Include Males Too In Addressing Human Papilloma Virus And Related Cancers
Press Release – CNS
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 …
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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This model has proven to help accelerate community-led responses towards ending AIDS with government's support, said Dr Praphan Phanuphak. 'Therefore, it is a collaborative effort with equal responsibility and equal importance [between key populations or communities and the government]. One has to respect the other. It is not that the NGOs are snatching the work or the territory of the government,' he said. 'Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down approach). It fills the gaps that government cannot do and it is acceptable by the community they serve,' emphasised Dr Praphan Phanuphak. However, there could be some misunderstanding from the government side in some instances. 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Treatment is also prevention because when people with HIV are on treatment and their viral load is undetectable, then there is zero risk of any further HIV transmission. Thailand government rolls out PrEP under its universal health coverage since 2019 onwards. A majority of PrEP is being provided through key population led health services in Thailand. Eliminate legal and structural barriers Dr Praphan calls for eliminating all legal and structural barriers including stigma and discrimination that block access to existing HIV and other health and social support services – especially for HIV key populations. He not only calls for strong and sustained national political commitment which is essential to end AIDS by 2030 but also for accountability of political leaders if we fail to deliver on the promise to end AIDS by 2030. He acknowledges that USA President Trump's current policy decisions have severed research funding and development financing for a range of programmes including HIV in the Global South. 'This could pose to be a big obstacle for ending AIDS in many developing countries,' said Dr Phanuphak. Lot of progress towards ending AIDS but challenges remain Thailand has seen alarmingly high HIV rates in certain sub-national areas or key populations in late 1980s and early 1990s. But a strong community-led response to prevent HIV has turned the tide since then and brought down HIV rates significantly. Thailand today champions a HIV response which parallels only a few other nations in the Global South. And Thailand is on track to deliver on HIV goals for 2025 too. '100% condom use campaign to prevent HIV infection from commercial sex was a game changer. 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Thailand government took over and provided science-based triple antiretroviral therapy from 2010 to all HIV infected pregnant women so that no child is born of HIV. In 2016, Thailand became the first country in Asian region to eliminate mother to child transmission of HIV as well as syphilis. Another gamechanger which helped Thailand progress towards ending AIDS is generic manufacturing of lifesaving antiretroviral medicines from 2006 onwards. Thailand is a leading manufacturer of generic medicines in the region and also procures lifesaving medicines from other nations including India. Test and treat policy was rolled out in Thailand, a year before the WHO recommendation came in A year before the WHO recommendation came for 'Test and Treat' policy, Thailand had begun its rollout. WHO 'Test and Treat' policy meant that anyone diagnosed with HIV, regardless of their CD4 count or stage of infection, should be offered and immediately linked to lifesaving antiretroviral therapy. 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Together with late Professors Joep Lange and David Cooper, Prof Praphan co-founded HIV-NAT (the HIV Netherlands, Australia, Thailand Research Collaboration), Asia's first HIV clinical trials centre in Bangkok in 1996. Prof Praphan served as the Director of the Thai Red Cross AIDS Research Centre for 31 years (1989-2020) and is currently the Senior Research and Policy Advocacy Advisor of the Institute of HIV Research and Innovation (IHRI) in Bangkok as well as the Advisor of HIV-NAT. Dr Phanuphak was speaking with CNS (Citizen News Service) around 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025), 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). When people lead, change happens Sterling examples of high impact key population or community-led health service deliver models come from Thailand. HIV key populations continue to play a major role in delivering Pre-Exposure Prophylaxis (PrEP for HIV prevention) to those who are at a heightened risk of HIV acquisition. Thailand has the largest PrEP rollout in Asia Pacific region, 80% of people using PrEP in Thailand receive it from a clinic led and staffed by members of the community that it serves. Key population led health services mean that community thinks, demands and does the work and manages the programmes, for the benefit of their own community members (and the country). This model has proven to help accelerate community-led responses towards ending AIDS with government's support, said Dr Praphan Phanuphak. "Therefore, it is a collaborative effort with equal responsibility and equal importance [between key populations or communities and the government]. One has to respect the other. It is not that the NGOs are snatching the work or the territory of the government," he said. "Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down approach). It fills the gaps that government cannot do and it is acceptable by the community they serve," emphasised Dr Praphan Phanuphak. However, there could be some misunderstanding from the government side in some instances. For example, some may opine that 'government is getting blamed for not doing enough good work because of which NGOs are trying to compete with them'. Truth is that KPLHS or community-led models are only helping complement government's work. "One has to show the evidence that KPLHS (key population led health services) can actually provide quality services to the populations that conventional healthcare providers cannot. Key population led health services will lead to ending AIDS and other sustainable health goals beyond HIV, such as mental health and NCDs, i.e., KPLHS is in accordance with government policy," said Dr Phanuphak. He added: "KPLHS or key population or community led health services is one arm of the holistic healthcare approach. They need to collaborate with the main stream public healthcare systems. Once the government accepts these facts, legal and financial supports will follow. However, key population led health services may be more expensive than conventional healthcare since the personnels and office facilities are not provided by the government. Therefore, they need enough financial support to ensure sustainability of the programme." 95-95-95 HIV targets for 2025 Dr Praphan firmly believes that the 95-95-95 HIV goals can be achieved. We have science-based tools to deliver on these goals, he said. 95-95-95 goals refer to ensuring 95% of people living with HIV know their HIV positive status, 95% of them are receiving lifesaving antiretroviral therapy, and 95% of those on treatment are virally suppressed. According to the World Health Organization (WHO), there is ZERO RISK of any further HIV transmission from a person living with HIV whose viral load remains undetectable. That is why it is referred to as Undetectable Equals Untransmittable or #UequalsU. Dr Praphan Phanuphak stresses upon "finding people with HIV early in all sub-groups of the population." He calls for focussing on HIV key populations as well as general population too. "General population is the group currently being left behind since we have rightly focussed on key populations now - but if we are to end AIDS by 2030, we need to reach out to everyone. Each individual - from general population or key population - should have at least one HIV test in their life - earlier the better (and repeat test as appropriate)," he said. "Pre-Exposure Prophylaxis (PrEP) can prevent up to 99.9% HIV acquisition": Dr Praphan Phanuphak Pre-Exposure Prophylaxis (PrEP) is a medicine taken by those without HIV to reduce the risk of getting infected with the virus. "PrEP can prevent up to 99.9% of HIV acquisition. One needs to scale up access to PrEP widely and rapidly. Once HIV cannot spread further and individual-at-risk cannot acquire new HIV infection with PrEP use, AIDS can be ended," said Dr Praphan Phanuphak. Treatment is also prevention because when people with HIV are on treatment and their viral load is undetectable, then there is zero risk of any further HIV transmission. Thailand government rolls out PrEP under its universal health coverage since 2019 onwards. A majority of PrEP is being provided through key population led health services in Thailand. Eliminate legal and structural barriers Dr Praphan calls for eliminating all legal and structural barriers including stigma and discrimination that block access to existing HIV and other health and social support services - especially for HIV key populations. He not only calls for strong and sustained national political commitment which is essential to end AIDS by 2030 but also for accountability of political leaders if we fail to deliver on the promise to end AIDS by 2030. He acknowledges that USA President Trump's current policy decisions have severed research funding and development financing for a range of programmes including HIV in the Global South. "This could pose to be a big obstacle for ending AIDS in many developing countries," said Dr Phanuphak. Lot of progress towards ending AIDS but challenges remain Thailand has seen alarmingly high HIV rates in certain sub-national areas or key populations in late 1980s and early 1990s. But a strong community-led response to prevent HIV has turned the tide since then and brought down HIV rates significantly. Thailand today champions a HIV response which parallels only a few other nations in the Global South. And Thailand is on track to deliver on HIV goals for 2025 too. "100% condom use campaign to prevent HIV infection from commercial sex was a game changer. Establishment of HIV-NAT (the HIV Netherlands Australia Thailand Research Collaboration), the first HIV clinical trials centre in Asia to provide free up-to-date HIV treatment through clinical trials in 1996, was another major step forward," said Dr Praphan Phanuphak. Helping children born to HIV positive parents are HIV free When world's first therapy was rolled out in the rich nations in 1994 to reduce the risk of vertical transmission of HIV (from mother to child), Thailand soon began its rollout two years later (1996 onwards). Zidovudine was the first available antiretroviral agent for reducing mother-to-child HIV transmission in 1994. "Princess Soamsawali prevention of mother to child transmission of HIV (PMTCT) project was another gamechanger to provide up-to-date PMTCT drugs to all pregnant women in Thailand, free of charge, from 1996 to 2010," said Dr Praphan Phanuphak. Thailand government took over and provided science-based triple antiretroviral therapy from 2010 to all HIV infected pregnant women so that no child is born of HIV. In 2016, Thailand became the first country in Asian region to eliminate mother to child transmission of HIV as well as syphilis. Another gamechanger which helped Thailand progress towards ending AIDS is generic manufacturing of lifesaving antiretroviral medicines from 2006 onwards. Thailand is a leading manufacturer of generic medicines in the region and also procures lifesaving medicines from other nations including India. Test and treat policy was rolled out in Thailand, a year before the WHO recommendation came in A year before the WHO recommendation came for "Test and Treat" policy, Thailand had begun its rollout. WHO "Test and Treat" policy meant that anyone diagnosed with HIV, regardless of their CD4 count or stage of infection, should be offered and immediately linked to lifesaving antiretroviral therapy. Strong scientific evidence showed that this approach maximises the benefits of early treatment for individual health and to prevent further transmission of the virus. What could have gone better in HIV response Dr Praphan Phanuphak reflects and shares that although "Test and Treat" and PrEP was rolled out by Thailand but it has not been implemented to its full scale. To some extent, it lacks a sense of urgency, and frequent changes of policy makers also impacted the rollout. Flashback to 1980s: When first HIV cases were diagnosed in Thailand by Dr Praphan Phanuphak "I was accidentally involved in HIV/AIDS arena. I am not an infectious disease doctor, but an allergist and clinical immunologist trained in USA. The first patient, an American gay man living in Thailand, was referred to me at King Chulalongkorn Hospital in October 1984 to investigate the cause of his recurrent muco-cutaneous infection. Immunologic investigations revealed that his T-helper cell numbers and T-cell functions were moderately low, but no diagnosis was made. In February 1985 the patient was admitted into the hospital with confirmed diagnosis of Pneumocystis carinii pneumonia (PCP) and his T-cell numbers and functions were further deteriorated. With the diagnosis of PCP and severe T-cell defect, AIDS was diagnosed at that time," shared Dr Praphan Phanuphak. He added: "During the same month, a Thai male sex worker was referred to Chulalongkorn Hospital because of multi-organ cryptococcal infection. His T-cell numbers and T-cell functions were also severely impaired. AIDS was diagnosed in this second patient since he had sexual contact with a foreign man who had sex with men. The girlfriend of this patient was asymptomatic but had generalised lymphadenopathy, Her T-cell numbers and functions were moderately impaired. This patient was counted as the third case. Sera collected from these 3 patients were tested for HIV in May 1985 when the anti-HIV test kit was available in Thailand. All were HIV-positive. These are the first 3 HIV/AIDS cases diagnosed in Thailand, all in February 1985. With the availability of anti-HIV test in Thailand, more and more patients were diagnosed. This accidentally drove me deeper and deeper into the HIV field, coupled with the fact that there were not very many infectious disease doctors in the early days who were willing to see HIV patients." Dr Phanuphak's lifetime contribution and continuing guidance to shaping HIV responses in Thailand and worldwide is commendable. We hope community-led responses would steer the global AIDS response towards getting on track to end AIDS by 2030. 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)
NZ Herald
2 days ago
- NZ Herald
Gilead's twice-a-year HIV prevention shot wins regulatory approval in US
Gilead Sciences Inc said it won United States approval from Food and Drug Administration regulators for a drug to prevent HIV that only has to be given twice a year. That makes it a convenient new way to ward off infection in a wide range of people. In two
