Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors.
Authors: Adsul Prajakta , Myers Katie J , Kanda Deborah , Jaffe Talya , Tawfik Bernard , Wu Emily , McClain Molly , Pankratz Shane , Mishra Shiraz I , Nair Uma , Stimatze Tamara , Madhivanan Purnima , Kano Miria Adler 
Published: June 2022

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Background: Population-based studies to examine cervical cancer screening (CCS) and prevention among sexual and gender diverse (SGD) individuals have been limited. We conducted a state-wide survey in New Mexico to examine differences in CCS and HPV vaccination uptake based on gender and sexual orientation. Methods: The survey was advertised using mailed flyers, social media, and targeted internet ads across the state. We received a total of 2534 responses, of which 797 respondents were CCS eligible (i.e., between 21-65 years old, had a cervix, and did not have a prior cervical cancer diagnosis) and provided information about CCS and were included in this analysis. Descriptive statistics were conducted using SAS 9.4. Results: Of the 797 respondents, 83% were 21 - 40 years old, 44% were white, 34% reported an annual household income below $50,000, 83% were employed, 81% had health insurance, and 73% reported having a primary care provider. Fourteen percent were transgender men or nonbinary, 86% were cisgender women, 34% were bisexual, 48% were lesbian, and 18% were queer. While there were no statistical differences in self-reported CCS based on gender identity, 31% of cisgender women and 25% of transgender men and nonbinary individuals reported never receiving a Pap test. The top reason for never receiving a Pap test among cisgender women was that their healthcare provider told them they did not need it (17%) and for transgender men and nonbinary individuals the top reasons were that they had an HPV vaccine (21%) or that it was too painful, unpleasant, or embarrassing (21%). There were significant statistical differences based on sexual orientation for receiving a Pap test (p < 0.001) and for being up to date on screening (Pap test in the past 3 years, a co-test, or primary HPV test in the past 5 years) (p = 0.03). Among lesbians, 39% reported never having a Pap test, compared with 17% of bisexuals and 30% of queer individuals. For lesbians, the top reason for not receiving a Pap test was not knowing that Pap tests existed (19%), while the top reason for both bisexual and queer individuals was that their healthcare provider told them they did not need it (17% and 19%, respectively). No significant differences were noted in HPV vaccination uptake among respondents. Conclusions: In order to address sexual orientation differences noted in our study, future research is needed to explore mechanisms through which these differences operate using community-based approaches. Additionally, educational interventions inclusive of different gender identities and sexual orientations are needed to improve motivations for screening uptake among SGD individuals. Finally, specific considerations for SGD individuals should be incorporated into screening recommendations and guidelines and clearly communicated to providers, further enabling them to make recommendations for these populations.