Why Are We Not Screening for Anal Cancer Routinely

HIV Physicians' Perspectives on Anal Cancer and Its Screening in HIV-Positive Men Who Have Sex With Men: A Qualitative Study

Jason J Ong; Meredith Temple-Smith; Marcus Chen; Sandra Walker; Andrew Grulich; Jennifer Hoy; Christopher K Fairley


BMC Public Health. 2015;15(67) 

In This Article



Semi-structured in-depth telephone interviews were conducted with HIV physicians throughout Australia. Health care services for Australians living with HIV are provided in hospital based settings (Infectious Disease, Immunology specialists) or community based clinics (Sexual health physicians, high-HIV caseload General Practitioners(GP)).[15] Purposive sampling (i.e. selective sampling that identifies particular characteristics of the study population) was used to maximize diversity of physicians. Selection was based on characteristics that the authors discussed and agreed upon that may potentially influence views on anal cancer screening - fulltime or part-time work, setting of HIV care, specialty and gender of the physician. We interviewed physicians until data saturation was reached (i.e. when additional interviews did not shed any further light on the issue).


Physicians from major HIV clinics in each state were approached via an email containing study participant information and consent form. If consenting, the interview was conducted over the phone(JO) using a pre-piloted semi-structured questionnaire. Structured questions captured physicians' demographic data and the remainder of the interview contained open questions aimed at eliciting physicians' understanding and attitudes towards anal cancer and its screening. Screening was defined as 1) using anal cytology and 2) early cancer detection using an annual DARE, self-examination and partner-examination. This study focused on anal cancer screening in HIV-positive MSM population.


Data were transcribed, organized electronically and assigned codes using NVIVO (QSR International Pty Ltd, version 10.0, 2012), a qualitative research software program. Data were analyzed using an iterative approach. After each interview a preliminary analysis was performed to allow the follow up of emerging issues to be included in subsequent interviews. Once all interviews were completed, content analysis was performed to group and label the data in order to identify emerging themes. Coding was conducted independently by two researchers(one sexual health clinician, one sexual health researcher) and then discussed with the research team to achieve consensus on common themes. Finally, coding for themes and concepts was used to frame the remaining data. We adhered to the qualitative research review guidelines (RATS)[16] in reporting the findings of this research.

This research was approved by the Alfred Health Human Ethics Committee (Project 31/13).