Abstract
IntroductionThe incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group.MethodsA cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices) completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population.ResultsOf 72% (95% confidence interval (CI): 67–77) who had heard of anal cancer, 47% (95% CI: 41–53) could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57) underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01–1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93). They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96), to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59) or speak English at home (OR 0.28, 95% CI: 0.09–0.90).ConclusionsThis survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.
Highlights
The incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population
Knowledge of anal cancer Over a quarter (28%, 95% confidence intervals (CIs): 23Á33) of men had never heard of anal cancer
Given that MSM living with HIV are one suggested target group for anal cancer screening [18] and anal cancers are currently diagnosed late [19], strategies to improve screening or encourage early clinical presentation will need to improve knowledge and understanding of risk for anal cancer in this group
Summary
The incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01Á1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21Á3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18Á4.93). The group at highest risk for anal cancer is men who have sex with men (MSM) living with HIV They have multiple risk factors including high prevalence and persistence of highrisk anal human papillomaviruses (HPVs) [4,5], and high rates of smoking [6] in the context of a substantially increased life expectancy and chronic immune dysregulation [2]. In most settings, few MSM living with HIV are currently being screened for anal cancer or its precursors [8,9]
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