities of India except 3 who came from other countries.

“70% of study participants were living with HIV,” said Dr Prapti Gilada. “Overall, anal HPV infection rate was 62%.” She serves as CEO and consultant microbiologist at UniLabs Diagnostics. “Some of them also had other sexually transmitted infections such as syphilis, chlamydia, or gonorrhoea.”

“In the study we offered DNA test for HPV to all eligible study participants (105 men who have sex with men) who were receiving medical care at our centre. Most common HPV high risk genotype was 16. Other common high-risk HPV genotypes found among study participants were 18 and 45,” said Dr Prapti Gilada.

“HPV positivity rates were higher in those study participants who were also living with HIV (68.5%) compared to those without HIV (48%),” said Dr Prapti Gilada, who is also an independent Director of Thyrocare. Global data shows that among men who have sex with men, HPV is higher among those who are living with HIV than those without it.

She was speaking with CNS before 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and 13th International AIDS Society Conference on HIV Science (IAS 2025) open.

Dr Prapti Gilada calls for raising awareness, health and treatment literacy among the masses so that eligible boys and men and girls and women can access HPV vaccination, HPV screening and management of pre-cancerous lesions and other health issues. She also hopes governments will make HPV vaccination available to all those eligible of all genders, as well as screening and appropriate management.

Dr Prapti Gilada cites a study published in The Lancet in 2023 which showed that almost 1 in 3 men over the age of 15 were infected with at least one genital HPV genotype, and 1 in 5 men were infected with one or more of high risk (or oncogenic) HPV genotypes.

It is high time all eligible boys and men too are included in HPV responses globally

Agrees Vijay Nair who is the Chairperson of Udaan Trust and a prominent community rights activist from India: “With no HPV vaccination and screening facilities for males, there are people who have even probably died with undiagnosed HPV-related anal cancers or other health issues. Some may be getting services for piles or anal fissures or fistula as there is hardly any HPV screening facilities for anal HPV. We need to screen high-risk men for HPV and HPV related health conditions including pre-cancerous lesions or anal cancers. Also, we need to include males too for vaccination against HPV."

Vijay was speaking at the India's National Dialogue and Stakeholder Consultation held last month in preventing cancers and addressing ageing among people living with HIV. It was organised by National Coalition of People Living with HIV in India (NCPI Plus).

Colposcopy and anoscopy: Do we have enough facilities?

Those with persistent HPV infection may need a specialised follow up medical examination with colposcopy (medical experts examine with an equipment for any HPV-related changes or abnormalities in vulva, vagina or cervix of women) or anoscopy (medical experts examine with an equipment for any HPV-related changes or abnormalities in anus or rectum). If any changes or abnormalities, further appropriate medical treatment is required.

“We need more medical centres for anoscopy,” said Dr Prapti Gilada whose study participants may require further follow up. Her centre is continuing to follow up with all the study participants, one of whom has become HPV negative during the study.

Dr Smita Joshi is a widely recognised colposcopy trainer too. “We have screened over 40,000 women for HPV and cervical cancer and managed them appropriately as per the WHO latest guidelines.” Her centre at Prayas is a recognised colposcopy centre too which has trained several medical professionals including gynaecologists from within India and other countries too.

She appeals for financial resources to scale up trainings of medical professionals in India and other countries which would go a long way in strengthening capacities and competencies towards addressing HPV and related cancers.

Addressing HPV lacks ambition

Governments have promised to eliminate cervical cancer by end of this century. In order to be on track towards cervical cancer elimination, all countries must reach and maintain an incidence rate of below 4 per 100,000 women. Achieving that goal rests on 3 key pillars and their corresponding targets to be achieved by 2030 so that countries are on track towards eliminating cervical cancer by end of the century.

- vaccination: 90% of all eligible young people must be fully vaccinated with the HPV vaccine by the age of 15

- screening: 70% of women should be screened using a high-performance test by the age of 35, and again by the age of 45

- treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed.

Cervical cancer is preventable as vaccines exist since almost two decades now. HPV screening and DNA tests exist. Medical management of pre-cancerous lesions can save lives and avert cancers. Is not a goal to eliminate cervical cancer by turn of this century, lacking ambition?

India's first indigenously validated Truenat HPV-HR Plus test in April 2025

Indian government announced in April 2025, India's first indigenously developed and point-of-care HPV DNA molecular test is Truenat HPV-HR Plus test that screens people for 8 high-risk genotypes (16, 18, 31, 33, 35, 45, 52 and 58). These 8 high-risk HPV genotypes cause over 96% of cervical cancers globally. Truenat HPV-HR Plus is developed by Indian company (Molbio Diagnostics). Its independent multi-centric validation was done by Government of India’s Department of Biotechnology, Biotechnology Industry Research Assistance Council (BIRAC) and Grand Challenges India.

This independent validation of Truenat HPV-HR Plus was conducted under the study “Validating Indigenous Human Papilloma Virus (HPV) Tests for Cervical Cancer Screening in India.” The study involved leading Indian government’s research institutes, including All India Institute of Medical Sciences (AIIMS) Delhi, ICMR National Institute for Cancer Prevention and Research (NICPR) Noida, and ICMR National Institute for Research in Reproductive and Child Health (NIRRCH) Mumbai, in collaboration with WHO's International Agency for Research on Cancer (IARC).

However, Truenat HPV-HR DNA molecular test has been around for over 2 years now to screen people for 4 high-risk genotypes.

Follow the science: Vaccinate and screen all eligible people for HPV and related cancers

Dr Smita Joshi led several researchers in her distinguished career over two decades. She was part of a multi-centric study of WHO's IARC on HPV vaccine which was initiated in 2009 onwards. This study was to evaluate efficacy of HPV vaccine (2 doses vs 3 doses at 0, 2 and 6 months).

However, due to government's order to stop HPV vaccination in studies (owing to adverse outcomes in a PATH study), Dr Joshi's study also had to stop vaccination abruptly in April 2009.

"Because of that suspension of HPV vaccinatio, instead of two versus three doses, this study resulted in a cohort of girls that had received only a single dose, two doses (at 0 and 2 months), two doses (at 0 and 6 months) and three doses (at 0, 2 and 6 months). So, the long-term follow-up of these vaccinated girls is still being carried out since then," said Dr Joshi. "We have now completed 15 years of the study and of immunogenicity data."

Dr Joshi's study majorly impacted and contributed to informing vaccine dosage in many countries as well as to WHO's recommendation of single dose HP vaccination in the young girls.

She was also part of the HPV vaccine study (for India's indigenously developed HPV vaccine Ceravac). She wonders when HPV vaccine would become a part of Indian government's public vaccination programme. Some Indian states (like Sikkim, Delhi, Punjab) had introduced HPV vaccination using a foreign-made vaccine) but latest information on status of these programmes is not with us.

Dr Prapti Gilada and Udaan's Vijay Nair too call for including HPV vaccination for those eligible from all genders in the government's programme at the earliest - as well as HPV screening and management of all related health conditions especially pre-cancerous lesions and cancers.

Dr Smita Joshi adds that when government of India includes indigenously developed HPV vaccine in its programme, then "one good thing about Ceravac of Serum Institute of India is that it is also approved for boys.

Appeal to world leaders who will meet at UNHLM on NCDs

Next High Level Meeting on Non-Communicable Diseases (UNHLM on NCDs) will happen in September 2025 at the United Nations General Assembly. Although HPV is an infection, yet it causes one of the top cancers worldwide. We appeal to world leaders to commit to scale up HPV vaccination for all those eligible (regardless of genders), and screen all eligible people (regardless of gender) for HPV and related pre-cancerous and cancerous conditions.

Developing vaccine or point-of-care diagnostics is not enough but deploying them at point-of-need in the Global South is critical pathway towards increasing access to lifesaving services and improving HPV-related responses on the ground.

Shobha Shukla – CNS (Citizen News Service)

(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)

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