Experiences, Beliefs, and Attitudes About Cervical Cancer Screening Among Women in Pietermaritzburg, KwaZulu-Natal, in South Africa: A Qualitative Study

Abstract

Objective: The aim of this study was to understand women's experiences, beliefs, and attitudes about cervical cancer screening and the influence of living with Human Immunodeficiency Virus (HIV) on preventive Papanicolau (Pap) smears in South Africa. Design and Setting: Semi-structured interviews were conducted with participants in a private office at Thandanani Children’s Foundation (TCF) in Pietermaritzburg, KwaZulu Natal during July 2015. Data from transcripts was coded for themes using NVivo qualitative research software to identify meaningful patterns for analysis using both content and thematic analysis. Participants: 30 women participated in semi-structured interviews Results: The median age was 48, all participants had some high school education or less, and 77% of participants were unemployed. Seventeen participants were living with HIV, and 70% of participants had received at least one Pap smear at time of interview. Lack of knowledge about Pap smears and fear of the screening procedure were the most common barriers to obtaining Pap smears. Being HIV positive was associated with increased awareness about cervical cancer screening, and a positive facilitator for having had at least one Pap smear in their lifetime. Participants described the role of religion, patient autonomy, financial burdens, healthcare providers, and community awareness as other important factors influencing the decision to obtain a Pap smear. Conclusion: In South Africa, the barriers to cervical cancer screening continue to include lack of education and awareness about Pap smears, financial burdens to attending clinics, lack of connection of HIV negative women to the health care system, and reduced community awareness about cervical cancer and the role of Pap smears in prevention. However, there is improved awareness and utilization of cervical cancer screening among women living with HIV in Pietermaritzburg, Kwa-Zulu Natal. This study highlights that living with HIV in a peri-urban community in South Africa, in clinics with stable integration of HIV care into other health aspects, allows women living with HIV to extend their health care access to other areas of their life, hence improving cervical cancer screening.