Knowledge, attitudes and beliefs about anal cancer screening among HIV-positive women

Background: Women with HIV are at increased risk for anal cancer; it is unknown whether women are amenable to screening. Goal: To assess knowledge, attitudes and beliefs regarding anal cancer and screening among an HIV-positive female population. Methods: English-speaking adult women presenting for HIV care at an urban safety-net hospital completed a survey using the Health Belief Model framework to measure knowledge, perceived susceptibility, perceived benefits and barriers to anal cancer screenings. History of anal cancer screening (anal cytology) was abstracted from medical records. Results: 100 women participated; mean age 45 (SD 10), 85% Black, 15% Hispanic; 32% non-US born, and 75% publicly insured. Most (75%) agreed that HPV can cause anal cancer and 58% agreed that HIV increases risk of anal cancer. However, 33% did not perceive themselves at risk. Almost all (97%) agreed having anal cytology is important, and 98% agreed screening finds abnormalities before becoming cancer. Perceived barriers to screening included: fear of sexual assault flashbacks (24%), fear of pain (22%), embarrassment (20%) and lack of social support (20%). No differences in knowledge, attitudes or beliefs of anal cancer screening were found when comparing women who participated in anal cancer screening (45%) versus those who had not. Conclusions: Women with HIV believe that anal cancer screening is important for their health. Barriers to participation that would need to be addressed in implementing a screening program include: Not perceiving themselves at risk, fear of pain, embarrassment, and limited social support.