Awareness, perceived risk and practices related to cervical cancer and Pap smear screening: A cross-sectional study among HIV-positive women attending an urban HIV clinic in Johannesburg, South Africa

Abstract

Background. Cervical cancer is a major cause of cancer-related deaths, especially in the context of the HIV epidemic. Objective. To examine awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women. Methods. Interviewer-administered structured questionnaires were administered to HIV-positive women (aged ≥18 years) enrolled in a cervical cancer screening study at the Themba Lethu Clinic, Johannesburg, South Africa, from November 2009 to December 2011. Modified Poisson regression with robust standard errors was used to identify factors at enrolment associated with awareness, perceived risk and adequate practice related to cervical screening. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) are presented. Results. Of the 1 202 women enrolled, 71.3% and 18.2% were aware of the Pap smear and HPV, respectively. Of the 1 192 participants with data evaluated, 76.5% were worried and 23.5% were not worried about cervical cancer; 28.6% of the women had adequate screening practice. Older age (40 -49 years or ≥50 years v. 18 -29 years) (aRR 1.63, 95% CI 1.12 -2.37; aRR 2.22, 95% CI 1.44 -3.41), higher education (tertiary v. less than grade 10) (aRR 1.39, 95% CI 1.00 -1.93), initiation on combination antiretroviral therapy (aRR 1.36, 95% CI 1.00 -1.85) and awareness of Pap smear screening (aRR 16.18, were associated with adequate screening practice. Conclusions. High levels of Pap smear awareness and low levels of Pap smear screening uptake were observed. However, Pap smear awareness was associated with adequate screening practice. More research into effective health education programmes to address these gaps is needed.

Poor Cervical Cancer Knowledge and Awareness among Women and Men in the Eastern Cape Province Rural Community

“…Overall, this study finds that both women and men in rural Eastern Cape, South Africa had limited knowledge and awareness about cervical cancer, its risk factors, and prevention methods even though they reported having heard of cervical cancer. Similar findings have been reported elsewhere [13][14][15][16][17][18][19][20][21][22][23][24]26,27,31,32]. It was apparent that the level of knowledge about cervical cancer decreased with increasing age among rural community women and men.…”

“…Approximately three-quarters of the women participating in the study did not consider themselves at risk of the development of cervical cancer. Because this population perceive themselves as not at risk, they are more likely not to participate in cervical cancer screening and miss the opportunity for early disease detection and treatment [31]. It is worrisome that the women who did not consider themselves at risk of cervical cancer had a lower knowledge score about cervical cancer and its risk factors than those who considered themselves at risk of cervical cancer development.…”

Uptake and barriers to cervical cancer screening among human immunodeficiency virus-positive women in Sub Saharan Africa: a systematic review and meta-analysis

“…The lowest coverage of cervical cancer screening uptake was estimated by Bulto G. et al [ 52 ] at 2.1%, while the highest coverage was estimated by Cholli P. et al [ 35 ] at 79.7%. There were 9 studies from Ethiopia [ 52 ], and the remainder were from Kenya [ 45 , 51 ], Zimbabwe [ 46 , 47 ], Côte d’Ivoire [ 36 , 37 ], Uganda [ 40 , 44 ], Cameron [ 35 ], Nigeria [ 42 ], Malawi [ 41 ] and the Republic of South Africa [ 43 ]. Twelve of the included studies were conducted in both rural‒urban settings simultaneously.…”

Uptake and Barriers to Cervical Cancer Screening among Human Immunodeficiency Virus-Positive Women in Sub Saharan Africa: A Systematic Review and Meta-Analysis

“…The lowest coverage of cervical cancer screening uptake was estimated by Bulto G.et al (32) at 2.1%, while the highest coverage was estimated by Cholli P. et al (33) at 79.7%. There were 9 studies from Ethiopia (32,(34)(35)(36)(37)(38)(39)(40)(41) and the remainders were from Kenya (42,43), Zimbabwe (30,44), Côte d'Ivoire (45,46), Uganda (31,47), Cameron (33), Nigeria(48), Malawi (49) and Republic of South Africa (50). Twelve of the included studies were conducted in both rural-urban settings simultaneously.…”