Access to gynecological services and Papanicolau tests in HIV-infected Italian women : a questionnaire survey

The objective of the study was to evaluate the access to Papanicolau (Pap) tests of HIV-infected women in Italy. A cross-sectional survey on a cohort of HIV-infected women seen at 27 HIV clinics was performed. At each clinic a female physician involved in the care of HIV-infected women was asked questions on clinic and patients' characteristics and on access to Pap tests. The outcome of the study was to find the percentage of women who had not had a Pap test before coming to the HIV clinic and the percentage having had a Pap test in 2001. In the survey, 7,600 HIV-infected women were represented. Women who came to the clinic without having ever had a Pap test were 62 ± 22%, while women who had had a Pap test in 2001 were 43 ± 36%. Women who reported never having had a Pap test before coming to the HIV clinic were more often from the south than the north of Italy (17.9 ± 49% from the north, 18 ± 53% from the center and 9.3 ± 83.9% from the south; p <0.001). This a difference disappeared when comparing the women who had had a Pap test in 2001 (28 ± 39.6% from the north, 31.6 ± 44.2% from the center and 25.6 ± 45.7% from the south; p = 0.88). Despite the published guidelines in Italy, only 38% of women had ever had a Pap test before coming to the HIV clinic and only 43% had had a Pap test in 2001. Strategies aimed to improve these proportions should be rapidly implemented at all levels of care organization.