Addressing anal health in the HIV primary care setting: a disappointing reality

The increased risk of anal cancer among individuals living with HIV suggests that anal health (e.g., anal symptoms, anal practices, examination of the anus) should be an issue of priority for HIV care providers to discuss with their HIV-infected patients. We investigated the prevalence of HIV-infected individuals discussing anal health with their HIV primary care provider and factors associated with this discussion. We surveyed 518 adult patients from 5 HIV primary care clinics in Miami, Florida, from May 2004 to May 2005. Overall, only 22% of women, 32% of heterosexual men, and 54% of men who have sex with men (MSM) reported discussing anal health with their HIV providers in the prior 12 months. In a multivariable logistic regression, when adjusting for other factors, heterosexual men and MSM were 2.31 and 5.56 times, respectively, more likely to discuss anal health with their HIV providers compared to their women counterparts. Other factors associated with anal health discussion were the patients' better perception of engagement with HIV providers and having had a sexually transmitted disease exam in the past 12 months. Reporting of unprotected sex with HIV-negative or unknown HIV status was inversely related to discussion of anal health with primary care providers (odds ratio [OR] = 0.53). Efforts are greatly needed to increase the focus on anal health in the HIV primary care setting for both men and women.