PURPOSE OF REVIEW: In the US, people with HIV (PWH) are more likely to be diagnosed with cancer at advanced stages, contributing to higher cancer-specific mortality rates. As such, the leading cause of non-AIDS death among PWH is cancer, including cancers with guideline recommended screening as a part of preventative care. Nonmedical drivers of health contribute to poor access to timely cancer screening among PWH. Thus, the purpose of this systematic review is to summarize the available evidence on the relationship between social determinants of health (SDoH) and cancer screening behaviors among PWH in the US.
RECENT FINDINGS: Following PRISMA guidelines, we conducted a systematic search for peer-reviewed US-specific studies published between 2010–2024 using PubMed, Embase, CINAHL, and Web of Science. Our search strategy included key terms that fell under four key concepts: 1. SDoH, 2. HIV, 3. Cancers of interest, and 4. Outcomes of interest. Of the 2334 articles identified, 1146 underwent title/abstract screening and 86 full-length articles were reviewed for eligibility. Overall, 40 articles met eligibility criteria for inclusion in our data synthesis. Over two-thirds (68%, n =27) of articles focused on screening for anal and cervical cancer, both HPV-associated cancers, and less than one-quarter (22%) of studies provided information on screening for cancers without an infectious etiology (lung [i = 3], prostate [n =1], colorectal [n =4], breast cancers [n =1]). Importantly, the main SDoH reported by studies in this review were individual-level factors related to economic stability (i.e., annual income or employment status) or educational attainment. With respect to healthcare access and quality, the most reported indicator was health insurance coverage with a few studies reporting on provider or facility type, and number of visits per year. Finally, for neighborhood and built environment factors, only two studies reported on county-level social vulnerability and area-level poverty.
SUMMARY: Although cancers without an infectious etiology, such as lung cancer, are major causes of cancer deaths among PWH, most existing work focuses on cervical and anal cancer prevention with limited SDoH measures. Measurement of SDoH in cancer prevention research among PWH should be prioritized and broadened to include structural factors.
Cancer screening behaviors among people with HIV in the United States and the role of multi-level social and economic factors: A systematic review
Current Epidemiology Reports, 13, 3. doi: 10.1007/s40471-025-00378-2.