Despite the availability of free cervical cancer screening services, most female sex workers living with HIV do not seek this service.
A recent study shows that less than half—just 45.3 per cent—of those in Nairobi, have been screened in the past year.
The number is far much lower in other parts of the country. Why? Fear they would actually be diagnosed with the disease, inconvenient clinic hours, lack of awareness and exaggerated stories on how uncomfortable the procedure is.
Cervical cancer is curable if detected and treated early. Sex workers, particularly those living with HIV, are at higher risk of HPV infection, which can rapidly develop to cervical cancer.
The study indicates most of them lack this knowledge.
"A significant proportion of the participants were unaware of the link between HPV (human papillomavirus) and cervical cancer," the study notes.
HIV weakens the immune system, making it harder to fight off infections like HPV, which in turn accelerates the progression of pre-cancerous lesions into invasive cancer.
Despite these risks, data from across Sub-Saharan Africa show that only a fraction of HIV-positive women, including sex workers, receive regular screenings.
The discomfort associated with the screening method was another significant deterrent.
Two-thirds (66.7 per cent) of respondents said they found the screening process uncomfortable, with some fearing the potential results or finding the procedure itself painful.
"Fearing the outcome" was cited by half of those who avoided screening and cultural beliefs about the disease added another layer of resistance.
Almost 40 per cent of participants mentioned that stigma rooted in cultural practices prevented them from seeking screening services.
In particular, beliefs that cervical cancer was a result of promiscuity or witchcraft deterred many women from seeking help.
The study, published in Therapeutic Advances in Infectious Disease, focused on female sex workers living with HIV who accessed services through the Sex Workers Outreach Programme (Swop) health facilities in Nairobi, between August 2022 to January 2023.
Swop is a network of health facilities that offer free sexual reproductive health and HIV services that include free cervical cancer screening to sex workers.
Researchers collected data from 75 women aged 18 to 49. At least 77.6 per cent of participants also identified inconvenient clinic hours as a major barrier.
The Swop facilities operate from 8am to 5pm, hours that conflict with many sex workers’ schedules, as noted by one participant:
"We work at night and sleep during the day, making it hard to access services during clinic hours."
Geographic and logistical challenges also played a role.
More than a third (36 per cent) of the participants lived over 10km from the nearest clinic, adding transportation costs and time to the list of obstacles.
This distance proved to be a significant barrier for a population already facing economic challenges.
Cervical cancer is the second most frequent cancer among women in Kenya, according to the National Cancer Institute, which coordinates all prevention and control activities in the country.
Current estimates indicate that every year 5,236 women are diagnosed with cervical cancer and 3,211 die from the disease.
This study adds to the growing body of research that underscores the vulnerability of HIV-positive women to cervical cancer.
Maureen Akolo of the Aga Khan University School of Nursing & Midwifery, and her co-authors, noted that the low uptake in Nairobi mirrors trends seen in other regions.
Only five per cent of FSWs living with HIV were screened for cervical cancer in 2019, suggesting that cultural, financial and logistical barriers remain unaddressed.
"These barriers need to be addressed urgently if we are to prevent unnecessary deaths from cervical cancer in this high-risk population," said the study.
The authors recommend several strategies to improve cervical cancer screening among HIV-positive sex workers in Nairobi.
Flexible clinic hours and mobile screening units could help address the scheduling and distance barriers, while community-based education programmes could dispel myths about cervical cancer and reduce stigma.
Furthermore, training healthcare workers to provide culturally sensitive care could help bridge the gap between service availability and uptake.
"FSWs face a triple burden of stigma: for their work, their HIV status and the potential of cervical cancer," they noted.