Abstract B72: HPV knowledge and screening among gay men of color in South Florida
Authors: Koskan Alexis , Leblanc Natalie 
Published: May 2016

Introduction: Squamous cell carcinoma of the anus (SCCA), also known as anal cancer, is on the rise, particularly among HIV-infected gay and bisexual men. The disease is caused by persistent infection of two strains of the human papillomavirus (HPV), the most common sexually transmitted infection worldwide. Persistent infection of two cancer-causing strains (16 and 18) leads to the development of high-grade squamous intraepithelial lesions (HSIL) in the anal canal which, left untreated, can develop into SCCA. Two different strains (6 and 11) cause non-cancerous genital warts, a condition more difficult to treat among HIV-infected populations. SCCA can be prevented through timely screening for HSIL via anal Papanicolau (Pap) smear or high resolution anoscopy. However, HIV-infected gay and bisexual men are continuing to suffer disproportionate burden of this disease due to various reasons included underutilization of anal cancer screening. Therefore, this study explored what HIV-infected gay and bisexual men understand about HPV, SCCA, the need to screen for this disease, and their preferences for receiving information about SCCA screening.

Methods: Authors conducted in-depth interviews with 58 HIV-infected gay and bisexual men and analyzed the data using a qualitative content analysis approach.

Results: Participants' HPV and SCCA awareness differed based on whether or not they had been diagnosed for either HSIL (n=3) or SCCA (n=3) compared to those who were never diagnosed for either condition. The men treated for HSIL (n=3) understood the relationship between HPV and the precancerous lesions while men diagnosed with SCCA (n=3) did not know this cancer was caused by HPV. On the other hand, men with no past diagnosis of HSIL or SCCA were not aware of HPV and its potential health repercussions. The few participants who had heard of HPV perceived the virus to be a women's health issue.

Screening behaviors varied based on the clinic where participants received HIV primary care. Men who regularly received care at one specific federally qualified health center were screened for HSIL within the previous two years, and they reported that provider recommendation was the greatest facilitator that led to their screening uptake. Men receiving care at other locations or who were currently out of care did not realize the need to screen for HSIL or SCCA. They reported lack of awareness about SCCA and lack of provider recommendation to be the greatest barriers to anal cancer screening. Other barriers cited include embarrassment of screening procedures and the fear of being diagnosed with cancer. However, as men learned of their risk for cancer and upon realizing the severity of this potential diagnosis, they described their desire to screen in the near future.

Participants: recommended numerous health education strategies to raise awareness about the need to screen for SCCA among HIV-infected gay and bisexual men. The most common recommendation was to ensure that HIV primary care clinicians promoted screening for HSIL and SCCA. They also recommended mass media campaigns in which educational posters and informational advertisements could be posted in public locations such as bus stops or in local print media.

Conclusion: Similar to past research, HIV-infected gay and bisexual men reported willingness to screen for anal cancer, and they requested more widely communicated information about the risk for anal cancer and the need to screen. Future intervention work should use a community-based approach to raise awareness about SCCA among HIV-infected gay and bisexual men. Further, it is critical to ensure that both HIV primary care providers as well as general primary care providers promote HSIL screening, particularly among HIV-infected gay and bisexual men to prevent the development of anal cancer.

Citation Format: Alexis Koskan, Natalie Leblanc. HPV knowledge and screening among gay men of color in South Florida. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B72.