Open Access Open Badges Research article

Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study

Luigino Dal Maso12*, Silvia Franceschi3, Mauro Lise1, Priscilla Sassoli de' Bianchi4, Jerry Polesel1, Florio Ghinelli5, Fabio Falcini6, Alba C Finarelli4 and the Screening of HIV-positive women in Emilia-Romagna (SHER) Study

Author Affiliations

1 Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico (CRO) - IRCCS, Via Gallini 2, 33081 Aviano (PN), Italy

2 Dipartimento di Medicina del Lavoro "Clinica del Lavoro Luigi Devoto," Sezione di Statistica Medica e Biometria "GA Maccacaro," Università degli Studi di Milano, Milan, Italy

3 International Agency for Research on Cancer, cours Albert Thomas 150, 69372 Lyon cedex 08, France

4 Servizio Sanità Pubblica, Assessorato Politiche per la Salute - Regione Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy

5 Presidente commissione consultiva tecnico-scientifica per la promozione di interventi per la prevenzione e la lotta contro l'AIDS, Regione Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy

6 Romagna Cancer Registry, Department of Medical Oncology, Cancer Institute of Romagna (IRST), Via Piero Maroncelli 34/36, 47014 Meldola, Italy

For all author emails, please log on.

BMC Cancer 2010, 10:310  doi:10.1186/1471-2407-10-310

Published: 21 June 2010



The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.


A cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.


A total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age ≥45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/μl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.

Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.


In recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women.