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

Background Cervical cancer remains a leading cause of cancer-related deaths among women in low- and middle-income countries, particularly in sub-Saharan Africa. Sociocultural barriers including stigma significantly influence women’s decisions around screening and treatment.

To explore how stigma influences women’s experiences with cervical precancer care in the context of emerging self-administered topical therapies. Design A qualitative approach using convenience sampling.

Seventeen in-depth interviews were conducted between 2024 and 2025 in Kisumu, Kenya, with women who had been diagnosed with cervical precancer. Participants were recruited to self-administer intravaginal artesunate in a Phase I clinical trial, and interviews explored their experiences. Thematic analysis was conducted using the Health Stigma and Discrimination Framework.

All women discussed experiences indicative of enacted, anticipated, and internalized stigmas related to partner blame, disclosure, and imagining the diagnosis as an imminent death sentence. These stigmas were driven and facilitated by poverty and limited health care access, embarrassment around sexual health, community fears of cervical cancer death, patriarchal norms, and cervical precancer’s disproportionate burden on women. Women with cervical precancer feel “marked” by medication usage, clinic visits, community expectations of a “cancer” appearance, or painful sexual intercourse. By exercising relational autonomy, women in this trial were able to navigate stigmas around sexual health and overcome the debilitating fear of death. They were ultimately able to complete the self-administered artesunate treatment course and initiate conversations in their communities to address stigmas around cervical precancer treatment. Nevertheless, stigmas caused delays to screening and treatment among some participants, while others experienced intimate partner violence or conflict during artesunate treatment.

Stigmas around cervical precancer, artesunate usage, and abstinence requirements can deeply impact women’s social experiences, intimate partnerships, and mental health. Future trials of self-administered therapies should integrate stigma reduction strategies developed in collaboration with participants and survivors. ClinicalTrials.gov NCT06165614, https://clinicaltrials.gov/study/NCT06165614 Competing Interest Statement The authors have declared no competing interest. Clinical Trial NCT06165614 Funding Statement This research was supported by the Department of Obstetrics and Gynecology at University of North Carolina-Chapel Hill and the Women’s Reproductive Health Research (WRHR) Career Development Program under National Institutes of Health award number 5-K12-HD103085-04, Gilead Sciences, Inc., and the University of North Carolina Center for AIDS Research under award number 5-P30-AI050410. Support was also provided by the UNC Lineberger Comprehensive Cancer Center (LCCC) Developmental Funding Program supported by the Research Women’s Cancer Research Fund in the Health Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study has full ethics review board approval from the University of North Carolina Chapel Hill and Amref ESRC Kenya. Written informed consent was obtained from all study participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes included "National Institutes of Health" in the funding statement. Data Availability All data produced in the present study are available upon reasonable request to the authors.