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Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care

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Abstract

Cervical cancer prevention/control efforts among women living with HIV/AIDS (WLH) are socially and structurally challenging. Healthcare access and perceived HIV stigma and discrimination are factors that may challenge risk reduction efforts. This study examined socio-structural determinants of cervical cancer screening among women engaged in HIV care. One hundred forty-five WLH seeking health/social services from AIDS Service Organizations in the southeastern US completed a questionnaire assessing factors related to cervical cancer prevention/control. Ninety percent were African American, mean age 46.15 ± 10.65 years. Eighty-one percent had a Pap test <1 year ago. Low healthcare access was positively associated with having a Pap test <1 year ago, (Odds ratio [OR] 3.80; 95 % Confidence interval [CI] 1.34–10.78). About 36 % reported ≥2 Pap tests during the first year after HIV diagnosis. Lower educational attainment was positively associated with having ≥2 Pap tests, OR 3.22; CI 1.08–9.62. Thirty-five percent reported more frequent Pap tests after diagnosis. Lower income was moderately associated with more frequent Pap tests post-diagnosis, OR 2.47; CI .98–6.23. Findings highlight the successes of HIV initiatives targeting socio-economically disadvantaged women and provide evidence that health policy aimed at providing and expanding healthcare access for vulnerable WLH has beneficial health implications.

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Acknowledgments

This work was supported by Grant Number 3U01 CA114601-05S4 [Hébert, JR (PI)] from the National Cancer Institute, Center to Reduce Cancer Health Disparities (Community Networks Program) to the South Carolina Cancer Disparities Community Network-II (SCCDCN-II). Dr. Hébert was supported by an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the National Cancer Institute (K05 CA136975). Dr. Wigfall was supported by a National Cancer Institute Mentored Research Scientist Award to Promote Diversity (K01 CA175239). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Department of Health and Human Services, or the United States Government.

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Correspondence to Shalanda A. Bynum.

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Bynum, S.A., Wigfall, L.T., Brandt, H.M. et al. Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care. AIDS Behav 20, 2101–2109 (2016). https://doi.org/10.1007/s10461-016-1345-6

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