Acceptability of an Anal Cancer Screening Chatbot Among High-Risk Men Undergoing Community-Based Screening

Background Anal cancer incidence and mortality are increasing in the United States, with highest risk among men who have sex with men (MSM) and people living with HIV. Targeted anal cancer screening is recommended for these populations. Low awareness, stigma, and limited provider engagement are barriers to implementation of anal cancer screening guidelines. Artificial intelligence (AI)-powered chatbots may offer scalable, stigma-sensitive education and follow-up support, but their acceptability for anal cancer prevention is unknown. Objective To assess attitudes toward an AI-powered anal cancer prevention chatbot among high-risk adults undergoing onsite screening, and identify demographic, behavioral, and clinical correlates of favorable attitudes. Methods A cross-sectional survey was conducted during a Midwestern LGBT pride festival (June 2025). Eligible participants were ≥ 35 years, male at birth, with a history of anal intercourse, and no prior anal cancer diagnosis. Attitudes toward a prevention chatbot were measured using six Likert-type items (comfort, helpfulness/accuracy, willingness to use for risk assessment and results delivery; 1–5 scale). A composite index (Cronbach’s α = 0.97) was dichotomized (> 3 = favorable). Logistic regression estimated associations between covariates and favorable attitudes. Results The sample (N = 107) was predominantly cisgender men (95.3%), gay-identified (89.5%), and White (84.1%), with mean age 49 years. The chatbot beliefs and attitudes index mean was 3.17 (SD = 1.26; range 1–5); 48.1% reported favorable attitudes. No demographic, behavioral, or clinical variables were significant predictors. Adjusted predicted probabilities were similar by age (35–44: 53%; ≥45: 49%) and higher among HIV-positive (67%) versus HIV-negative (49%) participants. Conclusion Attitudes toward an AI-powered chatbot for anal cancer prevention were largely positive. Chatbot-based education may complement community-based screening by addressing persistent informational and motivational barriers.