Challenges and Opportunities to Reduce the Burden of Cervical Cancer in a Low Income, High HIV Prevalence Context

Abstract BackgroundCervical cancer is a leading cause of death among Cameroon women. The burden of cervical cancer is in part traceable to the inadequate understanding of contextual determinants of access to expanding screening and prevention opportunities. We explored multilevel individual, community and structural factors that facilitate or inhibit cervical cancer prevention in women at risk in a high HIV prevalence context. MethodsWe utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews. A two-stage sampling strategy was used to select 80 women and 20 men who participated in 8 focus group discussions and 8 in-depth interviews. The socio-ecological model guided the analysis of data to identify micro, meso and macro level determinants of cervical cancer screening. ResultsMicro-level factors-low level of awareness and knowledge about cervical cancer, lack of access to information about screening, low risk perceptions, poor health seeking behaviors and excessive cost of cervical cancer screening were major barriers for women seeking cervical cancer screening. Meso-level factors, such as social networks, socio-cultural norms, perceptions of the role of men and HIV-related stigma when screening is integrated into HIV care, also engender negative attitudes and behaviors. Poorly equipped health facilities and a lack of national cancer prevention policies and programs were among macro-level barriers limiting access to cervical cancer screening. ConclusionThe success of efforts to reduce the burden of cervical cancer in Cameroon rests on eliminating the myriad individual, familial, community and structural factors that limit access to screening among women in the study communities.