You are being invited to participate because HPV-related cancers and pre-cancers are frequent in HIV-positive MSM and there is a need to screen for them. If you agree to participate in this screening study, you will have an anal Pap smear to screen for high-grade (precancerous) anal disease. You will be enrolled with approximately 3,000 other MSM. If your Pap smear shows moderate to severely abnormal cells, called high-grade squamous intraepithelial lesion (HSIL), you will be offered a special anoscopy called High Resolution Anoscopy (HRA). An anoscopy is an exam of the rectum and anus with a small tube inserted into the anus. Approximately 300 men will have HSIL cytology and they will be enrolled in the treatment phase of the study. A subset of men whose Pap smear indicates only low grade (mildly abnormal cells) squamous intraepithelial lesions (LSIL), whose Pap is abnormal, those with a repeat unsatisfactory for diagnosis result, or whose Pap is normal will be randomized and also be invited to have HRA. The purpose of this research study is to improve decisions about which HIV-positive MSM should have HRA. 

The purpose of this research study is to optimize decision making about which HIV-positive MSM should be sent to HRA.