Trying to Heal Without “Bringing Problems” - Navigating Cervical Precancer Stigma in a Phase I Clinical Trial in Western Kenya

Sep 29, 2026

Stigma shapes how women engage with cervical precancer services, including screening, disclosure, and treatment decisions, especially where health access is constrained. This Phase I qualitative study examined how stigma influenced women’s experiences receiving emerging self-administered topical therapy. Seventeen in-depth interviews (2024–2025) in Kisumu, Kenya, explored experiences among women diagnosed with cervical precancer using thematic analysis grounded in the Health Stigma and Discrimination Framework. Findings identified enacted, anticipated, and internalized stigma impacting relational autonomy and treatment completion, with some participants experiencing delays or intimate partner conflict.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages31

Reading Time1 h 18 min

AccessFree to download

Abstract

Background and Objective

Design, Methods, and Analysis

Results and Conclusion

medRxiv preprint doi: [https://doi.org/10.1101/2025.10.24.25338728](https://doi.org/10.1101/2025.10.24.25338728); this version posted October 27, 2025. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . 1 Title: Trying to Heal Without “Bringing Problems”: Navigating Cervical Precancer Stigma in a 2 Phase I Clinical Trial in Western Kenya 3 4 Authors: Anagha Guliam 1, Annum Sadana2,3, Elizabeth Opiyo4, Felix Adundo4, Katherine 5 Sorgi3, Erum Agha5, Chemtai Mungo, MD, MPH3,6,7 6 Affiliations 7 1. Columbia University Vagelos College of Physicians and Surgeons, New York, New 8 York, United States 9 2. New York University Grossman School of Medicine, New York, New York, United 10 States 11 3. Department of Obstetrics and Gynecology, School of Medicine, University of North 12 Carolina at Chapel Hill, Chapel Hill, North Carolina, United States 13 4. Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), 14 Kisumu, Kenya 15 5. School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North 16 Carolina, United States 17 6. Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, 450 18 West Dr, Chapel Hill, North Carolina, 27599, USA 19 7. Center for AIDS Research, University of North Carolina Chapel Hill, Chapel Hill, North 20 Carolina United States 21 22 Corresponding Author: 23 Anagha Guliam, [avg2131@cumc.columbia.edu](avg2131@cumc.columbia.edu) 1 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: [https://doi.org/10.1101/2025.10.24.25338728](https://doi.org/10.1101/2025.10.24.25338728); this version posted October 27, 2025. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . 24 Abstract: 25 Background Cervical cancer remains a leading cause of cancer-related deaths among women in 26 low-and middle-income countries, particularly in sub-Saharan Africa. Sociocultural barriers 27 including stigma significantly influence women's decisions around screening and treatment. 28 Objective To explore how stigma influences women's experiences with cervical precancer care 29 in the context of emerging self-administered topical therapies. 30 Design A qualitative approach using convenience sampling. 31 Methods Seventeen in-depth interviews were conducted between 2024 and 2025 in Kisumu, 32 Kenya, with women who had been diagnosed with cervical precancer. Participants were recruited 33 to self-administer intravaginal artesunate in a Phase I clinical trial, and interviews explored their 34 experiences. Thematic analysis was conducted using the Health Stigma and Discrimination 35 Framework. 36 Results All women discussed experiences indicative of enacted, anticipated, and internalized 37 stigmas related to partner blame, disclosure, and imagining the diagnosis as an imminent death 38 sentence. These stigmas were driven and facilitated by poverty and limited health care access, 39 embarrassment around sexual health, community fears of cervical cancer death, patriarchal 40 norms, and cervical precancer’s disproportionate burden on women. Women with cervical 41 precancer feel “marked” by medication usage, clinic visits, community expectations of a 42 “cancer” appearance, or painful sexual intercourse. By exercising relational autonomy, women in 43 this trial were able to navigate stigmas around sexual health and overcome the debilitating fear of 44 death. They were ultimately able to complete the self-administered ar

FAQs

What was the objective of the Phase I study?

To explore how stigma influenced women’s experiences with cervical precancer care in the context of emerging self-administered topical therapies.

How was the study conducted?

The study used a qualitative approach with convenience sampling and collected seventeen in-depth interviews in Kisumu, Kenya (2024–2025). Participants had been diagnosed with cervical precancer and were recruited to self-administer intravaginal artesunate.

What stigmas did participants report and how did these affect treatment?

Women described enacted, anticipated, and internalized stigma related to partner blame, disclosure, and fear of diagnosis as imminent death. Stigma was linked to poverty, limited health care access, embarrassment around sexual health, community fears, patriarchal norms, and the disproportionate burden on women; relational autonomy helped some women navigate stigma and complete treatment, though some experienced delays or intimate partner violence/conflict.

Sep 29, 2026

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