HIV Status Splits Cancer Screening Patterns for Anal and Cervical Tumors

People living with HIV in the United States face a sharply elevated risk of cancers driven by human papillomavirus, yet the preventive services designed to catch these malignancies early are not reaching all patients equally. A new survey of adults receiving care through a community-based clinic network offers some of the clearest evidence yet that screening uptake for anal and cervical cancer moves in opposite directions depending on HIV status. Men with HIV were substantially more likely than men without the virus to have ever been screened for anal cancer, while women with HIV were markedly less likely than their HIV-negative counterparts to receive cervical cancer screening on the schedule that guidelines recommend for them.

The study, conducted by researchers affiliated with Moffitt Cancer Center in collaboration with CAN Community Health, a Ryan White-funded clinic network predominantly based in Florida, was published in the journal Cancer Causes & Control. It set out to identify the sociodemographic, health, and social predictors of anal and cervical cancer screening uptake among adults with and without HIV. The stakes are considerable: high-risk HPV causes more than ninety percent of anal and cervical cancers, and people with HIV are roughly seventeen times more likely to develop anal cancer than people without the virus, while women with HIV face about a fourfold increase in cervical cancer risk. HIV-related immunosuppression allows HPV infection to persist and progress more readily toward malignancy, and health system barriers contribute to later-stage diagnoses and higher mortality among this population.

Both anal and cervical cancers are unusual among malignancies in that they progress through well-defined, detectable precancerous lesions. Removing high-grade squamous intraepithelial lesions can halt progression before invasive cancer develops, which makes screening an unusually powerful prevention tool. For cervical cancer, established guidelines exist: the U.S. Preventive Services Task Force recommends screening every three years for women without HIV aged 21 to 65, while the Infectious Diseases Society of America advises annual screening for women with HIV beginning at age 21. Anal cancer screening guidance is more recent. The landmark ANCHOR study showed that treating anal high-grade lesions in people with HIV significantly reduced anal cancer incidence compared with active monitoring, and those findings underpin the International Anal Neoplasia Society consensus guidelines, which recommend screening for HIV-positive men who have sex with men and transgender women aged 35 and older, and for HIV-negative people in high-risk groups aged 45 and older.

To measure how these recommendations translate into real-world care, the research team implemented a cross-sectional survey between April and June 2024 among adult patients of the CAN clinic network, which serves more than 31,100 unique patients annually, a population that is 35 percent White, 35 percent Black, and 18 percent Hispanic or Latino. The questionnaire, distributed anonymously through the clinic’s electronic patient intake system and offered in English and Spanish, collected information on demographics, health history, cancer prevention behaviors, experiences with the health system, and social exposures including HIV-related stigma. Participants received a twenty-five dollar gift card. From the responses, 412 participants were eligible for anal cancer screening and 294 women were eligible for cervical cancer screening based on current guidelines.

The characteristics of the two screening-eligible groups reflected the populations most at risk. Among those eligible for anal cancer screening, the median age was 56 years, 88.8 percent were living with HIV, and 82.3 percent were men, with roughly two-thirds identifying as gay or lesbian. Among women eligible for cervical cancer screening, the median age was 38 and 43.5 percent were living with HIV. The researchers computed adjusted prevalence ratios using multivariable Poisson regression, guided by the Andersen Behavioral Model of health services use, with models stratified by HIV status and sex to account for documented differences in cancer risk and screening outcomes across these subpopulations.

The anal cancer findings delivered a cautiously optimistic signal. Overall, 58.6 percent of screening-eligible participants reported ever having been screened, most commonly through an anal Pap test or high-resolution anoscopy. After statistical adjustment, men with HIV were 57 percent more likely to have received anal cancer screening than men without HIV. Within the group of men with HIV, uptake was higher among those who had been diagnosed with any precancer and those living with three or more comorbidities, a pattern the authors attribute to more frequent medical encounters creating more opportunities for preventive services. Living in a household of three or more people was associated with significantly lower uptake among these men, possibly reflecting caregiving responsibilities, competing demands, or limited economic means that crowd out preventive visits.

The cervical cancer picture was far less reassuring. Only 47 percent of women with HIV had received guideline-adherent cervical screening, compared with 71 percent of women without HIV, a gap that persisted after adjustment, leaving women with HIV 40 percent less likely to be screened on time. This shortfall is particularly troubling because U.S. guidelines call for more frequent, annual screening in this higher-risk group, not less. The study also identified a psychosocial driver: among women with HIV, greater concerns about disclosing their HIV status were independently associated with lower guideline-adherent cervical screening uptake. This finding reinforces a growing body of evidence that stigma is not merely an abstract social burden but a concrete mechanism that undermines preventive care, engagement with health services, and trust in medical systems.

The researchers point to several practical implications. Community-based, culturally sensitive screening programs embedded in clinics that patients already trust appear to pay dividends, and the integrated social services offered by Ryan White-funded networks may help explain why anal cancer screening among men with HIV exceeded that of their HIV-negative counterparts. For cervical cancer, proven strategies exist to close the gap, including provider reminders, patient education campaigns, and HPV self-collection kits that can overcome geographic barriers, limited access, and the discomfort or stigma associated with pelvic examinations. The authors also note that clinician awareness matters, since gaps in provider knowledge and training about screening recommendations for people with HIV remain documented barriers alongside fragmented care, unstable housing, and transportation difficulties.

The study carries limitations worth noting. It was conducted within a single, highly diverse clinic network in Florida, so results may not generalize everywhere; it captured only patient-reported characteristics rather than provider-level factors; it assessed Pap testing rather than high-risk HPV testing for cervical screening adherence; and its cross-sectional design precludes conclusions about cause and effect, including the timing of precancer diagnoses relative to screening. Small sample sizes in some stratified models may also have limited statistical power. Still, the divergent findings, with anal screening lagging among women even as it advances among men, and cervical screening falling short precisely among the women who need it most, offer clinicians and public health planners a specific map of where targeted interventions, from stigma reduction to self-sampling, could save lives among one of the nation’s most cancer-vulnerable populations.

Subject of Research: Predictors of anal and cervical cancer screening uptake among adults with and without HIV

Article Title: Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network

Article References: Lin, Y. C., Hume, E., Boxtha, C., Commaroto, S. A., Lael, M., Christy, S. M., Vadaparampil, S. T., Giuliano, A. R., Coghill, A. E., Schabath, M. B., Vidrine, D. J., Peterson, J., DiPalmo, S., Joshi, H., Shukla, P., Vidrine, J. I., & Islam, J. Y. (2026). Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network. Cancer Causes & Control, 37(10), Article 159. https://doi.org/10.1007/s10552-026-02239-9

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02239-9

Keywords: HIV, anal cancer screening, cervical cancer screening, HPV, cancer prevention, health disparities, HIV stigma, Pap test, community health clinics, guideline adherence, Cancer Causes & Control, Ryan White clinics