Background: Cervical cancer is one of the most common types of
cancer worldwide. Throughout the sub-Saharan African region, the
World Health Organization recommends screening and vaccination
against Human Papilloma Virus (HPV) to prevent cervical cancer.
Sexual behavior has long been recognized as a major risk factor
for cervical cancer. However, population-based studies examining
the relationship between sexual behavior and cervical cancerscreening are currently lacking. This study examined the association
between risky sexual behavior and cervical cancer in screening
among a representative sample of women in Kenya.
Methods: This descriptive cross-sectional study utilized secondary
data from the 2014 Kenya Demographic and Health Survey to
examine 6,126 sexually active women who reported ever hearing of
cervical cancer. The main outcomes of interest were self-reported
cervical cancer examination, including Papanicolaou (PAP) test or
visual inspection with acetic acid (VIA) or with Lugol’s iodine (VILI).
Findings: Overall, 20.3% of the study sample reported having
cervical cancer examination. Approximately 13.1% of the participants
were involved in risky sexual behavior. Significantly lower
proportion of women engaged in risky sexual behavior reported
having cervical cancer examination (14.4% vs. 21.2%; p¼0.001).
In the multivariable model, we found a significant interaction
between risky sexual behavior and marital status on cervical cancer
examination. Among women who were married/living together,
risky sexual behavior was negatively associated with cervical cancer
examination, independent of confounders such as age, education,
household wealth index, parity, type of residence, total life time
number of sex partners, age of sexual debut and access to health
facilities (Odds Ratio, 95% Confidence Interval) (0.43, 0.24 e
0.76; p¼0.004). Similarly, married/living together women who
were involved in risky sexual behavior were less likely to have visual
inspection with VIA or VILI (0.41; 0.19-0.90; p¼0.027). However,
we were unable to detect any significant association between risky
sexual behavior and having PAP test.
Interpretation: With increasing rates of cervical cancer in lowresource
settings, it is critical to identify populations at increased risk
of infection and provide effective screening and follow-up services.