Facilitators and barriers to anal cancer screening among men with HIV and their providers in Alabama.

Anal cancer, primarily caused by persistent high-risk HPV infection, is increasing worldwide. Men who have sex with men (MSM) and men with HIV (MWH) have incidence rates over ten-fold the rate among the general population. We explored health beliefs related to anal cancer, and perceived benefits, barriers, and facilitators to screening among MWH and their HIV care providers in the U.S. South, where HIV incidence remains high. We conducted in-depth interviews and thematic analyses to identify themes related to health beliefs (i.e., perceived knowledge of HPV and cancer, benefits of screening, and self-efficacy), barriers and facilitators to screening. Among MWH (N=12), benefits of screening included early detection to prevent negative outcomes and awareness about one's body. Among providers (N=4), suggestions for overcoming barriers to screening included access to standard screening guidelines, patient education, inclusion of screening into routine care, social work services, and self-collection. Among MWH that were aware of HPV-associated cancers, perceived risk of cancer and a desire to receive HPV vaccination were common. In conclusion, improving patient education about HPV-associated cancer, inclusion of screening as part of routine care, and access to self-collection kits could facilitate anal cancer screening uptake among MWH in the South.