This review systematically examined the effectiveness of 24 mass media interventions on changing human immunodeficiency virus (HIV)-related knowledge, attitudes and behaviors. The intervention studies were published from 1990 through 2004, reported data from developing countries and compared outcomes using (i) pre- and post-intervention data, (ii) treatment versus control (comparison) groups or (iii) post-intervention data across levels of exposure. The most frequently reported outcomes were condom use (17 studies) and knowledge of modes of HIV transmission (15), followed by reduction in high-risk sexual behavior (eight), perceived risk of contracting HIV/acquired immunodeficiency syndrome (AIDS) (six), interpersonal communication about AIDS or condom use (six), self-efficacy to negotiate condom use (four) and abstaining from sexual relations (three). The results yielded mixed results, and where statistically significant, the effect size was small to moderate (in some cases as low as 1-2% point increase). On two of the seven outcomes, at least half of the studies did show a positive impact of the mass media: knowledge of HIV transmission and reduction in high-risk sexual behavior. Further rigorous evaluation on comprehensive programs is required to provide a more definitive answer to the question of media effects on HIV/AIDS-related behavior in developing countries.

The potential for human papillomavirus (HPV) DNA testing in cervical cancer prevention programs has been a topic at the forefront of cervical cancer policy discussions in recent years. To prevent some of the anxiety and psychological distress often experienced on HPV diagnosis and during the period of management, mass patient education must accompany the incorporation of HPV DNA testing into screening protocols. To contribute to a growing body of work that provides an empiric basis for development of effective counseling messages about HPV and HPV testing, this paper highlights women's most common information gaps and psychosocial concerns and describes the different perspectives offered by women's usual sources of information about HPV, including the crucial role of the clinical community in creating a shared decision making environment in which screening decisions and results can be discussed. (CA Cancer J Clin 2004;54:248 -259.) © American Cancer Society, Inc., 2004. Research in the last decade has conclusively demonstrated that sexually-transmitted infection with carcinogenic types of HPV, often referred to as high-risk types of HPV, is required for the subsequent development of virtually all cervical cancers.1 However, HPV infections are extremely common in sexually active women and the vast majority will spontaneously resolve or cause only transient minor lesions. HPV DNA testing is now included in cervical cancer screening guidelines as an adjunct to cytological screening.2,3 Mass patient education must accompany the incorporation of HPV DNA testing into screening protocols to prevent the anxiety and psychological distress often experienced on HPV diagnosis and during the period of management. To contribute to a growing body of work that provides an empiric basis for development of effective counseling messages about HPV and HPV testing, this paper will highlight women's most common information gaps and psychosocial concerns and describe the crucial role of the clinical community in creating a shared decision making environment in which screening decisions and results can be discussed. EPIDEMIOLOGY AND PATHOGENESISHPV is associated with nearly all cases of preinvasive and invasive cervical neoplasia.1 Eighty HPV types have been sequenced, although more than 200 types likely exist based on data from partially sequenced DNA fragments. 4 Approximately 30 specific HPV types infect the male and female genital tract and two-thirds of these are classified as high risk because of their etiological association with cervical cancer. In most countries, HPV-16 accounts for more than 50% to 60% of cervical cancer cases followed by HPV-18 (10%-12%) and HPVs 31 and 45 (4%-5% each).5 HPV types associated with genital warts, such as HPV-6, and HPV-11, are referred to as low risk because they are rarely associated with malignant disease. Ms. Anhang is Research Associate,

Although most of the predominantly Hispanic, low-income, uninsured, and recently screened women in the study preferred clinician-collected HPV tests to self-collected sampling, self-sampling is acceptable to the majority and may increase the likelihood of participation in cervical cancer screening programs.

BACKGROUND As human papillomavirus (HPV) DNA testing is incorporated into cervical carcinoma screening programs, educational messages must be developed to inform women's screening choices and manage psychosocial responses to HPV DNA test results. However, little is known about women's questions and concerns about HPV or their attitudes toward HPV testing. METHODS Eight focus groups with 48 ethnically diverse, low‐income women were conducted at community centers, family planning and primary care clinics, and substance abuse rehabilitation facilities in Massachusetts. RESULTS The participants' comments and questions about HPV revealed five major themes. First, most women overestimated the likelihood that women with HPV would develop cancer. Second, women struggled to balance the anxiety of knowing that HPV infection causes cervical carcinoma with the information that HPV infection often regresses without treatment. Third, many women were confused that Papanicolaou smear results could be normal when HPV infection is present. Fourth, women preferred to receive a personalized risk profile to assess their own likelihood of contracting HPV infection and cervical carcinoma. Fifth, younger women focused on the sexual transmission of HPV infection, rather than on its potential to cause cancer. CONCLUSIONS Effective HPV education must include information about transmission, prevention, treatment, and cervical carcinoma risk; tailor messages to describe HPV susceptibility according to age and risk profile; present clarification regarding HPV strains and their consequences; offer explanations of different types of tests and their results; and provide a balance between accurate discussion of cancer risk and reassurance that following recommended screening practices will reduce risk to negligible levels. Cancer 2004;100:315–20. © 2003 American Cancer Society.

BACKGROUND Now that human papillomavirus (HPV) DNA testing is being incorporated into cervical cancer screening programs, salient and accurate media information about HPV will be crucial to inform women's screening choices and to manage psychosocial responses to HPV DNA test results. METHODS The authors conducted a content analysis of 111 news stories about HPV from the 10 most circulated newspapers and from 3 major television networks for the period from January 1995 through July 2002. Stories were assessed for predominant theme (STD, cancer, or new tests); information about symptoms, transmission, prevention, and cancer‐causing properties of HPV; screening test descriptions; and recommended screening guidelines. RESULTS Thirty‐six percent of stories primarily were about new tests for HPV or cervical cancer, 30% of stories focused on cervical cancer or its link to HPV, and 27% of stories emphasized sexually transmitted diseases (STDs) or genital warts. Seventy‐nine percent of stories mentioned that HPV is an STD, and 50% of stories reported that HPV is very common. Twenty‐six percent of stories reported that most women with HPV will not develop cervical carcinoma. Of 81 stories that mentioned a screening test for HPV or cervical carcinoma, 38% reported the sensitivity of the test; 30% mentioned wrong, uncertain, or unnecessary test results; and 25% mentioned consequences of such results. CONCLUSIONS Media coverage of HPV could better fulfill women's educational needs by including information about low‐risk and high‐risk types of HPV and their differing links to cervical cancer; describing HPV prevention, transmission, and symptoms; explaining the benefits and consequences of HPV testing; and outlining the latest screening guidelines in every story. Cancer 2004;100:308–14. © 2003 American Cancer Society.