Factors influencing HIV and HPV risk and prevention among Tongan and Chamorro young adults in Southern California

Background: Recent research suggests that medically underserved and ethnic minority populations are at significant risk of the intersection of HIV/AIDS, HPV, and cancer. Little is known about the intersection of these public health issues in Pacific Islanders on the U.S. mainland. Purpose: As a first step to understanding this disease nexus, we examined HIV and HPV risk and prevention among Chamorro and Tongan young adults in Southern California. Methods: Within a Community Based Participatory Research (CBPR) framework, we acquired qualitative data using focus groups with male and female young adults and parents (n=72) and key informant interviews with medical, mental health, and social service providers; and community leaders from social, youth, and faith-based groups (n=24). Results: Five clusters of common factors impacted HIV/HPV risk and prevention among young adults in both communities: 1) religio-cultural taboos limit communication about sexual health between generations and from community leaders; 2) limited knowledge of HIV and, particularly, HPV engender misperceptions about transmission and prevention; 3) sexual abstinence, especially for young women, is promoted by parents and religious leaders, which might be decreasing risk; however, 4) the focus on abstinence leads to low levels of condom acceptance; and 5) collectivist notions of filial shame, associated with HIV/HPV testing and utilization of other sexual health services, constrains prevention. Discussion: Future interventions should be multigenerational, gender appropriate, and address cultural norms –especially those related to religion and the interplay between individualism and collectivism. Subsequent research to identify HIV/HPV links specifically to cancer in these communities is needed.