Social and Structural Determinants of Cervical Health among Women Engaged in HIV Care

AIDS Behav. 2016 Sep;20(9):2101-9. doi: 10.1007/s10461-016-1345-6.


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.

Keywords: Cervical cancer; HIV/AIDS; Health status disparities; Papanicolaou test; Women.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Anti-HIV Agents / therapeutic use
  • Discrimination, Psychological
  • Early Detection of Cancer
  • Educational Status
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / psychology
  • Health Services Accessibility*
  • Health Status Disparities*
  • Humans
  • Middle Aged
  • Papanicolaou Test / statistics & numerical data*
  • Poverty
  • Social Stigma
  • Surveys and Questionnaires
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / ethnology
  • Uterine Cervical Neoplasms / prevention & control
  • Vaginal Smears / statistics & numerical data*
  • Young Adult


  • Anti-HIV Agents