# Anal cancer risk and HPV infection knowledge and awareness among Hispanic persons living with HIV in Puerto Rico

## TL;DR

This study found that while many HIV-positive people in Puerto Rico are aware of HPV, few understand the risks of anal cancer or how to prevent it.

## Contribution

The study provides new insights into the knowledge gaps about HPV and anal cancer among Hispanic HIV-positive individuals in Puerto Rico.

## Key findings

- Only 40.2% of participants had adequate knowledge about HPV, and just 3.8% understood anal cancer risk factors.
- Higher education and prior HPV diagnosis were linked to better HPV knowledge.
- Educational efforts are needed to improve understanding of anal cancer prevention in this population.

## Abstract

Persons living with HIV (PLWH) have a higher risk of persistent infection with human papillomavirus (HPV) and anal cancer. We evaluated knowledge and awareness of HPV infection and risk factors for anal cancer among PLWH in Puerto Rico (PR).

Data from a cross-sectional study (2020–2021) were analyzed (n=212). Inclusion criteria included PLWH, aged ≥ 26 years, and living in PR. Telephone interviews collected information on sociodemographic, lifestyle and clinical characteristics. Two 13-item scales were used to assess knowledge of HPV and anal cancer risk factors; adequate knowledge for both scales were defined as scoring >70%. Logistic regression models using generalized linear models were used to determine the association between 1) HPV infection awareness, 2) HPV infection knowledge, and 3) Anal cancer risk factors knowledge.

The median age was 54 years (IQR: 46,58), 67.5% were male, 71.7% reported having an income <$20,000, and 54.3% had an education level of more than high school. HPV awareness was high (82.1%), but only 40.2% and 3.8% had adequate knowledge of HPV and anal cancer risk factors, respectively. In adjusted logistic regression models, men who have sex with men (OR: 1.26, 95%CI: 1.07–1.47) and women (OR: 1.35, 95%CI: 1.15–1.59) aged ≥50 years had higher odds of HPV awareness than heterosexual men in that age group. Moreover, those with history of anal Pap test aged <50 years had more HPV awareness (OR 1.34, 95%CI: 1.08–1.66) than their counterparts. Adequate HPV knowledge was higher among 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) than their counterparts. In addition, people with good/very good/excellent health perception had higher odds of HPV knowledge (OR:1.23, 95%CI: 1.03–1.47) than those who reported poor/regular health perception. For anal cancer risk factors, PLWH for ≥15 years had increased odds of having adequate knowledge (OR:1.07, 95%CI: 1.02–1.14) than their counterparts.

Despite high awareness of HPV, limited knowledge about HPV and anal cancer risk factors was observed among PLWH. Results from our study highlight the need for educational efforts within this population as an anal cancer prevention strategy.