The median age of the participants was 54 years (IQR: 46, 58). The majority (67.5%) reported being assigned male sex at birth, having an income less than $20,000 (71.7%), an education level of high school or more (54.3%), and having government health insurance (84.4%). Furthermore, 44% of the participants were MSM, 33% were women and 23% were men who have sex with women (MSW). The median years for living with HIV was 17 years (IQR: 9-25). Almost all participants reported using antiretroviral therapy (99.1%), and 20.8% reported having a history of acquired immunodeficiency syndrome (AIDS).
The self-reported prevalence of HPV infection was 12.0%. Although awareness of HPV vaccination was 53.8%, only 7.6% of the participants reported being vaccinated against HPV infection. More than half of the participants reported a history of sexually transmitted infections (STIs) (63%), while none reported having a history of AC. Regarding lifestyle characteristics, 29.3% reported being current smokers, 55.2% reported current alcohol intake and 64.1% reported use of non-IV drugs in their lifetime. Furthermore, more than half (80.2%) perceived having excellent/very good or good health. (Table 1)
HPV awareness was high among the study population (82.1%), but only 40.2% had adequate HPV knowledge (score ≥70). The majority correctly answered items about the risk of acquiring HPV; HPV can be transmitted by sexual contact (89.1%), having sex with multiple partners (95.4%), partners with multiple sexual partners (91.4%), or having sex at early ages (71.8%). When asked about HPV-related cancers, most of the participants correctly identified cervical cancer (87.4%), AC (83.9%) and oral cancer (67.2%). More than half think that HPV is uncommon (66.1%), that HPV-infected people always present symptoms (66.1%), and that genital warts are caused by HPV (62.6%). On the contrary, less than half think that condoms always prevent HPV infection (43.7%), and that HPV can disappear without treatment (8.6%).
Regarding AC, only 3.8% of the study population had adequate knowledge of AC risk-factors. However, a high proportion of participants correctly identified number of sex partners (87.3%), HPV infection (81.6%), unprotected sex (78.3%), anal sex (76.4%), HIV (69.8%), smoking (66.5%), and having gynecologic cancers (62.4%) as risk-factors for AC. Most felt they were at higher risk of AC than other people of the same age (51.4%). Some of the participants thought that screenings for AC are uncomfortable (40.0%), most of them had anal Pap (52.2%) history and the majority (59.6%) had done the anal Pap in the last 12 months. Additionally, 76.9% have considered getting tested for AC, and 96.7% indicated they will do the anal Pap test in the future (Data not shown). However, a history of high-resolution anoscopy (HRA) uptake was less common (19%) in this population.
Bivariate analysis
HPV awareness was significantly higher among women (89.9%), people with a history of anal Pap uptake (89.0%), and men who have sex with men (83.9%) (p<0.05). No other significant differences were seen. (Table 2)
Higher HPV knowledge adequacy was observed in participants with an education level of more than high school (51.6% vs 26.0%) and with a history of HPV infection (65.2% vs 35.8%). Also, participants with a history of sexually transmitted infections (47.8% vs 26.2%) and with a self-reported health perception of excellent/very good or good (45.6% vs 21.1%) showed more knowledge about HPV infection (p<0.05). (Table 4)
An association was seen between having adequate knowledge of AC risk-factors and the years living with HIV. More specifically, 6.8% of individuals living with HIV for 15 years or more had adequate knowledge of AC as compared to 0.0% of those who had lived with HIV for less time (p<0.05). (Table 4)
Multivariate analysis
Given significant interactions with age, logistic regression models were stratified by age-group (Table 5). Among PLWH aged 50 years or older, MSM (OR: 1.26, 95% CI: 1.07-1.47) and women (OR: 1.35, 95% CI: 1.15-1.59) had higher odds of HPV awareness than MSW in that age group. Among PLWH under 50 years, those with a history of anal Pap test had higher odds of HPV awareness (OR 1.34, 95% CI: 1.08-1.66) compared to their counterparts.
In multivariate logistic regression models, participants with an education level of more than high school (OR: 1.28, 95% CI: 1.10-1.50) and with a history of HPV diagnosis (OR: 1.33, 95%CI: 1.08-1.65) were more likely to have adequate HPV knowledge compared to their counterparts. In addition, PLWH who reported having good/very good/excellent health were more likely to have adequate knowledge as compared to those who reported poor/regular health (OR: 1.23, 95% CI: 1.03-1.47). Although not statistically significant, participants with a history of STIs (OR: 1.13, 95% CI: 0.97-1.32) were also more likely to have adequate HPV knowledge. (Table 6)
For knowledge of AC risk-factors, PLWH for 15 years or more had increased odds of having adequate knowledge (OR: 1.08, 95% CI: 1.02-1.14) compared to those diagnosed more recently (data not shown).