Date of Award

12-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

MARLYN A. ALLICOCK

Second Advisor

KATELYN JETELINA

Abstract

Background: The Republic of Zambia has the third-highest incidence of cervical cancer in the world, where approximately 700,000 women over age 15 are living with HIV. Women living with HIV (WLHIV) are at increased risk for cervical cancer. While literature suggests that discrimination is a barrier to HIV care, no studies have explored if discrimination experienced in HIV clinics is related to cervical cancer screening using nationally representative datasets. Objective: The primary objective of this study was to examine whether perceived discrimination by healthcare workers due to HIV status is related to having been screened for cervical cancer among WLHIV. Methods: This study used the Zambia Population-based HIV Impact Assessment (ZAMPHIA) weighted data to examine the logistic bivariate and multivariate relationships between experienced discrimination and cervical cancer screening as well as key demographic and covariates among 1,182 WLHIV ages 15-59 in Zambia. Results: Twenty-seven percent of WLHIV in Zambia had screened for cervical cancer and 5.5% experienced HIV-related discrimination. There was no significant relationship

between discrimination and cervical cancer screening (OR=1.26; 95% CI=0.69-2.29). In multivariate logistic regression, age (OR=1.03; 95% CI=1.02-1.05), having more than secondary education (OR=3.18; 95% CI=1.30-7.75), living in an urban area (OR=2.17; 95% CI=1.53-3.09), ethnicity (Tonga: OR=2.02; 95% CI=1.26-3.24; Lozi: OR=3.21; 95% CI=1.85-5.60; and Other: OR=1.61; 95% CI=1.11-2.34), being widowed (OR=0.60; 95% CI=0.38-0.95), and a history of sexual violence (OR=0.48; 95% CI=0.27-0.86) were significantly associated with cervical cancer screening. Conclusions: With the support of international partners, the Government of Zambia is scaling up its national cervical cancer screening program within the HIV platform. This study provides validation for these efforts but also underscores the importance of the equitable distribution of services across rural and urban areas as well as ethnicities.

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