{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:37:33Z","timestamp":1785436653635,"version":"3.56.0"},"reference-count":22,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Cervical cancer is more prevalent in human immunodeficiency virus (HIV)-positive women and is frequently diagnosed in an advanced stage. This study sought to understand factors contributing to the delayed diagnosis of cervical cancer in HIV-positive women at Mokopane Hospital in the Limpopo Province of South Africa.\nMethods:\u00a0A qualitative phenomenological study was conducted using individual interviews among purposively sampled HIV-positive women who were diagnosed with cervical cancer. Interviews were recorded, transcribed verbatim, translated and analysed thematically.\nResults:\u00a0Four major themes emerged from the study, providing possible explanations for the delay in cervical cancer diagnosis. Firstly, women believed that Papanicolaou (PAP) smears are diagnostic and should be performed when symptoms appear, rather than for screening. Secondly, their readiness, fear and embarrassment to do the procedure delayed them from having a PAP smear. Thirdly, consulting traditional healers initially, also caused delays. Fourthly, a lack of equipment, inadequate follow-up, health workers\u2019 low index of suspicion and unwillingness to do the procedure further delayed diagnosis.\nConclusion:\u00a0Human immunodeficiency virus-positive women have an inadequate understanding of cervical cancer screening and its importance. Patient education and health worker training are urgently needed to improve the screening. To counteract delays in screening, adequate staffing, regular maintenance and availability of equipment are vital for improved care for HIV-positive women.\nContribution:\u00a0This study highlights how a poor understanding of cervical cancer screening, patients\u2019 readiness, fear and embarrassment to do the procedure, as well as inadequate equipment and poorly motivated health workers, all contribute to the delayed cervical cancer diagnosis in HIV-positive women.<\/jats:p>","DOI":"10.4102\/safp.v67i1.6221","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T11:53:18Z","timestamp":1764762798000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors contributing to delayed diagnosis of cervical cancer in human immunodeficiency virus-positive women"],"prefix":"10.4102","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0176-8028","authenticated-orcid":false,"given":"Frenzar M.","family":"Tshiruruvhela","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017p87168","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Limpopo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5501-4017","authenticated-orcid":false,"given":"Mbuyisa J.","family":"Makhubu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017p87168","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Limpopo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-5706","authenticated-orcid":false,"given":"Gert J.O.","family":"Marincowitz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017p87168","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Limpopo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3955-9800","authenticated-orcid":false,"given":"Clara","family":"Marincowitz","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Stelzle D, Tanaka LF, Lee KK, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Glob Health. 2021;9:e161\u2013e169. https:\/\/doi.org\/10.2139\/ssrn.3611968","DOI":"10.1016\/S2214-109X(20)30459-9"},{"key":"ref1","unstructured":"Statistics South Africa. Cancer in South Africa (2008\u20132019) (Report 03-08-00) [homepage on the Internet]. Pretoria: Statistics South Africa; 2023 [cited 2023 Jul 07]. Available from: https:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwipx9S345iCAxVJVEEAHQumDrsQFnoECBkQAQ&url=https%3A%2F%2Fwww.statssa.gov.za%2Fpublications%2F03-08-00%2F03-08-002023.pdf&usg=AOvVaw2OmqYAI7CGe9S6zEvHIuZX&opi=89978449"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Mbuya W, Mcharo R, Mhizde J, et al. Depletion and activation of mucosal CD4 T cells in HIV infected women with HPV-associated lesions of the cervix uteri. PLoS One. 2020;15(10):e0240154. https:\/\/doi.org\/10.1371\/journal.pone.0240154","DOI":"10.1371\/journal.pone.0240154"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Li Z, Winer RL, Ba S, et al. Effect of human immunodeficiency virus infection on human papillomavirus clearance among women in Senegal, West Africa. J Infect Dis. 2023;227(9):1088\u20131096. https:\/\/doi.org\/10.1093\/infdis\/jiac428","DOI":"10.1093\/infdis\/jiac428"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Harries J, Scott SE, Walter FM, Mwaka AD, Moodley J. Women\u2019s appraisal, interpretation and help-seeking for possible symptoms of breast and cervical cancer in South Africa: A qualitative study. BMC Women\u2019s Health. 2020;20:251. https:\/\/doi.org\/10.1186\/s12905-020-01120-4","DOI":"10.1186\/s12905-020-01120-4"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Hauwa I, Oluwasanu MM, John-Akinola Y, Oyewole OE. Knowledge of cervical cancer and barriers to screening among women in a city in Northern Nigeria. J Public Health. 2022;30(8):1923\u20131933. https:\/\/doi.org\/10.1007\/s10389-021-01593-z","DOI":"10.1007\/s10389-021-01593-z"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Bukirwa A, Mutyoba JN, Mukasa BN, et al. Motivations and barriers to cervical cancer screening among HIV infected women in HIV care: A qualitative study. BMC Women Health. 2025;15:82. https:\/\/doi.org\/10.1186\/s12905-015-0243-9","DOI":"10.1186\/s12905-015-0243-9"},{"key":"ref7","unstructured":"Republic of South Africa. National Department of Health. Cervical cancer prevention and control policy [homepage on the Internet]. 2017 [cited 2023 Aug 03]. Available from: https:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwi7j6uNo5qCAxXpTEEAHQMuBzsQFnoECBoQAQ&url=https%3A%2F%2Fwww.health.gov.za%2Fwp-content%2Fuploads%2F2021%2F07%2Fcervical-cancer-policy.pdf&usg=AOvVaw2EdJnzNegziyehjUtBrBUT&opi=89978449"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Godfrey MAL, Mathenjwa S, Mayat N. Rural Zulu women\u2019s knowledge of and attitudes towards Pap smears and adherence to cervical screening. Afr J Prim Health Care Fam Med. 2019;11(1):e1\u2013e6. https:\/\/doi.org\/10.4102\/phcfm.v11i1.1994","DOI":"10.4102\/phcfm.v11i1.1994"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Ngambi D, Ramathuba DU. Challenges regarding the implementation of cervical cancer screening guidelines in Limpopo province, South Africa. Afr J Prim Health Care Fam Med. 2024;16(1):1\u20137. https:\/\/doi.org\/10.4102\/phcfm.v16i1.4487","DOI":"10.4102\/phcfm.v16i1.4487"},{"key":"ref10","unstructured":"World Health Organization. The global health observatory. Cervical cancer screening [homepage on the Internet]. 2025 [cited 2025 Aug 20]. Available from: https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/3240#:~:text=IARC%20concludes%20that%20there%20is,or%20more%20among%20screened%20women"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Mabuza LH, Govender I, Ogunbanjo GA, Mash B. African primary care research: Qualitative data analysis and writing results. Afr J Prim Health Care Fam Medicine. 2014;6(1):E1\u2013E5. https:\/\/doi.org\/10.4102\/phcfm.v6i1.640","DOI":"10.4102\/phcfm.v6i1.640"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Matenge TG, Mash B. Barriers to accessing cervical cancer screening among HIV positive women in Kgatleng district, Botswana: A qualitative study. PLoS One. 2018;13(10):e0205425. https:\/\/doi.org\/10.1371\/journal.pone.0205425","DOI":"10.1371\/journal.pone.0205425"},{"key":"ref13","unstructured":"Makuvire T. Experiences, beliefs, and attitudes about cervical cancer screening among women in Pietermaritzburg, KwaZulu-Natal, in South Africa: A qualitative study [Doctoral dissertation]. 2018 [cited 2023 Oct 01]. Available from: http:\/\/nrs.harvard.edu\/urn-3:HUL.InstRepos:41973524"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Assefa AA, Astawesegn FH, Eshetu B. Cervical cancer screening service utilization and associated factors among HIV positive women attending adult ART clinic in public health facilities, Hawassa town, Ethiopia: A cross-sectional study. BMC Health Serv Res. 2019;19(1):847. https:\/\/doi.org\/10.1186\/s12913-019-4718-5","DOI":"10.1186\/s12913-019-4718-5"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Bateman LB, Blakemore S, Koneru A, et al. Barriers and facilitators to cervical cancer screening, diagnosis, follow-up care and treatment: perspectives of human immunodeficiency virus-positive women and health care practitioners in Tanzania. Oncologist. 2019;24(1):69\u201375. https:\/\/doi.org\/10.1634\/theoncologist.2017-0444","DOI":"10.1634\/theoncologist.2017-0444"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Thapa DK, Visentin DC, Kornhaber R, West S, Cleary M. The influence of online health information on health decisions: A systematic review. Patient Educ Couns. 2021;784(104):770\u2013784. https:\/\/doi.org\/10.1016\/j.pec.2020.11.016","DOI":"10.1016\/j.pec.2020.11.016"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Chereka AA, Shibabaw AA, Butta FW, et al. Explore barriers to using the internet for health information access in African countries: A systematic review. PLoS Digit Health. 2025;4(1):e0000719. https:\/\/doi.org\/10.1371\/journal.pdig.0000719","DOI":"10.1371\/journal.pdig.0000719"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Kangmennaang J, Onyango EO, Luginaah I, Elliott SJ. The next sub Saharan African epidemic? A case study of the determinants of cervical cancer knowledge and screening in Kenya. Soc Sci Med. 2018;197:203\u2013212. https:\/\/doi.org\/10.1016\/j.socscimed.2017.12.013","DOI":"10.1016\/j.socscimed.2017.12.013"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Moucheraud C, Kawale P, Kafwafwa S, Bastani R, Hoffman RM. It is big because it\u2019s ruining the lives of many people in Malawi: Women\u2019s attitudes and beliefs about cervical cancer. Prev Med Rep. 2020;18:101093. https:\/\/doi.org\/10.1016\/j.pmedr.2020.101093","DOI":"10.1016\/j.pmedr.2020.101093"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Adepoju EG, Ilori T, Olowookere SA, Idowum A. Targeting women with free cervical cancer screening: Challenges and lessons learnt from Osun state, southwest Nigeria. Pan Afr Med J. 2016;24:319. https:\/\/doi.org\/10.11604\/pamj.2016.24.319.9300","DOI":"10.11604\/pamj.2016.24.319.9300"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Heena H, Durrani S, AlFayyad I, et al. Knowledge, attitudes, and practices towards cervical cancer and screening amongst female healthcare professionals: A cross-sectional study. J Oncol. 2019:5423130. https:\/\/doi.org\/10.1155\/2019\/5423130","DOI":"10.1155\/2019\/5423130"}],"container-title":["South African Family Practice"],"original-title":[],"link":[{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/6221\/9971","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T11:53:22Z","timestamp":1764762802000},"score":1,"resource":{"primary":{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/6221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,6]]}},"URL":"https:\/\/doi.org\/10.4102\/safp.v67i1.6221","relation":{},"ISSN":["2078-6190","2078-6204"],"issn-type":[{"value":"2078-6190","type":"print"},{"value":"2078-6204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]},"article-number":"a6221"}}