title: Beliefs About Anal Cancer among HIV-Infected Women: Barriers and Motivators to Participation in Research.
abstract: BACKGROUND
  Infection with the human immunodeficiency virus (HIV) remains associated with a greater risk of anal cancer, despite widespread use of combination antiretroviral therapy. Evidence concerning the acceptability of anal cancer screening gives little attention to women. Because HIV-infected women have a high prevalence of depression and history of sexual trauma, understanding acceptability among this group is critical.
  
  
  OBJECTIVE
  We sought to assess barriers and motivators to participation in anal cancer screening research among a racial/ethnically diverse HIV-infected female population.
  
  
  METHODS
  We conducted a survey based on the Health Belief Model to identify characteristics of women willing to participate in anal cancer screening research (n = 200). Bivariate analyses examined associations between willingness to participate and sociodemographics, clinical characteristics, and health beliefs. Logistic regression modeled willingness to participate in research.
  
  
  RESULTS
  Of the women who participated, 37% screened positive for depression, 43% reported a high trauma history, and 36% screened positive for posttraumatic stress disorder. Overall, 65% reported willingness to participate in research. Those likely to participate were older, reported intravenous drug use as their HIV risk factor, and had a history of prior high-resolution anoscopy (HRA) compared with those unwilling to participate. The most commonly reported barrier to anal Pap testing was fear of pain. In adjusted analyses, a lack of fear of pain and prior experience with HRA significantly predicted willingness to participate.
  
  
  CONCLUSIONS
  Findings suggest that, to increase participation in anal Pap and HRA-related research for HIV-infected women, a single approach may not be adequate. Rather, we must harness patients' previous experiences and address psychosocial and financial concerns to overcome barriers to participation.
authors.affiliation: Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
authors.affiliation: Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts. Electronic address: Christine.Gunn@bmc.org.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Gunn
authors.affiliation: Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
authors.forename: Molly E
authors.initials: ME
authors.lastname: McCoy
authors.affiliation: Department of Obstetrics and Gynecology, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Helen H
authors.initials: HH
authors.lastname: Mu
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Baranoski
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Elizabeth Y
authors.initials: EY
authors.lastname: Chiao
authors.affiliation: Department of Radiation Oncology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: Department of Obstetrics and Gynecology, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stier
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology*; D001294:Attitude to Health; D035843:Biomedical Research; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D010358:Patient Participation / Q000523:psychology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035502:Trust / Q000523:psychology*; D035862:Vulnerable Populations