article · International Journal for Equity in Health
Cervical cancer is preventable, yet women living with HIV face an elevated risk of disease due to persistent human papillomavirus infections. An analysis of national survey data from 361 Ethiopian women living with HIV aged 25 to 49 reveals substantial socioeconomic disparities in screening participation. Overall, only 15.5 percent of these women had received cervical cancer screening. Uptake was disproportionately concentrated among wealthier individuals, rising from 9.6 percent in the poorest quintile to 20.4 percent in the middle quintile. Geographical residence and marital status were identified as the primary drivers of this wealth-related divide, contributing 61.2 percent and 49.3 percent to the inequality, respectively. Meeting national and international elimination targets will require public health initiatives specifically designed to bridge geographical and social divides in screening access.
Women living with HIV are at high risk of cervical cancer, making regular screening essential for early detection and treatment. Identifying how residence and wealth shape access helps health planners design targeted screening outreach, ensuring preventative care reaches the most vulnerable populations and supports global elimination targets.
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Abstract Background Although cervical cancer is a preventable disease, its burden remains disproportionately high globally, predominantly affecting women in low- and middle-income countries because of inequalities in the uptake of cervical cancer screening. Women living with HIV are at substantially higher risk of developing cervical cancer because of persistent human papillomavirus infection, yet the uptake of cervical screening is very low. In Ethiopia, there is limited evidence on the underlying socioeconomic inequality in screening uptake. Therefore, this study aimed to assess socioeconomic inequalities in the uptake of cervical cancer screening among women living with HIV in Ethiopia. Methods This study was a secondary analysis of data from the Ethiopia Population-based HIV Impact Assessment (EPHIA) survey conducted in 2017–2018. 361 women living with HIV aged 25 to 49 years were included in the analysis. Survey-weighted analyses were performed to account for the complex sampling design. Socioeconomic inequalities were assessed using equiplot, concentration curves, concentration indices, the slope index of inequality (SII), and the relative index of inequality (RII). Fairlie decomposition analysis was performed to quantify the contribution of sociodemographic characteristics to wealth-related inequalities in cervical cancer screening uptake. Results The overall uptake of cervical cancer screening was 15.5% (95% CI: 11.8%–20.1%). Uptake was higher among wealthier women, increasing from 9.6% in the poorest wealth quintile to 20.4% in the middle wealth quintile, an absolute difference of 10.8% points. The concentration index was 0.077, indicating that screening uptake was slightly concentrated among women with higher socioeconomic status. Fairlie decomposition analysis showed that marital status (49.3%) and residence (61.2%) were the largest contributors to wealth-related inequalities. Conclusion This study found significant inequalities in the uptake of cervical cancer screening among Ethiopian women living with HIV, with relatively low uptake overall. Marital status and residence accounted for most of the wealth-based inequalities in service uptake in this group. Efforts to achieve the WHO cervical cancer elimination goals and comply with national policy will require a more purposeful approach. Emphasis should be placed on developing targeted, equality-focused interventions for women, considering their marital status and residence. Further research should consider these issues to ensure equality access to cervical cancer screening services.
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DOI: 10.1186/s12939-026-03012-9
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