Cervical Health Among Survivors of Intimate Partner Violence

Background and Purpose. Women who experience intimate partner violence (IPV) have increased risk for cervical cancer. Cervical cancer is caused by Human Papilloma Virus (HPV), a sexually transmitted disease. IPV survivors have unique risk factors for negative sexual health outcomes because of the context of abuse. Fortunately, primary prevention of HPV is possible because an effective vaccine exists for both sexes (now approved for ages ≤ 45). An important secondary prevention strategy, routine gynecological exams with Papanicolaou (Pap) testing, leads to early detection and treatment of cervical cancer.

Research Question. Among IPV survivors currently receiving services from domestic violence social service agencies, what are the self-reported experiences, levels of knowledge, and perceived self-efficacy with Pap testing and HPV vaccination?

Methods. Web-based and pen and paper surveys were distributed to IPV survivors (N = 30) in the Midwestern U.S. who enrolled in a trauma-informed sexual health program at participating domestic violence social service agencies. Questions included their history of sexual health care, including Pap testing and HPV vaccination, as well as barriers to Pap-testing self-efficacy.

Results. In this sample, most women had ever had a Pap test (n = 25; 83.3%), over half of whom reported abnormal results (n = 14 out of 25; 56%). Five participants (16.7%) reported a history of cervical cancer. Half of the sample (n = 15; 50%) had past-year comprehensive sexual health exams. Fewer participants received their Pap results (n = 9; 30%) or followed their doctor’s recommendations based on results (n = 7; 23.3%). Regarding primary prevention, most participants had heard of HPV (n = 21; 80%) and HPV vaccine (n = 19; 63%). However, fewer (n = 11; 36.7%) had ever talked to their provider about HPV vaccine and only six (n = 20%) had received the HPV vaccine. Among participants who had not been vaccinated, some intended to get the vaccine (n = 5; 16.7%), whereas others were undecided (n = 11; 36.7%). The greatest perceived barriers to self-efficacy of Pap-testing were using street drugs (n = 20; 66.6%), drinking heavily (n = 19; 63%), and having to self-pay (n = 18; 60%). Lack of health insurance could be a major barrier for Pap tests and HPV vaccine, as half of participants did not have health insurance (n = 15; 50%). Of those who did have health insurance, most had public insurance (n = 10 out of 15; 67%).

Conclusions and Implications: Results show the opportunity for increasing HPV vaccination as a primary prevention strategy for cervical cancer prevention among IPV survivors. They also show the importance of comprehensive programs that address substance use with sexual health, violence, and trauma. For policy practice, findings demonstrate the importance of increasing access to public health benefits and ensuring that sexual and reproductive health services are covered. Social workers are particularly situated to address the complex issues, like partner violence, substance use, and lack of insurance, that impact women’s sexual health. Social workers are needed on interdisciplinary teams to reduce sexual health disparities for IPV survivors.