The Study of Prevalence, Knowledge, Attitude, Beliefs and Practice of Cervical Cancer in HIV Positive Women in Purdah and HIV Positive Women Not in Purdah in Gombe State Nigeria

Introduction: Purdah or pardah is a Persian word which translated loosely to mean ‘curtain’, is a religious and social practice of female seclusion prevalent among some Muslim communities. In stating the reasons for the need of purdah, the Qu’ran declares that “the observance of hijab is so that the (pure and pious women) may be recognized and not be molested” Cervical cancer is a malignant disease of the cervix. The disease has a pre-malignant stage which usually occurs in younger women. Carcinoma of the cervix is associated with the following risk factors; early age at first sexual intercourse, multiple male sexual partners, male sexual partners who have had multiple partners, early age at first birth, multiparty, smoking, long-term use of oral contraceptive pills, immunosuppressed states. Cervical cancer is preventable through vaccination and can be easily diagnosed, but prevention and diagnostic programmes are not widely available in the developing world (Branca et al., 2003). Rates of cervical cancer are four to five times higher among women living with HIV than among HIV negative women, while the overall risk of acquiring HIV among women doubles when women are infected with the human papillomavirus, a cause of cervical cancer.
Aim: To study the Prevalence, Knowledge, Attitude, Beliefs and Practice of cervical cancer in HIV positive women in purdah and HIV positive women not in purdah, and relate this to the prevalence of cervical cancer.
Methods: The study was a cross-sectional study to determine the prevalence of cervical cancer among HIV positive women in purdah attending the anti retroviral therapy (ART) Clinic of the Federal Teaching Hospital, Gombe. A sample size of 150 each was used for both the subject group and controls. HIV positive women in purdah=150 subjects, HIV positive women not in purdah= 150 subjects and HIV negative women not in purdah =150 subjects. Sample size equals 450 to give room for alteration.
Results: Results collected using the questionnaire revealed that only a mean of about 41 (27.3%) HIV positive women in purdah had correct knowledge of Cervical Cancer as compared with HIV positive women not in purdah who had a mean of 129 (86.0%) and 114 (76.7%) for HIV negative women not in purdah. Large percentage of 61.3% of HIV positive women in Purdah, 86.0% of HIV positive women not in purdah and 76.7% of HIV negative women not in purdah, had previous knowledge of Cervical Cancer. The knowledge about the link between early marriages to increased risk of cervical cancer was not low amongst HIV positive women in purdah (34.7%) but this was not the case with their counterparts as 86.0% of HIV positive women not in purdah and 80.7% of HIV negative women in purdah were knowledgeable about the link. Not less than 95% of women in all groups expressed indifference towards the gender of the personnel collecting the Pap smear nevertheless some still showed some reluctance towards having their pap smear collected by personnel of the opposite sex. Women in purdah showed the highest percentage of this reluctance (4.7%). As regards to practices, the women in purdah had a mean positive practice of 63.3% as against 58.7% and 60.8% respectively of the control group (HIV positive women not in purdah and HIV negative women not in purdah). Women in purdah had a higher positive practice in all cases except the issues of husbands deciding the number of children (16.7% -HIV positive women in purdah, 88.0% -HIV positive women not in purdah and 100% -HIV negative women not in purdah) and husbands deciding when to stop having children (35.5% -HIV positive women in purdah, 52.0% -HIV positive women not in purdah and 43.3% -HIV negative women not in purdah).
Conclusion: The prevalence of cervical lesions in HIV positive women in purdah (42.0%) is higher than that of HIV negative women not in purdah (16.0%), but lower than that of HIV positive women not in purdah (56.0%).Hiv positive women in purdah had the lowest knowledge of cervical cancer with a mean score of (27.3%) while the control groups had a higher knowledge of 86.0% and 76.7% respectively. This implies that there is need for comprehensive and correct knowledge, positive attitude/ beliefs and positive behavioral practice are important in the control of cervical cancer and diseases in general.