Abstract
Cervical cancer rates are disproportionately high among women living with the human immunodeficiency virus (wlhiv). Cervical cancer is preventable through hpv screening, regular Pap tests, and early cancer detection. Evidence indicates that hpv and cervical cancer screening are suboptimal among wlhiv, who face a myriad of access barriers. Considering that screening is an effective first-line defense to cervical cancer, we conducted a scoping review with the aim of gaining a better understanding about: (1) the knowledge and perceptions of hpv and cervical cancer screening among wlhiv; and (2) the acceptability of self-sampling for hpv among wlhiv. We searched five electronic databases for peer-reviewed articles that were published in English within the last ten years, reported on studies with hiv-positive women who were aged 16 or older, and satisfied the topics of the review. A total of 621 articles were found. After accounting for duplicates and unmet criteria, 17 articles and 1 abstract, reporting on studies in the United States and Africa, were included in this review. The review highlighted that most wlhiv had inadequate knowledge of hpv transmission and cervical cancer prevention, which influenced their perceptions of risk and susceptibility. Screening barriers included misconceptions about Pap tests, fear of diagnosis of serious illness, perceived pain, embarrassment, bodily modesty, and limited access to female health care providers. This review also affirms that self-sampling is an acceptable and promising screening option for wlhiv. Implications for policy, research, and practice are discussed.
Highlights
Women account for a growing proportion of hiv cases in Canada and elsewhere
The results of this review show that there is a paucity of research on wlhiv’s knowledge on hpv and cervical cancer screening, and their acceptability of self-sampling
Ten of the articles focused on knowledge of hpv and cervical cancer screening among wlhiv, but 3 of these 10 articles were from the same research study reporting on different aspects of the study results
Summary
Women account for a growing proportion of hiv cases in Canada and elsewhere. Between 1985 and 2014, a cumulative total of 80,469 hiv cases were reported in Canada, with women accounting for 18.2% of all cases. Of the 2,044 hiv cases reported in 2014, women accounted for 24.6%. Cohort studies in Canada and the United States have consistently shown that the risk of invasive cervical cancer is higher among wlhiv than hiv-negative women[3,4]. Other studies have confirmed that the prevalence of high risk human papillomavirus (hrhpv) infection is higher and more persistent in wlhiv[5,6]. There is general agreement that a long history of hiv infection and prolonged immunosuppression are associated with persistent hpv infection and invasive cervical cancer[7,8]
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