HPV Knowledge, Screening Barriers and Facilitators, and Health Information Sources Among Women Living with HIV: Perspectives from the DC Community During the COVID-19 Pandemic | Women’s Health BMC

Sociodemographic characteristics

As presented in Table 1, FGD participants included WLH between the ages of 35 and 66 years. Half (50.0%) of the women interviewed had some college or technical school, and half (50.0%) received disability benefits. The majority (87.2%) of the women were residents of the District, representing Districts 8 (40.6%), 7 (15.6%), 1 (12.5%) and 5 (also 12.5%). ). Districts 7 and 8 have the lowest socioeconomic status and the highest level of unemployment [25].

Table 1 Characteristics of women living with HIV (N = 39)

Almost all of the MLH indicated that they are currently insured (94.4%) and have a source of regular care (91.7%). A quarter (25.6%) of the women indicated that they had a history of cervical cancer or hysterectomy. Regarding their history of cervical cancer screening, 94.4% indicated that they had ever had a Pap test in their life, and 77.7% indicated that they had had a Pap test in the last 12 months.

Overview of key topics

A visual/graphic representation of the key issues raised during the FGD sessions by WLH is presented in Fig. 1.

Figure 1
Figure 1

Frequency of topics shared by FGD participants on knowledge of cervical cancer and HPV prevention, barriers and facilitators of screening, and sources of health information. an Cervical cancer and HPV risk factors. b Prevention of cervical cancer and HPV. C Barriers to screening for cervical cancer. d Facilitators for cervical cancer screening. me Common sources of health information (before the COVID-19 pandemic)

Four thematic categories emerged from the six FGDs (Table 2).

Table 2 Key themes and representative quotes from focus group discussions

Knowledge about cervical cancer and HPV

Specifically in terms of their general knowledge about cervical cancer and HPV, most women accurately identified cervical cancer risk factors by citing lifestyle behaviors such as smoking and unprotected sex (see Fig. 1a). They also acknowledged that having HIV and not getting Pap tests as recommended increases the risk of cervical cancer (“With HIV, I think we’re more prone to infections, so there’s a higher chance of getting cervical cancer “). Prevention methods identified by the women included safe sex practices, healthy eating, exercise, and getting vaccinated against HPV (see Fig. 1b). Some of the women shared that they did not believe cervical cancer was preventable.

Although the participants conveyed adequate knowledge about cervical cancer, many did not know about HPV. Some of the women mentioned that they had never heard of HPV or had heard of it but had no additional knowledge beyond that. Some of the women expressed that they were only familiar with the term “HPV” because they had recently been exposed to HPV vaccine advertisements through billboards, radio, and television, but did not know that HPV was sexually transmissible ( “I don’t remember being told that it is transmitted by sex, this is the first [time] I’ve heard it”). Knowledge about cervical cancer screening was also low among our participants. The women were unable to explain what a Pap test is and what it involves; for example, some women incorrectly associated Pap smears with general STD testing (as opposed to identifying cellular changes or abnormal cells on the cervix). It was also not clear to our participants when a first Pap smear should be started: some mentioned that it should be started in a woman’s first menstrual cycle. Finally, although our participants were aware that cervical cancer screening guidelines differed for WLH, many were unsure of the specific guidelines.

Barriers and facilitators to cervical cancer screening

When asked about barriers to cervical cancer screening (see Fig. 1c), women in our study expressed that they were less likely to be tested due to their lack of knowledge about cervical cancer ( “There is very little information available for us to learn about it”), other competing priorities (such as having to take care of his family), not remembering the checkup, and the inability to go to his regular checkups due to the COVID-19 pandemic. to the COVID-19 pandemic, they expressed that they did not feel safe going to their provider’s office unless it was for an emergency (“Um, going to the office right now to get a Pap test and things like that is very dangerous, so I really need one that you can do at home.”). Some even said that if their provider didn’t offer it, they wouldn’t request the test unless they experienced abnormal symptoms.

Identified screening facilitators (see Fig. 1d) were receiving more information about cervical cancer risk factors and their susceptibility to HPV as WLH: “It’s easier to get an infection even if I’m taking my medicine as usual, so it’s a priority to get a Pap smear every time it’s needed.” They also indicated that having a family history of cervical cancer or knowing someone affected by cervical cancer made them more aware of cervical cancer and more likely to adhere to recommended screening tests (“My sister died from it. But, um, she had high-grade injuries and, um, I had my cervix removed.”). Among women who indicated they had a Pap test in the past 12 months, many directly attributed their adherence to screening to direct recommendations from their provider (“I need to do that, um, but you know, it’s kind of hard with the coronavirus, right?”. now. So, um, but usually I’m motivated by my doctor, the gynecologist”). They mentioned getting reminder notices (mail or calls) from their providers when their next screening is due (“I get a letter in the mail a week before it’s supposed to be done and then I get a notice, […] they make me an extra call because they know I don’t like them”).

Pathways to increase awareness and adherence to cervical cancer screening

To increase understanding of how knowledge gaps among the target population can be addressed, we asked women to share their usual source of health information and their preferences in health education (see Fig. 1e). Women mentioned getting their health information (general, cervical cancer, and HPV-focused) through various channels: in-person education with their providers, conversations with peers, or in group settings such as support groups, group discussions focus groups for research studies, workshops initiated by the community/organization (“A lot, I get a lot of information through focus groups and studies and everything”). Some women mentioned that they also got their health information through written literature such as brochures, although they also acknowledged that literacy level should be considered (“I think they should break it down a little more clearly when they do the cancer brochure”), and that some may prefer pictorial messages (“So I think a picture is always good for the person who can’t read as well as someone else or has problems”).

Impact of the COVID-19 pandemic on health information sources

Due to the COVID-19 pandemic, the women noted that they were no longer able to have those education sessions in person. As most sessions ceased or migrated to an online platform, they had to quickly transition and rely on tech-based and remote communication channels (“We’re not sure how long this COVID-19 thing will last, so I feel comfortable making video calls and phone calls from my doctor instead of going to the office”). Other forms of media channels raised by women were the Internet, television, radio, email, text messages (“You know, the focus group and […] support groups through Zoom, and that’s a good way to spread the word, of course, emails, text messages because there are a lot of women who don’t know about this”), videos, advertisements and social networks (“Yes, social media, word of mouth, because you know, […] We have been together for years, so we connect together to know different things, we communicate with each other and pass messages and things like that. When one person tells another person, we find out together and do things together to find out things like that”).. Although some women acknowledged that messages using scare tactics could work for some, they emphasized that messages conveying a sense of urgency were also effective (“Not really fear, but concern, a message of concern and how, how necessary is it to you know about HPV”).

Leave a Comment