{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:16:42Z","timestamp":1777677402201,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2015,12,2]],"date-time":"2015-12-02T00:00:00Z","timestamp":1449014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Promotion Practice"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:p>Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. Results are presented from six provider focus groups conducted to inform the promotion\/education component of a Hawai\u2018i-based project on anal cancer screening tools. Krueger\u2019s focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being \u201con the radar\u201d of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming\/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through \u201creal talk\u201d (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians\/Pacific Islanders, transgender persons, and other marginalized groups. Application of strategies for health practice are specific to the Hawai\u2018i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion\/education with diverse PLHIV in other locales.<\/jats:p>","DOI":"10.1177\/1524839915615611","type":"journal-article","created":{"date-parts":[[2015,12,2]],"date-time":"2015-12-02T21:13:07Z","timestamp":1449090787000},"page":"21-30","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening"],"prefix":"10.1177","volume":"17","author":[{"given":"Lana Sue I.","family":"Ka\u2018opua","sequence":"first","affiliation":[{"name":"University of Hawai\u2018i\u2013Ma\u2013noa, Honolulu, HI, USA"},{"name":"University of Hawai\u2018i Cancer Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Cassel","sequence":"additional","affiliation":[{"name":"University of Hawai\u2018i Cancer Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Shiramizu","sequence":"additional","affiliation":[{"name":"University of Hawai\u2018i\u2013Ma\u2013noa, Honolulu, HI, USA"},{"name":"University of Hawai\u2018i Cancer Center, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca L.","family":"Stotzer","sequence":"additional","affiliation":[{"name":"University of Hawai\u2018i\u2013Ma\u2013noa, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Robles","sequence":"additional","affiliation":[{"name":"University of Hawai\u2018i\u2013Ma\u2013noa, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy","family":"Kapua","sequence":"additional","affiliation":[{"name":"Life Foundation of O\u2018ahu, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malulani","family":"Orton","sequence":"additional","affiliation":[{"name":"Life Foundation of O\u2018ahu, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cris","family":"Milne","sequence":"additional","affiliation":[{"name":"University of Hawai\u2018i\u2013Ma\u2013noa, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maddalynn","family":"Sesepasara","sequence":"additional","affiliation":[{"name":"Life Foundation of O\u2018ahu, Honolulu, HI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,12,2]]},"reference":[{"key":"bibr1-1524839915615611","volume-title":"Health and culture: Beyond the Western paradigm","author":"Airhihenbuwa C. 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