Cervical cancer screening (Pap testing) behaviours and acceptability of human papillomavirus self-testing among lesbian and bisexual women aged 21-26 years in the USA

Objective: Lesbian and bisexual women are at risk for human papillomavirus (HPV) infection and cervical disease. We examined cervical cancer screening (Pap testing) behaviours among these women and their acceptability of HPV selftesting at home, a potential cervical cancer screening strategy. Methods: We analysed data from a national sample of lesbian and bisexual women aged 21-26 years (n=418) who completed our online survey in Autumn 2013. Logistic regression identified correlates of (1) having had a Pap test in the last 3 years and (2) willingness to use an HPV self-test at home. Results: About 70% of women had undergone a Pap test in the last 3 years. Pap testing was more common among women who had disclosed their sexual orientation to their health care provider [odds ratio (OR)=2.01, 95% confidence interval (CI) 1.02-3.95] and less common among women who self-identified as lesbian (OR=0.48, 95% CI 0.25-0.93). Just over half the women (51%) were willing to use an HPV self-test at home. Women were more willing to use an HPV self-test at home if they were older (OR=1.16, 95% CI 1.03-1.30) or reported higher levels of worry about getting an HPV-related disease (OR=1.28, 95% CI 1.01-1.63). The most common concerns about HPV self-testing at home were using the test incorrectly (70%) and test accuracy (64%). Conclusions: Many young lesbian and bisexual women have not had a recent Pap test. HPV self-testing at home may be a promising future strategy for reaching and screening these women. Findings highlight beliefs and concerns that could be addressed by self-test programmes.