In Nigeria, the intersection between sexual violence and cervical cancer remains one of the most critical yet under-discussed public health challenges facing women and girls. For Dr Oluwatosin Babalola, a Sexual Assault Referral Centre (SARC) doctor and infectious disease expert at the Women at Risk International Foundation (WARIF), this understanding drives her work.
With over ten years of experience tracking infectious diseases including HIV, tuberculosis, and HPV-related cervical cancer, coupled with nearly four years as a sexual assault forensic examiner, Dr Oluwatosin understands intimately how human papillomavirus (HPV) spreads through vulnerable populations and why prevention must begin long before exposure occurs.
As BellaNaija’s #StopHPVForHer campaign works to raise national awareness about cervical cancer prevention, Dr Oluwatosin’s insights reveal the urgent need to connect the dots between sexual assault, HPV infection, and long-term cancer risk. For survivors of sexual violence, the trauma extends far beyond the immediate physical and psychological harm: non-consensual sexual contact dramatically increases exposure to HPV, whilst the fear and stigma that follow often prevent timely medical intervention. Meanwhile, harmful practices such as female genital mutilation and early coerced sexual activity further compound these risks, creating conditions where HPV infections can progress undetected in communities with limited access to screening and healthcare.
In this interview, Dr Oluwatosin demystifies the science behind HPV transmission, explains why vaccination between ages 9 and 14 serves as a powerful shield against future health risks, and outlines the critical gaps in Nigeria’s approach to linking sexual violence prevention with cervical cancer care.
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Dr. Oluwatosin, your work spans infectious diseases and supporting survivors at WARIF. For parents, what is the single most important message you can give about the HPV vaccine being a powerful, proactive shield against a future health risk, regardless of a girl’s social environment?
Regardless of a girl’s background or social environment, the HPV vaccine offers a vital opportunity for a life free from cervical cancer and other HPV-related diseases. It represents not only a preventive health measure but also an empowering choice — one that safeguards a girl’s future and well-being. The HPV vaccine protects against multiple forms of cancer, including those of the cervix, vagina, vulva, and throat, all of which can be caused by the human papillomavirus (HPV). By receiving the vaccine before exposure to the virus, every girl is given the chance to live a healthier life, one filled with hope, opportunity, and protection, irrespective of her background.
As a SARC doctor, you understand that some girls face risks beyond their control. Why is the HPV vaccine, which is ideally given between 9 and 14, considered an essential piece of proactive social protection for our daughters’ long-term health in the face of various societal risks?
The 9–14-year age group represents a critical developmental stage in a child’s life — a period marked by growing self-awareness, curiosity, and increasing independence. At this stage, children begin to make decisions and take risks, often without a full understanding of the long-term consequences of their actions.
Ensuring access to the HPV vaccine during this formative period is therefore essential. This age range coincides with puberty, a time when young people are highly impressionable and influenced by peers and social media. Providing the HPV vaccine at this stage not only reduces the risk of future HPV-related cancers and infections but also empowers each child with the opportunity for a healthier and more secure future, free from preventable diseases.
What is the connection between sexual assault and HPV infection in Nigeria, and why do survivors of sexual abuse face a higher cervical cancer risk?
Sub-Saharan African countries, including Nigeria, bear one of the highest burdens of Human Papillomavirus (HPV) infection globally.
The epidemiological link between sexual assault and HPV infection in Nigeria is well established. Early exposure to sexual activity significantly increases the risk of contracting HPV. Survivors of sexual assault are at heightened risk due to the non-consensual nature of the act, which typically involves the absence of protective measures and potential genital contact with perpetrators whose HPV status is unknown. Furthermore, physical trauma to the genital and surrounding tissues during sexual violence may increase susceptibility to infection.
Compounding these risks are the psychological and social consequences of sexual violence, including stigma, fear, and post-traumatic stress, which often discourage survivors from seeking timely medical care. This delay can result in reduced uptake of STI and cervical cancer screening, leading to late detection of HPV infection and associated complications.
Working at WARIF as a sexual assault forensic examiner, you’re at the frontline of survivor care. From an infectious disease perspective, why is HPV vaccination and cervical cancer screening so critical in the immediate and extended aftermath of sexual assault, and how should this be integrated into survivor protocols?
At WARIF, we have established a standard operating procedure (SOP) for attending to survivors of sexual assault and abuse. This protocol includes sexually transmitted infection (STI) screening and cervical cancer risk assessment for every client who receives care at our facility.
HPV vaccination and cervical cancer screening are critical components of post–sexual assault care, underscoring the importance of early presentation. Early medical evaluation enables timely detection, intervention, and follow-up — all of which significantly improve health outcomes.
Comprehensive post–sexual abuse care protocols should encompass:
- Screening and treatment for STIs
- Education on cervical cancer screening and sexual risk behaviours associated with HPV
- Establishing a follow-up schedule for screening, including reminders to prevent missed opportunities
To ensure consistency and visibility, these protocols should be clearly documented, printed, and displayed within the clinic environment for easy reference by all healthcare providers.
In your research on comorbid diseases, what have you observed about the compound health risks when survivors of sexual assault are also exposed to HIV-positive perpetrators, and how does this change prevention and monitoring strategies?
HIV infection significantly compromises the immune system, reducing an individual’s ability to fight infections. Among those already immunocompromised, such as people living with HIV, HPV infection is more likely to progress to cancerous lesions, including cervical and other HPV-related cancers.
The traumatic nature of sexual assault further heightens this vulnerability. Survivors are at increased risk of both HIV and HPV infection due to unprotected, non-consensual sexual exposure — often involving perpetrators whose infection status is unknown.
Prevention and monitoring strategies should therefore prioritise:
- Increased awareness of HPV infection and its link to HIV and sexual assault
- Encouragement of early presentation following incidents of sexual assault
- Routine HPV and cervical cancer screening, particularly for high-risk individuals
- Comprehensive post–sexual assault care packages, including:
- Repeated HIV counselling and testing
- Post-exposure prophylaxis (PEP) for HIV prevention
- Emergency contraception
- STI screening and treatment
- Psychological support and counselling
An integrated, survivor-centred approach that combines prevention, early detection, and ongoing care is essential in mitigating the long-term health impacts of both HIV and HPV infections among survivors of sexual assault.
The trauma of sexual assault often triggers significant lifestyle changes in survivors. As both a medical professional and someone working directly with survivors, how do you balance acknowledging this reality without stigmatising survivors, and what role does HPV education play in their recovery?
The standard of care following sexual assault must include comprehensive psychological support and counselling, which are critical components of the healing and recovery process. Psychological care aids emotional recovery and helps assess the nature and extent of the violence experienced.
As part of holistic post-assault management, lifestyle changes are evaluated and monitored, with appropriate therapy and follow-up provided. Survivors should also receive continuous education on the association between HPV infection and risky sexual behaviours, empowering them to make informed health decisions.
Encouraging self-referral for HPV testing is essential. Healthcare providers should guide survivors through repeated, well-paced education sessions in a supportive and non-threatening environment. This approach reduces fear and stigma while building confidence to manage their health beyond the clinic.
Finally, HPV education must be integrated into routine post–sexual assault care and community outreach programmes to enhance public understanding, reduce stigma, and strengthen prevention efforts.
You’ve noted that practices like female genital mutilation and domestic violence are linked to cervical cancer risk. From your infectious disease perspective, why do these practices heighten HPV risk, and why is this connection still poorly understood in Nigeria?
Human Papillomavirus (HPV) infection is primarily transmitted through sexual contact; however, repeated trauma to the genital area can also facilitate transmission. Female Genital Mutilation (FGM) involves the partial or total removal or stitching of the external female genitalia, creating physical conditions that increase susceptibility to HPV infection. The resulting scarring and poor lubrication of the genital tissue make it more prone to micro tears during sexual contact, heightening HPV transmission risk.
Studies show that individuals who have undergone FGM are more likely to experience early or coerced sexual activity, often under non-consensual circumstances, further increasing HPV exposure. FGM is also linked to immune system compromise due to trauma and post-procedure complications, which may elevate infection risk.
The practice is most prevalent in areas with limited access to healthcare, where Pap smears and HPV screening are not routinely available, leading to undetected and untreated infections. Since FGM is often performed on young girls later exposed to early marriage or forced sexual activity, their vulnerability is compounded — underscoring the need for targeted HPV education, prevention, and vaccination programmes in affected communities.
For survivors of sexual assault who may have already been exposed to HPV, is the HPV vaccine still effective?
The HPV vaccine remains beneficial even for individuals with prior exposure to the Human Papillomavirus (HPV). This is because there are multiple strains of the virus, and the vaccine protects against several of them. While the HPV vaccine does not serve as a treatment or cure for an existing infection, it effectively prevents new infections caused by other HPV strains that the individual may not have previously encountered.
The optimal time for vaccination is before the onset of sexual activity, which is why early vaccination among school-aged children (9–14 years) is strongly recommended. However, the vaccine can still be administered after the first sexual experience and remains beneficial at any age.
Importantly, survivors of sexual violence or abuse represent a key population that should be prioritised for HPV vaccination, regardless of prior sexual exposure. Providing vaccination to this group not only reduces their risk of future HPV infections but also contributes to long-term protection against HPV-related diseases, including cervical and other reproductive cancers.
Given your expertise in infectious disease research and your frontline work at a sexual assault referral centre, what critical gaps do you see in Nigeria’s current approach to linking sexual violence prevention with cervical cancer prevention, and what should policymakers prioritise?
This is an important task, to cover gaps which has existed in this aspect of our healthcare sector. These gaps include:
- Poor cervical screening and uptake of services
- Limited number of SARC in Nigerian cities
- Poor community and cultural integration in cervical cancer screening intervention
- Limited access to care for survivors of sexual assault
- Poor health facility integration of services – i.e., integrating cervical cancer screening in routine clinic assessment, need for more data/studies detailing the link between sexual assault and HPV infection, including cervical cancer.
Strategies to help with gaps:
- Involving communities and providing culturally acceptable intervention modalities will enhance uptake of HPV immunisation and prevent missed opportunities.
- Forensic and sexual assault centres should be equipped to include HPV vaccination (for eligible clients) and follow-up cervical cancer screening for survivors. Staff should be trained and retrained. Screening and vaccine costs should be reduced for affordability.
- Policies should advocate for increased vaccination and reduced risky sexual behaviour. Collaboration between health and women’s ministries is essential to integrate vaccination into SARCs, community testing, and vaccination.
- Provision of care packages to young people through routine community engagement and sponsored healthcare services for cervical cancer screening is also key. It’s an all-inclusive approach involving both male and female, not just a feminine issue.
Now that BellaNaija has launched #StopHPVForHer to raise national awareness about cervical cancer prevention, what is the most critical message you want Nigerian women, survivors, parents, and communities to understand about the links between sexual violence, HPV, and cervical cancer?
Sexual violence serves as a harbinger of numerous health challenges whose consequences extend far beyond emotional, physical, and financial harm. It can lead to serious and long-term medical conditions, including an increased risk of infections and diseases such as cervical cancer.
It is therefore essential that individuals and communities speak up against sexual violence, challenge the culture of silence, and eliminate stigma surrounding survivors. Early action is equally critical—seeking immediate medical attention at accredited health facilities following an incident of sexual assault enables timely screening, preventive treatment, and access to comprehensive care.
Together, awareness, advocacy, and access to care can reduce the devastating impact of sexual violence and help survivors reclaim their health, dignity, and well-being
