AIDS | 21 February, 2020
Our objective was to quantify the extent of anal cancer screening among men receiving HIV specialty care in Ontario, Canada and evaluate factors associated with screening.
Cross-sectional questionnaire within a multi-site clinical HIV cohort.
A questionnaire assessing knowledge and experience with HPV-associated diseases and their prevention was administered in 2016-2017 to 1677 men in the Ontario HIV Treatment Network Cohort Study. We used logistic regression to identify factors associated with having discussed screening with a healthcare provider and self-reported receipt of screening (digital anorectal exams [DARE]; anal cytology or anoscopy). Results reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).
40% of men reported ever having had anal cytology/anoscopy, and 70% had ever had DARE. After accounting for differences in age, sexual orientation, years since HIV diagnosis, previous diagnosis with AIDS, knowing someone with HPV-associated cancer, comfort discussing anal health, education and income, the proportion screened differed by self-identified race. Compared to White men, Asian men were less likely to have discussed screening with a healthcare provider (aOR=0.48 95% CI:0.29,0.80) or to have been screened by DARE (aOR=0.27 95% CI:0.17,0.44) or anal cytology/anoscopy (aOR=0.51 95% CI:0.31,0.83); and African, Caribbean or Black men (aOR=0.47 95% CI:0.31,0.70) were less likely to have had DARE. Results were consistent when restricting the analyses to gay, bisexual and other men who have sex with men.
Our findings highlight the potential for disparities in anal cancer screening that need to be considered when developing guidelines and screening programs to reduce the burden of anal cancer among men living with HIV and ensure health equity.