title: Awareness, perceived risk and practices related to cervical cancer and Pap smear screening: A cross-sectional study among HIV-positive women attending an urban HIV clinic in Johannesburg, South Africa.
abstract: BACKGROUND
  Cervical cancer is a major cause of cancer-related deaths, especially in the context of the HIV epidemic.
  
  
  OBJECTIVE
  To examine awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women.
  
  
  METHODS
  Interviewer-administered structured questionnaires were administered to HIV-positive women (aged ≥18 years) enrolled in a cervical cancer screening study at the Themba Lethu Clinic, Johannesburg, South Africa, from November 2009 to December 2011. Modified Poisson regression with robust standard errors was used to identify factors at enrolment associated with awareness, perceived risk and adequate practice related to cervical screening. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) are presented.
  
  
  RESULTS
  Of the 1 202 women enrolled, 71.3% and 18.2% were aware of the Pap smear and HPV, respectively. Of the 1 192 participants with data evaluated, 76.5% were worried and 23.5% were not worried about cervical cancer; 28.6% of the women had adequate screening practice. Older age (40 - 49 years or ≥50 years v. 18 - 29 years) (aRR 1.63, 95% CI 1.12 - 2.37; aRR 2.22, 95% CI 1.44 - 3.41), higher education (tertiary v. less than grade 10) (aRR 1.39, 95% CI 1.00 - 1.93), initiation on combination antiretroviral therapy (aRR 1.36, 95% CI 1.00 - 1.85) and awareness of Pap smear screening (aRR 16.18, 95% CI 7.69 - 34.01) were associated with adequate screening practice.
  
  
  CONCLUSIONS
  High levels of Pap smear awareness and low levels of Pap smear screening uptake were observed. However, Pap smear awareness was associated with adequate screening practice. More research into effective health education programmes to address these gaps is needed.
authors.affiliation: Right to Care, Johannesburg, South Africa. idah.mokhele@gmail.com.
authors.forename: Idah
authors.initials: I
authors.lastname: Mokhele
authors.forename: D
authors.initials: D
authors.lastname: Evans
authors.forename: K
authors.initials: K
authors.lastname: Schnippel
authors.forename: A
authors.initials: A
authors.lastname: Swarts
authors.forename: J S
authors.initials: JS
authors.lastname: Smith
authors.forename: C
authors.initials: C
authors.lastname: Firnhaber