Cervical Cancer Screening Among Female Sex Workers in Uganda

Cervical Cancer remains a major health problem for women worldwide. In 2022, it ranked as the eighth most common cancer globally and was the ninth leading cause of cancer deaths. Around 661,021 women were diagnosed with cervical cancer, and 348,189 women lost their lives to this disease. The rate of cervical cancer cases varies between countries, especially between those with higher income and those with lower income. In richer countries, the rate of new cases and deaths from cervical cancer is lower compared to poorer countries, where it is much more common.

In certain regions, like East Africa, these numbers are alarming. For instance, in Uganda, 6,938 new cases of cervical cancer were reported in 2022, resulting in 4,782 deaths. This situation calls for urgent action to address the problem.

#Causes of Cervical Cancer

Cervical cancer is mainly caused by specific types of the Human papillomavirus (HPV), particularly types 16 and 18. These types are responsible for about 70% of new cervical cancer cases. Women living with HIV are at an increased risk of developing cervical cancer, compared to those who do not have HIV. Other factors that increase the risk of cervical cancer include starting to have sex at a young age, having a history of sexually transmitted infections (STIs), and having multiple sexual partners.

Female Sex Workers are particularly vulnerable. They often have multiple sexual partners and may practice unprotected sex, making them more likely to acquire HPV and other STIs. This group needs special attention and regular Screenings to catch cervical cancer early when it is easier to treat.

#Prevention and Screening Efforts

Preventing cervical cancer is possible through proven strategies. Regular screening can detect early signs of the disease, allowing treatments to be applied effectively. The global aim is to significantly reduce cervical cancer cases by 2030 through three main strategies: vaccinating 90% of eligible girls against HPV, ensuring 70% of women are screened with good tests, and properly managing 90% of women who test positive for cervical issues.

In countries with good health systems, screening has successfully identified over 90% of cervical cancer cases before they spread. However, many low- and middle-income countries struggle with low screening rates, often around 19%. In Uganda, for example, screening participation has been disappointingly low, with only about 4.8% of women taking part in a community study.

#Barriers to Screening

Several barriers prevent women from getting screened for cervical cancer. Many women have negative beliefs about screening. Issues within Healthcare facilities, such as a lack of awareness or support from medical staff, also contribute to the low rate of screenings. Studies have shown that fear of possible results, costs, and the procedures involved prevent many women from seeking screenings. Additionally, women in rural areas may find it harder to access healthcare facilities.

In Uganda, though some data exists regarding the general population's acceptance of cervical cancer screening, there is little information about female sex workers, who are at a higher risk. Their mobile lifestyle and limited access to healthcare services complicate matters. Therefore, it is essential to study the willingness and barriers to screening within this population.

#Study Overview

A recent study was conducted in northeastern Uganda, focusing on female sex workers aged 18-49. The aim was to understand how many of them were getting screened for cervical cancer, how acceptable screening was to them, and what factors influenced their decisions.

The study took place in a region with a high number of health facilities and a considerable population of female sex workers. Several healthcare centers provided services aimed at this group, and the study targeted those facilities to collect data effectively.

#Participants and Methods

The study involved a variety of female sex workers who were willing to participate. To get a robust sample size, researchers included a diverse group from different healthcare facilities that served a high number of sex workers. Data collection involved straightforward questionnaires completed by trained assistants who explained the study purpose and ensured informed consent.

Participants were asked whether they had ever undergone cervical cancer screening and if they would be willing to accept screening in the future.

#Findings

Out of 423 participants, the average age was around 28 years, and a majority were relatively young and had not completed their education. Most of the women were new to sex work, and many were using contraceptives. A significant number reported no history of STIs. However, the self-reported HIV prevalence in this group was notably high.

When analyzing the data, it was found that about 32.6% of the participants had undergone cervical cancer screening. The rate was significantly higher among those living with HIV.

Moreover, women living closer to certain types of health facilities, particularly private ones, were more likely to get screened. The availability of screening services in nearby facilities was also a strong factor influencing whether women participated. Those on preventive HIV treatments were also more inclined to seek screening.

#Acceptance of Screening

The study showed that most women (around 93.9%) were willing to accept cervical cancer screening if offered. Interestingly, women who had never been screened before were more likely to agree to screening in the future. Again, those living near private facilities were more likely to accept screening services.

#Implications

The findings reveal that many female sex workers understand the importance of cervical cancer screening and are open to participating. However, the limited availability of screening services remains a challenge. This presents an opportunity for health authorities in Uganda to build on the willingness shown by these women and expand accessible screening services.

Integrating cervical cancer screening into existing HIV care programs could be beneficial. This approach would allow for early detection and treatment, potentially saving lives.

#Conclusion

Cervical cancer is a pressing health issue for women, especially for high-risk groups such as female sex workers. Though there are barriers to screening, the acceptability of these services is high. It is crucial for health programs to focus on making screening services more accessible and promoting awareness about the importance of early detection.

By working to improve access and create support systems, the goal of reducing cervical cancer cases and deaths can become a reality.