Preventing anal cancer: Qualitative study among foreign-born Hispanic HIV-Infected Gay and Bisexual Men

Abstract

Background: This study explores foreign-born Hispanic HIV-infected gay and bisexual men's (GBM) anal cancer primary and secondary prevention understanding. These populations may be at greater risk for developing anal cancer given their reduced likelihood to engage and be sustained in HIV primary care. Methods: Between August 2015 and December 2016 researchers conducted 33 semi-structured in-depth interviews with foreign-born Hispanic HIV-infected Hispanic GBM. Interview questions sought to determine participants’ perceived barriers and facilitators to anal cancer primary and secondary prevention. Researchers analyzed interview transcripts using a qualitative content analysis approach. Results: For primary prevention, men reported lack of knowledge about the human papillomavirus (HPV) vaccine. However, for secondary prevention roughly 60% of participants had previously screened for anal dysplasia via anal Pap smear. Provider recommendation was the most common screening facilitator. Men reported stigma related to their HIV status, sexual orientation, and anal Pap smear procedures as barrier to HIV primary care retention and, in turn, anal cancer screening adherence. Participants reported willingness to use a self-screening anal Pap smear test if it were commercially available. Conclusions: Health providers continue to be the leading source of health information. Therefore, provider recommendation for HPV vaccination and anal cancer screening among age-eligible Hispanic HIV-infected GBM is critical. More work is needed to destigmatize HIV and sexual orientation to influence positive health behaviors among this population. Future intervention research could test the effects of provider-led interventions and also media campaigns aimed at influencing HPV vaccine uptake and anal cancer screening among this population.