Date of Award


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Haeok Lee

Second Advisor

Mary Cooley

Third Advisor

Ling Shi


Cervical cancer is the third most frequent cancer among women worldwide and about 265,672 women die from the disease annually. Abnormal cervical cells caused by human papillomavirus are more common in HIV-positive women than in HIV-negative women due to their compromised immune system. Malawi, in Sub-Saharan Africa, is one of the countries with the highest rates of cervical cancer and HIV in the world. The incidence of cervical cancer and deaths can be reduced by 80% if women go for screening. There are limited studies about cervical cancer screening behavior, level of knowledge and attitudes regarding cervical cancer and screening among Malawian HIV positive women. The purposes of this Situation-Specific guided study were to determine the prevalence of cervical cancer screening, level of knowledge and attitudes regarding cervical cancer and screening; and to examine factors associated with screening behavior among Malawian HIV-positive women. A cross-sectional survey was conducted with Malawian women living with HIV infection aged 18-50 from HIV support organizations in one district in Malawi. Two stage proportionate stratified cluster random sampling method was used to select 291 respondents. A face-to-face interviewer-administered survey was conducted after obtaining women’s informed consent. Data were analyzed using SPSS. Univariate descriptive statistics were used to describe respondents’ data. Bivariate and multivariate logistic regression models were used to identify independent variables associated with cervical cancer screening. The adjusted Odds Ratios (OR) and their corresponding 95% CI were used to measure the strength of associations between knowledge and attitudes, and cervical cancer screening. A two-tailed p-value of < .05 was considered statistically significant.

The prevalence of cervical cancer screening rate was 27.8% among 291 Malawi women living with HIV infection. The findings showed that women had a high knowledge level (M = 25.63, SD = 6.35) and positive attitude (M = 5.05, SD = 1.43) towards screening. The factors independently associated with cervical cancer screening in HIV positive women were occupation, OR = 5.12 (95% CI: 1.07, 24.43), knowledge OR =1.10 (95% CI: 1.02, 1.19), attitude, OR = 1.36 (95% CI: 1.04, 1.76), and access to screening services OR = 1.21 (95% CI: 1.01, 1.44). The cervical cancer screening rate among HIV positive women in Malawi is still low. There is need for developing health education messages culturally tailored to women living with HIV infection in Malawi to promote cervical cancer screening uptake.