title: Exploring anal self-examination as a means of screening for anal cancer in HIV positive men who have sex with men: a qualitative study.
abstract: BACKGROUND
  Anal cancer is relatively common in HIV-positive men who have sex with men(MSM). However there are no clear guidelines on how to effectively screen for anal cancer. As earlier diagnosis of anal cancer is associated with increased survival, innovative ways such as utilizing anal self-examination to identify anal cancer should be explored.
  
  
  METHODS
  Semi-structured interviews were conducted with 20 HIV-positive MSM from a range of ages (35 to 78 years). This study explored acceptability and barriers to implementing ASE as a method of anal cancer screening. Framework analysis was used to identify themes.
  
  
  RESULTS
  Seventeen out of 20 men had conducted an ASE before--six (35%) were for medical reasons, six (35%) for sexual reasons, three (18%) for both medical and sexual reasons, and two (12%) for cleaning purposes. Only 5 men were currently confident in detecting an abnormality. Whilst men were generally comfortable with the idea of utilizing ASE as a means for detecting anal cancer, potential barriers identified operated at three levels: attitudinal (discomfort with any anal examinations, anxiety about finding an abnormality, preference for health professional examination), knowledge (lack of awareness of anal cancer risk and ignorance of anal cancer symptoms) and practical (inadequate physical flexibility, importance of hygiene).
  
  
  CONCLUSIONS
  ASE may be an acceptable means for anal cancer detection in HIV-positive MSM but training in detecting abnormalities is needed. The preference for health professional examination and inadequate physical flexibility may preclude its use for some men. Future trials to confirm its wider acceptability will be needed before undertaking an effectiveness trial for detecting anal cancer.
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria 3010, Australia. j.ong@unimelb.edu.au.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Ong
authors.forename: Meredith
authors.initials: M
authors.lastname: Temple-Smith
authors.forename: Marcus
authors.initials: M
authors.lastname: Chen
authors.forename: Sandra
authors.initials: S
authors.lastname: Walker
authors.forename: Andrew
authors.initials: A
authors.lastname: Grulich
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms; D001315:Australia; D055088:Early Detection of Cancer; D006679:HIV Seropositivity; D018451:Homosexuality, Male; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D016353:Self-Examination