Factors Associated with Cervical Cancer Screening among Human Immunodeficiency Virus (HIV)-Infected Women – United States, 2007-2008

Background: HIV-infected women are at increased risk for cervical cancer. HIV care guidelines recommend 2 Pap smears within 6 months following HIV diagnosis and yearly thereafter. We examined cervical cancer screening prevalence and associated factors. Methods: We used interview data from the Medical Monitoring Project (MMP), a cross-sectional study conducted in 19 states and Puerto Rico that collects clinical and behavioral data on HIV-infected adults in care. We used bivariate analysis and computed odds ratios (OR) and 95% confidence intervals (CI) using logistic regression for the association between demographic characteristics, sexually transmitted disease (STD) testing, counseling by health care providers, and receipt of a Pap test. Results: Among 1002 women, 552 (55%) were black, 224 (22%) Hispanic, and 168 (17%) were white; 910 (91%) knew if they received a Pap. The prevalence of Pap screening in the past year was 76% (694/910). Factors associated with Pap smear receipt were, in the past year, having been tested for STDs (OR=2.3, CI = 1.7-3.2), having had a pelvic exam at their usual HIV provider (OR=2.4 CI=1.7, 3.3) versus another provider, and having had discussions about safe sex at the health care facility during more frequent visits (OR=2.4, CI= 1.7-3.4). Conclusions: We found that 24% of HIV-infected women in care did not receive a Pap test as recommended by the current HIV treatment guidelines. HIV care providers should use patient encounters as an opportunity to talk with patients about gynecologic care and ensure that they receive screening per HIV treatment guidelines.