title: Cervical Cancer Stigma in Rural Kenya: What Does HIV Have to Do with It?
abstract: Cervical cancer is a leading cause of cancer-related death amongst women in sub-Saharan Africa, largely due to the lack of early screening and treatment. In addition to poor access to screening services, inadequate uptake of available services is a barrier to early identification of precancerous lesions. Given that cervical cancer is caused by a sexually transmitted virus and is associated with HIV positivity, stigma is one of the potential barriers to the utilization of cervical cancer programs in sub-Saharan Africa. We conducted a cross-sectional survey of 419 women attending health facilities in rural western Kenya to measure levels of cervical cancer and HIV stigma and to measure the associations between cervical cancer stigma, HIV stigma, and HIV status. Women who qualified for cervical cancer screening were asked to complete an oral questionnaire using a modified 9-point HIV stigma scale. Low cervical cancer stigma was reported in this study, with only 85/419 (20.3 %) of respondents answering yes to at least one cervical cancer stigma question. However, cervical cancer stigma was highly correlated with HIV stigma (correlation coefficient 0.72) and was significantly lower in HIV-positive women (p < 0.001). Reducing cervical cancer stigma in the general population is an important part of promoting screening in sub-Saharan Africa.
authors.affiliation: School of Medicine, Emory University, 1648 Pierce Dr NE, Atlanta, GA, 30322, USA. joelleir@u.washington.edu.|Department of Internal Medicine, University of Washington, 1959 NE Pacific Street Box 356421, Seattle, WA, 98195-6421, USA. joelleir@u.washington.edu.
authors.forename: Joelle I
authors.initials: JI
authors.lastname: Rosser
authors.affiliation: Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), P.O. Box 54840-00200, Mbagathi Way, Nairobi, Kenya.
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, 50 Beale Street, San Francisco, CA, 94143, USA.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Huchko
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D012424:Rural Population; D057545:Social Stigma; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult
keywords: Cervical cancer; HIV; Health education; Stigma; Sub-Saharan Africa