Anal cancer examination study

Using DARE in routine HIV care

We evaluated the use of digital anorectal examination (DARE) in routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service.

We found that including an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.

Awareness and risk of anal cancer in HIV+ MSM

We also surveyed 327 MSM living with HIV to measure their awareness, knowledge and perceived level of personal risk for anal cancer. The results showed that men who underestimated their risk were older, had poor anal cancer knowledge, and had more likely never had an anal examination. This survey showed that this population has limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.

Anal HPV detection related to anal sexual activity

We looked at whether anal HPV DNA detection is related to recent anal sexual activity, what types of anal sexual activity or the persistence of HPV genotypes. This study involved 281 MSM living with HIV. We detected anal HPV in MSM living with HIV in the majority of men throughout all age groups. Anal HPV detection remains high even in men reporting no anal sexual activity in the preceding six months.

Using DARE to detect early anal cancer in HIV+ MSM

We also investigated DARE as a way to detect early anal cancer in MSM living with HIV. We surveyed MSM about their anal and sexual health, adverse effects from the anal examination, cancer worry and quality of life. Annual DARE to detect anal cancer in MSM living with HIV was acceptable for patients. Strategies to increase HIV physician’s patient recruitment would be needed if DARE were to be implemented in anal cancer screening.

Performing ASE

We also interviewed MSM living with HIV to explore if anal self-examination (ASE) is acceptable as a method of anal cancer screening. Men were generally comfortable with the idea of ASE as a means for detecting anal cancer. Men expressed discomfort with ASE and anxiety about finding an abnormality. Participants preferred examination by a health professional.

Researchers

Principal investigators

Associate investigators

Publications