HIV-positive women in one of the world’s richest countries are receiving suboptimal gynaecological care, according to a study published in the December 15^th edition of the Journal of Acquired Immune Deficiency Syndromes. Investigators from the Swiss HIV Cohort Study found that a significant proportion of women were not having regular gynaecological examinations and PAP smears to check for cervical abnormalities. Non-white ethnicity, poor education, injecting drug use and being under or over weight were factors associated with a lack of gynaecological care.

Gynaecological diseases occur with greater frequency and severity in HIV-positive women. Common conditions include vulvo-vaginal thrush, menstrual abnormalities, and genital ulcers. More serious conditions that HIV-positive women experience are pelvic inflammatory disease (PID) and cancerous and pre-cancerous cervical cell changes.

It is therefore recommended that HIV-positive women should have at least one gynaecological examination a year that includes a PAP smear test.

Investigators from the Swiss HIV Cohort Study wished to determine if the recommendations for an annual examination and PAP smear were being followed, and the factors associated with poor compliance.

At twice-yearly intervals between 2001 and 2004, a total of 2,150 women in the cohort were asked to complete questionnaires about their gynaecological care since their last visit. The investigators also gathered information on individual’s demographics, weight, smoking, drug use, immunological and virological characteristics.

A gynaecological examination was reported at 45% of the follow-up visits, and at 22% of these visits an abnormality was detected. A PAP smear was performed at 82% of the visits when a gynaecological examination was performed.

The investigators then conducted further analysis this time focusing on the 1,146 women who were followed over the entire study period. They found that 7% of these women had never had a gynaecological examination, 57% had had inconsistent examinations, and that only 35% of women had gynaecological examinations in each period analysed. The investigators also found that 13% of women had never had a PAP smear, 62% had had inconsistent smears, and that only 26% had had smears at regular, six-monthly intervals.

Factors significantly associated with poor gynaecological care included non-white ethnicity (p = 0.02), lower level of education (p < 0.001), being under weight (p = 0.02), being obese (p = 0.01), current injection drug use (p = 0.001), being a smoker (p < 0.001), and receiving private medical care (p < 0.001).

“Gynaecological care among HIV-positive women followed in the Swiss HIV Cohort Study is not satisfactory”, comment the investigators, adding “if gynaecological care does not occur, the treating physician should try and elucidate possible reasons and explain to patients why this care is so important.”

Reference

Keiser O et al. Frequency of gynecological follow-up and cervical cancer screening in the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 43: 550 – 555, 2006.