title: Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening.
abstract: Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales.
authors.affiliation: University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA lskaopua@hawaii.edu.
authors.forename: Lana Sue I
authors.initials: LS
authors.lastname: Ka'opua
authors.affiliation: University of Hawai'i Cancer Center, Honolulu, HI, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cassel
authors.affiliation: University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Shiramizu
authors.affiliation: University of Hawai'i-Ma-noa, Honolulu, HI, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Stotzer
authors.affiliation: University of Hawai'i-Ma-noa, Honolulu, HI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Robles
authors.affiliation: Life Foundation of O'ahu, Honolulu, HI, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Kapua
authors.affiliation: Life Foundation of O'ahu, Honolulu, HI, USA.
authors.forename: Malulani
authors.initials: M
authors.lastname: Orton
authors.affiliation: University of Hawai'i-Ma-noa, Honolulu, HI, USA.
authors.forename: Cris
authors.initials: C
authors.lastname: Milne
authors.affiliation: Life Foundation of O'ahu, Honolulu, HI, USA.
authors.forename: Maddalynn
authors.initials: M
authors.lastname: Sesepasara
mesh_terms: D000328:Adult; D000368:Aged; D001005:Anus Neoplasms / Q000175:diagnosis / Q000523:psychology*; D054521:Cultural Competency; D055088:Early Detection of Cancer; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology; D006254:Hawaii; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology*
keywords: HIV; Native Hawaiians/Pacific Islanders; anal cancer screening; cancer disparities; cultural competence; sexual minorities