Background:  Approximately 250,000 women in the United States are HIV-infected. An estimated 13 to 60% of these women have cervical cytological abnormalities, which can lead to invasive cervical cancer. HIV treatment guidelines recommend initial and annual Pap tests for all HIV-infected women. We assessed screening prevalence and associated factors among HIV-infected women to determine whether Pap screening is performed as recommended.

Methods:  We used data collected during 2000 to 2004 in the Supplement to HIV/AIDS Surveillance project, a cross-sectional interview study of HIV-infected persons aged ≥18 years in 18 states. Variables included demographic/socioeconomic factors, gynecologic history, HIV care, and use of medical services. We performed logistic regression to compute adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the association between various factors and not having a Pap test.

Results:  Among 2417 women, 556 (23.0%) had not had a Pap test during the past year. Factors associated with not having a Pap test included increasing age (AOR = 1.3/10 years, CI 1.1 to 1.4) and most recent CD4 cell count of <200 (AOR 1.6, CI 1.1 to 2.1) or unknown (AOR 1.4, CI 1.1 to 1.7). Compared with women whose most recent pelvic exam was performed at their HIV care provider’s office, those whose pelvic exam was performed elsewhere had increased odds of not having a Pap test during the past year (AOR 2.6, CI 2.1 to 3.2). Educational level, household income, drug use, and insurance status were not significantly associated with Pap screening.

Conclusions:  HIV care providers should ensure that annual Pap tests are performed for women of all ages who have low CD4 cell counts or receive gynecologic care elsewhere. Integrating HIV and gynecologic care and educating clinicians about Pap screening recommendations for HIV-infected women may increase screening among this population.