HIV Comes First: Perspectives on Cancer Screening Utilization among Men Living with HIV/AIDS

Background: Men living with HIV/AIDS (MLH) have a long established history of bearing an excess burden of AIDS-defining malignancies and are disproportionately impacted by certain non-AIDS defining cancers. Although reduced immune function may play a role in cancer development, gaps in cancer screening may also contribute to increased morbidity/mortality. Thus, the purpose of this study was to understand MLH perspectives related to cancer screening utilization.

Methods: Theoretically guided by the Behavioral Model for Vulnerable Populations, 20 face-to-face qualitative interviews were conducted to understand predisposing, enabling, and need-for-care factors related to cancer screening utilization among MLH attending a community medical practice in Washington, DC. Data were analyzed using Qualitative Content Analysis technique.

Results: The majority of participants were African American/Black (n=14), non-Hispanic (n=18), mean age=45±8.86 years, mean time since HIV/AIDS diagnosis=14±8.03 years. About half of participants reported ever hearing about cancer development among MLH. Although most participants were concerned personally about cancer, HIV disease management was the primary concern. Two predisposing themes emerged regarding the propensity of MLH to utilize cancer screenings: positive experiences with the healthcare system and beliefs that screening can prevent death. Four enabling themes emerged related to the ability of MLH to engage in cancer screenings: awareness/knowledge, healthcare access, integration of health services, and provider relationship/recommendation. Maintaining a good quality of life overall, and more specifically psychological and financial stability emerged as need-for-carethemes.

Conclusions: Medical and public health efforts to improve cancer prevention and control outcomes among MLH should focus on awareness/knowledge, health beliefs, and healthcare system factors.