Latinas have the highest rate of cervical cancer among all women, according to CDC data. In the mainland U.S. and Hawaii, rates are about 32 percent higher than for non-Hispanic White women, and 78 percent higher in Puerto Rico.
Cervical cancer, caused by the human papillomavirus (HPV), is highly preventable through routine screening and vaccination.
Yet many Latinas still face barriers to accessing care.
To better understand these barriers in Iowa and how health workers are responding, PGN spoke with Zuli Garcia, founder and CEO of Knock and Drop Iowa. Garcia was diagnosed with precancerous HPV cells in 2023. She shared how that experience led her to rethink how health information reaches Latinos in Des Moines and beyond.
Here’s more of what Garcia had to say.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
PGN: How did Knock and Drop Iowa first start providing HPV outreach?
Zuli Garcia: Knock and Drop Iowa started as a culturally-specific Latino food pantry during the pandemic.
In 2023 I was diagnosed with cervical cancer cells of HPV, pre-cancer cells. And when I was diagnosed, it really took me into a bad moment of life, of not understanding why I was going through this. You know the frustration … when you hear the word cancer.
I decided that in my moments of darkness, I would turn around because I’m not one to just be crying.
I wanted to bring something to the community to [promote] awareness. Because I felt like I didn’t know anything. And I don’t have a language barrier. I had insurance. I, you know, had gone to the doctor so many times.
So what does the community that has these other barriers know?
I actually met a survivor who started giving me more information. I started going to training, and ever since, we partner with the local county health department and others to offer the information and make sure that women get checked and that they are asking the right questions, and they learn how to advocate for themselves.
PGN: What happened when you shared your story with the community for the first time?
Z.G.: I remember that they asked, well, “how many women or individuals do you think will attend?” And I was like, anywhere from 15 to 20 will be there.
And I remember my team called me and said, ‘You have no idea how many people showed up.’
I was like, ‘Oh my gosh. 10?’ They’re like, ‘Nope’. One hundred and twenty women showed up to this chat.
That was our first cervical cancer chat in Spanish and we had a line of 120 women wanting to come in and learn more and hear the story and why this was important.
We still maintain the same numbers. I mean, as much as we visited the same cities over and over, people are still coming to the chats because they hear it from others, from their friend, from their comadre, from their sister.
We hear them and then say, “Hey, Zuli’s here, and she’s got a lot of information. I think you might want to come hear her, because remember the issues that you’re dealing with. She might be able to help you.”
PGN: What’s been working in your approach in raising awareness about HPV and getting more people vaccinated?
Z.G.: What’s working is sharing the story of how, as a survivor, what I went through from the beginning to the end and what could have prevented this.
If there’s a doctor available, they come in, if there’s a health department available, they come in, they give their piece. But it really is, as a survivor, sharing what I went through from the beginning to the end, and if I would have received the vaccine, I wouldn’t have been going through this, right?
This vaccine is for boys and girls. Sometimes in our community and amongst our men, you know, they’re like, “I don’t need that. I don’t want to get vaccinated against that.” But I’m very blunt. I tell them, you know, HPV causes cancer including the penis. And I’m just very blunt with them, because I want them to know how they need to protect themselves and protect their loved ones, protect their wives, protect their partner.
PGN: What barriers are you still seeing? How do you and your team work to overcome them?
Z.G.: The challenge right now is funding for a lot of us, to be honest with you, but finding those strong allies that want to continue supporting you and join forces—like that small ethnic community-based organization. Sometimes those organizations may be smaller but they actually work much more one-on-one with people.
Another barrier is sometimes finding a local health department that wants to come out of their building to administer the vaccine on site. Some don’t want to come out. They’re not used to doing that.
Some are like, “Yes, I’ll do it. Because when you come, you bring the community we want to serve.”
Others are like, “Nope, they need to make an appointment. Nope, they need to come here.”
So what we do in those instances is, you know, we just help the community as much as we can. If there’s a county health department that doesn’t want to come in, then we ask them, okay, what’s the best way that we can make an appointment for them? How can we help this community member to make an appointment after they listen to my story to get vaccinated? And so that’s where we step in because as much as we’ve referred people to our local county health department, there’s times that there’s still a barrier of the language, right? Or they’re not getting their questions answered the way they should be answered. So we become that bridge to gap.
PGN: What does outreach look like in practice? What could other health workers take away from it?
Z.G: It is very important to find a local community leader that can connect you with the community, because no matter what you’re bringing, if you are not being recommended by someone locally, it’s going to be hard for people to come see you, right?
Vaccines have been available on spot with the local county health departments that want to partner with us. For all the grants that I write—and with the partners that reach out to me that want to write a grant with me—they know that they must add fresh produce just for you attending and getting the information, you get a bag of fresh produce.
Why? Because I believe that everybody’s time is valuable.
It’s always been bringing some type of stipend for the community, bringing either fresh produce or a gift card, or even if it’s a $10 gift card, and I think that’s something that I always did from the beginning.
Times are hard right now for everyone, and giving them a bag of fresh produce is something huge right now.