CERVICAL CANCER AND PAP SMEAR SCREENING IN HIV-POSITIVE WOMEN: AWARENESS, PERCEIVED RISK, AND PRACTICES

By  Idah Mokhele  Dr. Denise Evans  Schnippel K,  Swarts A  Smith JS  Firnhaber C  |  | 

Among women, cervical cancer is the second most common cancer globally, with more than half a million new cases and a quarter million deaths from the disease annually [1]. The association between HIV and invasive cervical cancer (ICC) is complex, with several studies demonstrating an increased risk of pre invasive cervical lesions among HIV-positive women [2,3]. Previous studies have found significantly higher prevalence of human papillomavirus (HPV) infection and of high-risk HPV types in HIV positive women than in HIV negative women, with HIV positive women more likely to have high-grade cervical disease [3]. Because of the increased risk of acquiring HPV among women who are HIV-positive, after 2010 South Africa’s national HIV treatment guidelines included specific guidance for cervical cancer screening [4]. Most studies of cervical cancer and HIV in southern Africa focus on clinical aspects of both diseases, as opposed to behavioral issues such as women’s cervical cancer screening practices. For this reason we set out to examine awareness, perceived risk, and practices related to cervical cancer screening among HIV-positive women in an urban HIV clinic in Johannesburg, SA. In April 2005, the non-governmental organisation Right to Care, in partnership with the South African government, established a cervical cancer screening and treatment centre alongside the HIV care, management, and treatment facility at Themba Lethu Clinic, situated in a tertiary hospital in Johannesburg. At this site, the Validation of Implementation of Cervical Cancer Screening Applications in HIV-Seropositive Women Study (VICAR 1) was conducted in 2009-2011 to compare three methods for detecting cervical cancer  standard Pap smear, visual inspection with acetic acid, and HPV detection. VICAR 1’s main goal was to estimate sensitivity, specificity, and predictive values for each method [5]. VICAR 1 participants, however, also answered an interviewer-administered, structured questionnaire containing coded questions about their medical, social, and sexual history. We used these questionnaire data to analyze women’s awareness, perceived risk, and practices concerning cervical cancer and cervical cancer screening.

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