Developing a tool to measure cervical cancer stigma among HIV+ women in Kenya

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Cervical cancer is an AIDS-defining malignancy, and there is clear evidence that HIV increases the risk of infection with human papillomavirus (HPV) and development of pre-cancer and cancer. Further, there is a global disparity in HIV and cervical cancer burden, with the greatest incidence and mortality for both diseases in low- and middle-income countries. The poor outcomes related to both cervical cancer and HIV are preventable with access to and uptake of quality healthcare. As HIV care has become more widely available, researchers and program planners have recognized the importance of interventions to address stigma. Negative social perceptions and stigma about HIV have led to reluctance to test or access treatment in some populations; however, little is known about the presence and potential impact of cervical cancer-related stigma, particularly among HIV-positive women. Uptake of cervical cancer screening and prevention services depends on a convergence of service availability, personal perception of risk and willingness to seek services, all of which may be significantly affected by disease-related stigma. Further, as more programs adopt HPV testing as their method of cervical cancer screening, there may be an additional layer of stigma related to diagnosis with a sexually transmitted disease. A better understanding of whether and how HIV-related stigma intersects and possibly amplifies HPV and cervical cancer stigma and willingness to seek services would guide the development of stigma reduction interventions that could improve screening and follow-up rates. To facilitate this understanding, we propose to use intersectional theory to develop and validate measures for stigma related to HPV and cervical cancer among HIV-infected women. We will carry out in-depth interviews with HIV- positive women, HIV-negative women and providers in Kisumu, Kenya to develop a framework for understanding the individual and intersectional HPV, cervical cancer and HIV-related stigmas. Using data from these interviews, we will develop context-specific measures of HPV, cervical cancer and intersectional stigmas of HPV, cervical cancer and HIV. We will then pilot and validate the instrument using rigorous survey development methods. Finally, we will administer the finalized survey among HIV-positive women enrolled in care at the Family AIDS and Education Services Program in Kisumu, Kenya to evaluate the relationship between stigma related to HPV and cervical cancer among HIV-positive women and engagement in care. Insight into the interplay between individual and intersectional stigmas and willingness to seek services will help us inform future interventions to increase the reach and impact of cervical cancer screening among HIV- positive women.