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

宫颈癌是一种艾滋病定义的恶性肿瘤，有明确的证据表明，艾滋病毒会增加宫颈癌的风险。 人乳头瘤病毒（HPV）感染和癌前病变和癌症的发展。此外，还有一个 艾滋病毒和宫颈癌负担的全球差异，这两种疾病的发病率和死亡率最高 在低收入和中等收入国家。与宫颈癌和艾滋病毒相关的不良结局是 通过获得和接受高质量的医疗保健来预防。随着艾滋病毒护理的普及， 研究人员和方案规划者已经认识到干预措施对解决污名问题的重要性。 社会对艾滋病毒的负面看法和污名化导致一些人不愿进行检测或接受治疗， 然而，对宫颈癌相关污名的存在和潜在影响知之甚少， 尤其是艾滋病毒抗体阳性的妇女。接受子宫颈癌检查和预防服务取决于 基于服务的可获得性、个人对风险的认识和寻求服务的意愿的融合， 这可能会受到与疾病相关的耻辱感的严重影响。随着越来越多的项目采用HPV检测， 作为他们的宫颈癌筛查方法， 患有性传播疾病更好地了解与艾滋病毒有关的污名是否以及如何交叉 并可能放大HPV和宫颈癌的耻辱感，寻求服务的意愿将引导 制定减少耻辱感的干预措施，以提高筛查和随访率。以促进 基于这种理解，我们建议使用交叉理论来开发和验证污名的测量方法 在感染艾滋病毒的妇女中，与HPV和宫颈癌有关。我们将对艾滋病患者进行深入访谈- 肯尼亚基苏穆的艾滋病毒抗体阳性妇女、艾滋病毒抗体阴性妇女和提供者， 了解个人和交叉HPV，宫颈癌和艾滋病毒相关的耻辱。使用的数据来自 通过这些访谈，我们将制定针对HPV、宫颈癌和交叉污名的具体措施， HPV、宫颈癌和艾滋病病毒。然后，我们将使用严格的调查对仪器进行试验和验证 发展方式最后，我们将对参加艾滋病毒/艾滋病方案的艾滋病毒抗体阳性妇女进行最后调查。 在肯尼亚基苏穆家庭艾滋病和教育服务项目中， 在艾滋病毒阳性妇女中，与HPV和宫颈癌有关的耻辱感与参与护理之间的关系。 深入了解个人和交叉污名之间的相互作用以及寻求服务的意愿， 帮助我们为未来的干预措施提供信息，以增加宫颈癌筛查在艾滋病毒感染者中的覆盖面和影响力， 积极的女性

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.