Assessing Differences in Healthcare Access for Women in Rural Uganda by HIV Status

PURPOSE Although a preventable disease, cervical cancer is a leading cause of cancer death among women in low- and middle-income countries (LMICs). Uganda has one of the highest cervical cancer incidence rates, largely due to limited accessibility and availability of screening services. Human immunodeficiency virus (HIV) positive women are significantly more likely to develop cervical cancer and face barriers to accessing healthcare when compared to HIV-negative women. As such, HIV-positive women represent a priority population for cervical cancer prevention. This study aims to compare how HIV-positive and HIV-negative women in rural Uganda access health services to inform the integration of cervical cancer screening with HIV care. METHODS This cross-sectional study recruited women living in the South Busoga District Reserve from January to August 2023. Women were eligible if they were aged 30 to 49 years old, had no history of cervical cancer screening or treatment, had no previous hysterectomy, and could provide informed consent. Participants completed a survey administered by village health teams, which included questions on HIV status, demographics, healthcare access, and services received. The data was analyzed using bivariate descriptive statistics, including chi-square and Fisher's exact tests. RESULTS Among the 1437 participants included in the analysis, 8.8% were HIV-positive. The majority of the respondents were between 30-39 years of age, were married, had received primary education or higher, and were farmers. The majority of women in both groups had accessed outreach visits (HIV-positive = 89.0%, HIV-negative = 85.8%) and health centers (HIV-positive = 96.1%, HIV-negative = 80.2%). The most commonly received services among both groups of women at outreach visits and health centers were immunization and antenatal care, respectively. CONCLUSION Our study demonstrated that there were no significant differences in healthcare access between HIV-positive and HIV-negative women in rural Uganda. Additionally, the high usage of healthcare services by women living with HIV suggests that the integration of cervical cancer and HIV screening may facilitate early detection and prevention of cervical cancer among this population. This can reduce the burden of disease in Uganda and further contribute to the World Health Organization's initiative to eradicate cervical cancer.