Vol.5, No.11, 1829-1834 (2013) Health
http://dx.doi.org/10.4236/health.2013.511246
Description of socioeconomic and demographic
profile of young women vulnerable to infection
by human papillomavirus and risk behavior
in a school in Rio de Janeiro
Maria Cristina de Melo Pessanha Carvalho1,2*, Ana Beatriz Azevedo Queiroz3,
Maria Aparecida Vasconcelos Moura3
1Researcher Center Women’s Health, School of Nursing Anna Nery, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil;
*Corresponding Author: [e-mail]
2Federal Hospital Ipanema, Rio de Janeiro, Brasil
3Department of Maternal-Child Nursing, Researcher Center Women’s Health, School of Nursing Anna Nery, Federal University of
Rio de Janeiro, Rio de Janeiro, Brasil
Received 24 August 2013; revised 25 September 2013; accepted 8 October 2013
Copyright © 2013 Maria Cristina de Melo Pessanha Carvalho et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
work is properly cited.
ABSTRACT
Background: HPV is one of the main sexually
transmitted diseases, especially among the fe-
male population. This is an important etiologic
agent for the development of cervical intraepi-
thelial lesions and cervical cancer. It is consid-
ered a public health problem, since young wo-
men are the most vulnerable group to this virus.
Therefore, it is import ant that the socioeconomic
and demographic profile of these women and
their risk behaviors are known, so that it is pos-
sible to contribute in reducing infection occur-
rences in the studied population. Objectives: To
describe the socioeconomic and demographic
characteristics and investigate the behavioral
sexual-affective aspects of risk of adolescents
and young students from Rio de Janeiro/Brazil
when tackling HPV infection. Methods: A group
composed by 128 individuals susceptible to
HPV—clas sified a s adolescent women a nd young
women who are students at a high school in one
unity of the municipality of Rio de Janeiro. The
studied period was from May to November. A
quantitative descriptive approach was used, in
which data were highlighted in variables, divi-
ded into economic, demographic and behaviora l
characteristics. Data were entered into an Excel
spreadsheet and organized by descriptive sta-
tistics performed by simple frequency (%). Re-
sults: The age range of the young women who
have the possibility of being infected with HPV
was from 15 to 25. The focused family income
among these young women was up to 2 mini-
mum wages. The risk behavior detec ted in 37.5%
of adolescent women and in 43.8% of young
women is that these women never used con-
doms in sexual intercourse. Conclusion: The re-
search showed that the studied women are vul-
nerable due to risk behavior practices that may
lead to the virus acquisition. More focuses on
educational actions of preventive measures re-
garding HPV infection should be emphasized,
favoring a lower incidence of human papillo-
mavirus infection and cervical cancer.
Keywords: Women’s Health; HPV; Risk-Takin g
1. INTRODUCTION
Human papillomavirus (HPV) is a virus that infects
the epithelial cells of the skin and mucosa, being one of
the most common sexually transmitted diseases in the
female population. This infection occurs preferentially in
the genital organs, as the vulva, vagina, uterine cervix,
penis and perianal areas and oropharynx. Thanks to the
molecular biology techniques, the association between
HPV and cancer has been increasingly investigated.
There are over 100 viral types and subtypes, and some of
these viruses may cause lesions, which, if not treated,
may evolve to cancer [1]. HPV is grouped in viral sub-

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1830
types of low-risk (6, 11, 42, 43 and 44) and high-risk (16,
18, 31, 33, 34, 35, 39, 45, 46, 51, 52, 56, 58, 59, 66, 68,
70), thereby establishing the relationship between per-
sistent infection by HPV with some viral types and cer-
vical cancer. Thus, in 95% of cases, HPV is associated to
cervical cancer [2]. The highest prevalence of this infec-
tion is among adolescent and young women, from 15 to
25, which causes this group to be considered as the one
of higher vulnerability to HPV [3]. Early initiation of
sexual activity and multiple partners are some behav ioral
factors that lead this population segment to a greater su-
sceptibility [3]. Adding to that, there are the environ-
mental and individual factors, which, together with HPV
virus, modulate the risk of transition from infection to
malignancies, including genetic susceptibility, immune
and nutritional condition, tobacco use, multiparity, infec-
tions by other sexually transmitted agents—such as HIV,
chlamydia trachomatis and herpes type 2 [4].
However, studies have reported that there are still b ar-
riers that prevent young people to adopt effective pre-
ventive measures against this infection, since big chal-
lenges are found in the difficulty of the adolescent to
understand himself as vulnerable and make decisions and
act in order to face this infection and other sexually
transmitted diseases [5]. In this scenario, it is necessary
to know the characteristics of this populational group,
indicating their behaviors and attitudes that make them
vulnerable to the infection [6]. Studies on this topic be-
come relevant when building strategies of assistance that
may reduce the chain of transmission of HPV and con-
sequently morbimortality through precursor lesions and
cervical cancer. From these arguments, this study aims to
describe the socioeconomic demographical characteris-
tics and to investigate the behavioral sexual-affective
aspects of risk in adolescents and young students from
Rio de Janeiro/Brazil against HPV infection.
2. METHODS
This is a descriptive study with quantitative analysis,
held in a high school (public school) of the municipality
of Rio de Janeiro. Such study had, as participants, 128
young women enrolled in the referred school, aged be-
tween 15 and 25 years. The sample was divided in two
groups: adolescent women (AW) and young women
(YW). The first group was composed by adolescent wo-
men in the age group from 15 from 19 and the second
group by young women from 20 to 25. This division was
partially grounded in the chronological limits of adoles-
cence, as defined by World Health Organization (WHO),
which are from 10 to 19. For young people, this limits
are from 20 to 24, which division is used mainly for sta-
tistical and political purposes. As inclusion criteria, this
study had adolescents and young people who were not
infected by HPV, and had as exclusion criteria ages be-
low 15 and above 25. To collect data, we used a form
with the purpose of tracing the socioeconomic and de-
mographic profile of the sample and raising the sex-
ualaffective behaviors that may lead these young women
to contract HPV. The data was divided in two blocks of
variables: identification data in which were highlighted
variables such as age, ethnicity, education, marital status,
family inc ome; the second block dealt with the ch aracter-
istics related to risk behavior variables: beginning of
sexual activity, number of partners in the last year, con-
dom use and type of sexual activity. The sampling was
determined by non-probability sampling technique by
convenience, after the confirmation that the studied ones
did not have HPV. At school the students were subjected
to individual interviews between the months of May and
November of 2012, to respond to the form in private lo-
cal to ensure the privacy of the individuals. Data was
entered into an Excel spreadsheet and organized by de-
scriptive statistics performed by simple frequency (%),
and were subsequently inserted in tables for easy visu-
alization of the results. The analysis was performed by
percent calculation and organization by variables of each
group. The study was submitted to the Comitê de Ética
da Escola de Enfermagem Anna Nery (Ethics Commit-
tee of Anna Nery Nursing School)/Hospital-Escola São
Francisco de Assis (Teaching Hospital São Francisco de
Assis)/Universidade Federal do Rio de Janeiro (Federal
University of Rio de Janeiro), being approved by record
number 030/2011. The recommendations of Resolution
number 196/96 of the Conselho Nacional de Saúde (Na-
tional Health Council) Brazilian document that com-
prises standards and rules for the development of human
research. Also, as recommended, the data was collected
only after signing the Free and Clarified Consent Form
and the Assent Form, signed by the responsible for stu-
dents under 18.
3. RESULTS
The study included 128 subjects: 64 adolescent women
and 64 young women. The age between 20 and 22 was
most representative among both gr oups. The white group
predominated among women vulnerable to HPV, repre-
sented by 53% of adolescent women. As for education
level, only 25.1% of adolescent women and 18.6% of
young women remained in high school, with a reduc-
tion in the number of women enrolled in the last year. In
terms of marital status, there was a significant number of
bachelor adolescent women with partner, represented by
56.25%—being him a boyfriend or a casual partner.
However, 46.8% of young women are married , and often
it is not an officially legal marriage, but guided by the
choice of living in a consensual union with the partner.
In contrast, 53.1% of respondents said they did not have
a partner at the time of the interview. In this study, the

M. C. de Melo Pessanha Carvalho et al. / Health 5 (2013) 1829-1834 1831
variable family income predominated among adolescent
women between 3 and 4 minimum wages. This fact was
different among young women with 43.7% of them with
fami liar income up to 2 minimu m wages. As for charac-
teristics related to sexual-affective behavior, Table 1
shows that 31.25% of adolescent women and 37.5% of
young women had between 4 and 5 partners in the last
year. On the issue of condo m use, only 15.6% of adoles-
cent women and 9.3% of young women assert they al-
ways use a condom during sexual intercourse. The type
of sexual intercourse preferred by adolescent women
was vaginal sex and oral/vaginal sex was preferred by
31.25% of young women. In the variable beginning of
sexual activity, it was observed that the age group be-
tween 14 and 17 was predominant in both groups—
43.7% in the adolescent women and 37.5% in the young
women.
Ta bl e 1. Risk behavioral characteristics in young women vul-
nerable to infection by human papillomavirus.
Variable AW YW
n % n%
Number of partners (last year)
0 - 1 partner 24 37.8 1015.6
2 - 3 partner 12 18.7 1625.1
4 - 5 partner 20 31.2 2437.5
Above 5 partners 08 12.2 1421.8
Condom usage
Only in the first relation 16 25.1 1218.7
Always 10 15.6 069.30
Sometimes 14 21.8 1828.2
Never 24 37.5 2443.8
Type of performed sex
Vaginal sex 11 34.4 0618.7
Oral/vaginal sex 04 12.5 1031.2
Anal/vaginal sex 06 18.8 0515.6
Oral sex 03 9.30 026.25
Anal sex 08 25.0 0928.2
Início de vida sexual
9 - 13 years old 12 18.7 1015.6
14 - 17 years old 28 43.7 2437.5
18 - 21 years old 16 25.1 2031.3
22 - 25 years old 8 12.5 1015.6
AW: Adolescent women; YW: Young women.
4. DISCUSSION
Given the description of the young women attending a
school unit that have the possibility of being infected
with HPV, Table 2 illustrates a predominance of ages
between 17 and 22. There is a decline from 23 years old
and above. This age group is more prone to be infected
by the virus because studies show that one of the major
risk factors is age—and there is a prevalence among
young women up to 24 years old [7,8]. It is noteworthy
that this prevalence peak among these women is due to a
higher level of switching of partners and early sexual
initiation [9]. HPV infection affects young women at the
start of sexual activity, being a transient phenomenon—
for that, it declines spontaneously in most cases [10].
Table 2. Socioeconomic and demographic characteristics of
young women vulnerable to infection by human papillomavi-
rus.
Variables AW YW
n % n%
Age group
15 - 16 15 46.8
17 - 19 17 53.2
20 - 22 1959.4
23 - 24 1340.6
Ethnic group
Black 06 9.50 1218.7
Medium brown 24 37.5 3046.8
White 34 53.0 1828.2
Brazilian natives 0 0 046.25
Education level
High school (first year) 13 40.6 1443.7
High school (second year) 11 34.3 1237.5
High school (third year) 08 25.1 0618.8
Marital status
Single without partner 24 37.5 1015.6
Single with partner 36 56.2 2437.6
Married/consensual union 04 6.25 3046.8
Family income
Up to 2 MW 26 40.6 2843.7
Between 3 and 4 MW 32 50.0 2437.6
Above 5 MW 06 9.40 1218.7
AW : Adolescent Woman; YW: Young Wom an; MW: Minimum Wage.

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As for ethnicity, scarce literature mentions the asso-
ciation of ethnicity/color with a predisposition to HPV
infection. The present study indicates that white women
predominated among adolescents; between young wo-
men the medium brown had greater prominence, with a
total of 46%. That confir ms the study by Pereyra et al., in
which it is referred that more than half of the cases of
cervical cancer due to infection by HPV is co nstituted by
nonwhite women [11]. It was observed that the black
ethnicity was associated with the prevalence and inci-
dence of HPV carcinogenic infection, but it was not a
significant risk factor for infection [12]. However, an-
other study indicates that the increased risk of HPV in-
fection in black women is attributed not to genetics, but
to socioeconomic characteristic. [13].
In terms of educatio n level, the dropping-out of young
women before completing high school was emphasized.
Many of them stop attending high school. Many of these
young women are confronted with events in their lives
that prevent them from continuing their studies—for
example, inclusion in the labor market or early preg-
nancy. It is noticed that the studied individuals are vul-
nerable when there is a hindrance to improve the knowl-
edge of a cognitive mechanism when facing situations
that may favor the acquisition of sexually transmitted
diseases. Still the sub-information is also considered as
one of the main barriers to be overcome in the control of
sexually transmitted diseases, especially when it comes
to the human papillomavirus, because the lack of educa-
tion influences the risk p erceptio n ; and th e non-provid ing
of attitudes to prevent HPV suggests the association of
lower education with higher prevalence of HPV infection
[14,15].
With regard to the marital status of these young wo-
men, more than half of the adolescents are unmarried
with partne r, and on ly 6.25% are married or are living in
a consensual union. This fact illustrates that these women
may be vulnerable to HPV virus, independently of ap-
propriate sexual behavior or sexual risk behavior. Some
studies show that having a steady partner establishes a
condition of defenselessness to the virus since condom
use is discarded after the relationship becomes stable
[16]. This fact may occur by reason of trust or even by
submission to the partner when it comes to discussing the
continuity of usage of condom in sexu al intercourse [17].
Regarding family income of the analyzed vulnerable
to HPV women, it is clear that incomes are still low
among the subjects of study and that few women live
with incomes superi or to two MW. The results s how tha t
some adolescents have a higher income than the other
group by reason of living with their parents and/or family,
by whom they are still supported. However, in what re-
fers to non-adolescent women, many of them no longer
live with their families and are now inserted in the labor
market, being responsible for their own sustenance or
must support their families, and that interferes in the
learning process. It is assumed that this is a vulnerable
population when the low incomes lead to social ine-
qualities, hindering the access to necessary information
to prevent sexually transmitted diseases [18].
Several studies show that the number of partners
among women is a relevant factor because de multiplic-
ity of partners is a major risk factor for acquiring HPV
infection [13, 19]. As for the present study there is a vari-
ety of partners especially among young women. Thus,
the studied women with more than three partners are sub-
mitted to a vulnerable situation when there is a frequent
exchange of partners, allowing unsafe sexual behavior
and consequently a major chance of contracting sexually
transmitted diseases, especially when condom is not used.
The increased number of sexual partners during the life
of the studied women also favors different sexual prac-
tices that may lead to a greater possibility of HPV infec-
tion. Age difference between the couple may also in-
crease the risk [20]. However, other than literature indi-
cates, the survey also illustrated that 37.8% of adoles-
cents only had one partner in the last year. This fact may
lead to the absence of protective measures, as it involves
a long-term relationship and the adolescent stops using
condoms.
Data suggests that the number of women who do not
use condoms is still high, favoring a greater exposure to
the human papilloma virus, because 37.5% of adole-
scents and 43.8% of young women said they never used
condoms. This information is relevant when it is known
that these women are in a situation of vulnerability to
HPV, since they are exposed to beliefs, gender inequali-
ties and are passive to the partner, becoming dependent
on him to condom usage. The use of condoms among
women is a subject that is related to sexual-affective re-
lationship, because the type of relationship that young
people establish—of great affection or only casual sex—
is a contributing factor to the decision to use condom or
not [17].
There is a difficulty among the studied women to use
condom when they are faced with negotiating about con
dom usage with their partners, either for fear of losing
the partner or insecurity in the relationship. Thus, it is
clear that condom usage is linked to intimacy between
partners. Some reasons are associated with this behavior,
like: only having sex with a partner that the woman trusts,
disliking condom usage because it would diminish plea-
sure in intercourse or because the studied woman thinks
she will not have any disease [21].
The age group that prevailed in this research about
sexual initiation was between 14 and 17, a result that
agrees with the study by Martins et al., wherein from a
total of 8649 women, 74% reported that the first inter-

M. C. de Melo Pessanha Carvalho et al. / Health 5 (2013) 1829-1834 1833
course occurred between the ages of 14 and 20 [22]. This
is an important fact when the early onset of sexual ac-
tiveity is one of the factors for contracting HPV. This is
due to the fact that young cells are more receptive to in-
fection by human papillomavirus and to the fragility of
the uterine cervix in the initiation of sexual life [23,24].
Adding to that there is a relation between the early onset
of sexual activity and an increased risk of infection with
HPV due to the augmentation of time of exposure, lead-
ing to a larger risk of being infected with the virus [25].
In terms of sexual preferences among young women,
even predominating the choice for vaginal sex, there was
also a prominence for anal sex. The incidence of anal
cancer associated to HPV among women has shown an
increase of 40% in recent years [26]. This may be linked
to socio-cultural factors that may be decisive in the be-
havior of these women, since family, education level and
access to media and social networks are important
sources of information and influence the behavior of
these women, especially when it comes to sexual behave-
ior. Adding to that, there is the fact that the studied
women are vulnerable, since during intercourse there is
an exchange of sexual fluids, which directly relates to the
transmission of various microorganisms, such as HPV,
HIV and other STDs, depending on the performed sexual
practice [27]. As for oral sex—also mentioned by young
women—there is a significant evolution for squamous
cell carcinoma in the oropharynx area, basis of the
tongue and palatine tonsils, associated with HPV [28].
This condition can be worsened with modifiable risk
factors for cancer such as smoking and alcohol consump-
tion [29]. This situation determines the vulnerable cond i-
tion of these women, finding themselves in a situatio n of
defenselessness concerning the virus.
5. CONCLUSION
From the results, it was possible to identify that these
young woman students that have the possibility of being
infected with HPV are inserted into a profile of low so-
cioeconomic conditions, especially when these women
interrupt the cycle of learning, characterized by dropping
out of school, which interferes in the seizure of infor-
mation and in the understanding of the importance of
preventive meas ures. The results showed that high school
students are in a situation of vulnerability due to their
risk behaviors, primarily by low adherence to condom
usage, in addition to th e multip licity of partners. It can be
seen that according to the profile of the socioeconomic
and demographic level and also of some risk behaviors,
there are important factors that may lead to the acquisi-
tion of HPV. The development of goals for educational
actions to improve the awareness of young women po-
pulation—so they will have prevention attitudes and safe
sexual behaviors in sexual and affective relationships—
must be encouraged. Health professionals, specially nur-
ses, have an important role in reducing HPV infection,
with procedures that identify risks, emphasizing appro-
priate prevention conducts.
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