title: Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care.
abstract: Cervical cancer prevention/control efforts among women living with HIV/AIDS (WLH) are socially and structurally challenging. Healthcare access and perceived HIV stigma and discrimination are factors that may challenge risk reduction efforts. This study examined socio-structural determinants of cervical cancer screening among women engaged in HIV care. One hundred forty-five WLH seeking health/social services from AIDS Service Organizations in the southeastern US completed a questionnaire assessing factors related to cervical cancer prevention/control. Ninety percent were African American, mean age 46.15 ± 10.65 years. Eighty-one percent had a Pap test <1 year ago. Low healthcare access was positively associated with having a Pap test <1 year ago, (Odds ratio [OR] 3.80; 95 % Confidence interval [CI] 1.34-10.78). About 36 % reported ≥2 Pap tests during the first year after HIV diagnosis. Lower educational attainment was positively associated with having ≥2 Pap tests, OR 3.22; CI 1.08-9.62. Thirty-five percent reported more frequent Pap tests after diagnosis. Lower income was moderately associated with more frequent Pap tests post-diagnosis, OR 2.47; CI .98-6.23. Findings highlight the successes of HIV initiatives targeting socio-economically disadvantaged women and provide evidence that health policy aimed at providing and expanding healthcare access for vulnerable WLH has beneficial health implications.
authors.affiliation: Division of AIDS, Behavioral, and Population Sciences, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA. shalanda.bynum@nih.gov.
authors.forename: Shalanda A
authors.initials: SA
authors.lastname: Bynum
authors.affiliation: Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.|Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.|South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Lisa T
authors.initials: LT
authors.lastname: Wigfall
authors.affiliation: South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.|Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Brandt
authors.affiliation: Palmetto AIDS Life Support Services, Inc., Columbia, SC, USA.
authors.forename: Carmen Hampton
authors.initials: CH
authors.lastname: Julious
authors.affiliation: Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.|Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Saundra H
authors.initials: SH
authors.lastname: Glover
authors.affiliation: South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D004192:Discrimination, Psychological; D055088:Early Detection of Cancer; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D011203:Poverty; D057545:Social Stigma; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Cervical cancer; HIV/AIDS; Health status disparities; Papanicolaou test; Women