title: Cervical screening in HIV-positive women: characteristics of those who default and attitudes towards screening.
abstract: OBJECTIVE
  To determine the characteristics of HIV-positive women who undergo cervical screening and to identify negative attitudes and experiences of these women to screening and the factors associated with these.
  
  
  METHODS
  We compared the Royal Free Cohort data from 59 newly diagnosed HIV-infected women, 31 of whom did and 28 of whom did not attend for cervical screening in 2001, and from 227 women under active cervical screening follow-up (at least one cervical screen since June 2001) and 88 HIV-infected women lost to follow-up (not screened since January 2001). Attitudes to screening were investigated with the aid of a questionnaire given to all women attending clinic who had had a previous colposcopy.
  
  
  RESULTS
  Of the 59 newly HIV diagnosed women, 31 (53%) underwent cervical screening. These 31 women were more likely to be heterosexual (100 vs 89%, P=0.05), to have lower median viral loads (< 50 vs 3210 HIV-1 RNA copies/mL) and to be receiving antiretrovirals (ARVs) (74 vs 54%, P=0.1) than those not screened. Of the 315 women who had at least one screen, 72% returned for further follow-up. There were no differences in age or ethnicity between these groups. Those under active follow-up had a higher CD4 count (P=0.04) and lower viral load (P=0.0001) at their last visit. They were also more likely to be on highly active antiretroviral therapy (HAART) (68 vs 52%, P=0.006). A total of 78 of 104 questionnaires (75%) were returned. Women participating in the questionnaire study were mainly of back ethnicity (68%), did not speak English as their first language (59%) and were taking ARVs (76%). Most agreed that regular smears and colposcopy were valuable. Women of white ethnicity, and those speaking English as a first language, were more likely to dislike colposcopy compared with those of nonwhite ethnicity (87 vs 25%, respectively, P=0.0007) and not speaking English as a first language (74 vs 26%, respectively, P=0.002). Those of white ethnicity were more likely to find smears and colposcopy painful (60 and 73%) compared with those of black ethnicity (46 and 51%, P=0.47 and 0.28, respectively).
  
  
  CONCLUSIONS
  Our results suggest that women on HAART with better disease control, older women, and those of black African ethnicity are more likely to take up cervical screening. Cervical screening experience varies by ethnicity and language.
authors.affiliation: Department of Thoracic Medicine, Royal Free Centre for HIV Medicine, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Shah
authors.forename: H
authors.initials: H
authors.lastname: Montgomery
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Madge
authors.forename: P
authors.initials: P
authors.lastname: Walker
authors.forename: H
authors.initials: H
authors.lastname: Evans
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.forename: C
authors.initials: C
authors.lastname: Sabin
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000523:psychology* / Q000821:virology; D006801:Humans; D007802:Language; D008131:London; D008403:Mass Screening / Q000941:ethics / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts / Q000523:psychology; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears; D019562:Viral Load