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In 2011, both the National Prevention Strategy and Healthy People 2020 recognized "reproductive and sexual health" as a key area for improving the lives of Americans.1,2 This increasing national emphasis on sexual health provides an important opportunity to refocus the efforts of U.S. health-care professionals. While reproductive health has historically been considered a U.S. public health priority, 3 the addition of sexual health to the short list of national priorities has important implications for clinicians and patients. Broadly embracing the concept of sexual health in health-care settings has the potential to reduce redundancy in care compared with current, more categorical approaches and to minimize the stigma associated with some aspects of sexuality and related adverse outcomes. These changes could increase both clinical efficiency and the proportion of the population receiving sexual health services.To foster sexual health, the National Prevention Strategy and Healthy People 2020 recommend increasing access to sexual health services, emphasizing sexual health education and encouraging screening for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV).1,2 To be most effective, these activities should involve both health-care providers (physicians, nurses, and related clinical providers) and patient audiences. Although this new national emphasis represents an opportunity to improve sexual health throughout the country, it also represents a challenge for the health-care community. The approach to patient care in matters of sexuality and sexual behavior will need to be reframed in subtle but critical ways. To meet this challenge, educational efforts for both health-care providers and patients will need to shift to support a more comprehensive approach to understanding and promoting sexual health throughout the life span.

BackgroundCervical cancer claims the lives of 275,000 women each year; most of these deaths occur in low-or middle-income countries. In Kenya, cervical cancer is the leading cause of cancer-related mortality among women of reproductive age. Kenya’s Ministry of Public Health and Sanitation has developed a comprehensive strategy to prevent cervical cancer, which includes plans for vaccinating preteen girls against human papillomavirus (HPV) by 2015. To identify HPV vaccine communication and mobilization needs, this research sought to understand HPV vaccine-related perceptions and concerns of male and female caregivers and community leaders in four rural communities of western Kenya.MethodsWe conducted five focus groups with caregivers (n = 56) and 12 key-informant interviews with opinion leaders to explore cervical cancer-related knowledge, attitudes and beliefs, as well as acceptability of HPV vaccination for 9–12 year-old girls. Four researchers independently reviewed the data and developed codes based on questions in interview guides and topics that emerged organically, before comparing and reconciling results through a group consensus process.ResultsCervical cancer was not commonly recognized, though it was understood generally in terms of its symptoms. By association with cancer and genital/reproductive organs, cervical cancer was feared and stigmatized. Overall acceptability of a vaccine that prevents cervical cancer was high, so long as it was endorsed by trusted agencies and communities were sensitized first. Some concerns emerged related to vaccine safety (e.g., impact on fertility), program intent, and health equity.ConclusionFor successful vaccine introduction in Kenya, there is a need for communication and mobilization efforts to raise cervical cancer awareness; prompt demand for vaccination; address health equity concerns and stigma; and minimize potential resistance. Visible endorsement by government leaders and community influencers can provide reassurance of the vaccine’s safety, efficacy and benefits for girls and communities. Involvement of community leadership, parents and champions may also be critical for combatting stigma and making cervical cancer relevant to Kenyan communities. These findings underscore the need for adequate planning and resources for information, education and communication prior to vaccine introduction. Specific recommendations for communication and social-marketing strategies are made.