In May, the Government announced $53 million for an HPV self-testing screening programme to start in July 2023, following three previous attempts to get this funded.

Bev says this makes Aotearoa New Zealand the first country to provide HPV self testing as a universal offer—and it has the potential to reduce cervical cancers by 15 percent annually.

“Testing for HPV is 60–70 percent more effective at detecting pre-cancer and preventing cervical cancer than cervical smears,” she says.

Bev’s team’s research shows self testing is more acceptable for Māori women, who face inequities due to difficulty accessing services—an issue Conservation and Emergency Management Minister Kiri Allan highlighted following her cervical cancer diagnosis in May.

Māori are twice as likely to be diagnosed with cervical cancer than non-Māori and more than twice as likely to die.

“The current programme is not working for Māori, with 34 percent of Māori under-screened,” says Bev. “We say black or brown lives matter but we just expect Māori to die more. We normalise it.”

A 2016–2018 study with research fellow Anna Adcock (Ngāti Mutunga) explored the perspectives of more than 500 under- and never-screened Māori women. Many felt whakamā, in this context reticence or reservation about having a smear. Other barriers were cost, including transport or childcare, and time.

The self test was considered quick, easy, private, and empowering to do.

In a subsequent trial in Te Tai Tokerau Māori electorate in the Far North, 48 percent of under-screened Māori women and 43 percent of those never screened chose to take up the self test, compared with 10 percent and 13 percent respectively for those offered the smear.

Some women were treated for cervical changes—women who might not have been screened and may have gone on to have cancer, says Anna.

Considering 2021’s COVID-19 lockdowns resulted in backlogs of up to 20,000 smears, a low-contact, self-administered test is a useful tool in a pandemic world, says Bev. The United Kingdom is piloting a self-testing programme for that reason, and Victoria in Australia is also exploring a universal offer.

Bev was involved in HPV vaccine acceptability studies and its rollout more than a decade ago.

“The science has been incredible. First, we knew the virus was affecting the cells, then we knew that if you looked for the virus, it was far more effective than looking for changes in the cells. Then we could produce a vaccine against it. It was a simple logic step—looking for what caused it—that got us here.”

Demonstrating the need for the self test involved national and international collaboration and considerable grant money.

“We’ve also got to thank Minister Allan for bravely sharing her story—in one month, over 1,400 extra smear tests were done by Māori women.”

However, concerns remain about the Ministry of Health’s planned pathway following a positive HPV result.

“We’d prefer people go to diagnosis for strains 16 and 18 [those most strongly linked to cervical cancer] rather than another smear. And we need an interim solution. Two years is too long. Many people, not just Māori, find the smear intrusive. The longer the self test is not available, the more people will get cervical cancer unnecessarily.”

The Centre for Women’s Health Research is currently seeking to raise $10 million to establish a permanent research team and chair.

“There are a lot of disparities we still need to tackle,” says Bev.