Self-sampling to Optimize Anal Lesion Outcomes

A potential study subject who meets all of the following inclusion criteria is eligible to participate in the study. Note that these criteria apply regardless of HPV vaccination status or disability status. Inclusion Criteria: 1. Age ≥ 35 years for those who are HIV-positive or ≥ 45 years for those who are HIV-negative. 2. Must be either: 1. A cisgender or transgender sexual minority man, or 2. A transgender woman who has sex with men. 3. Resides in Chicago, Houston, or Milwaukee metropolitan area. 4. Is willing to attend a study clinic. 5. Speak and understand either English or Spanish 6. Ability to understand a written informed consent document, and the willingness to sign it. Exclusion Criteria: A potential study subject who meets any of the following exclusion criteria is ineligible to participate in the study. 1. Was a participant in the PAC Self-Swab Study in Milwaukee. 2. Currently on anticoagulants, with the exception of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen, naproxen. 3. Diagnosed with hemophilia, cirrhosis with bleeding varices, or thrombocytopenia. 4. Presence of any contraindicating severe disease or condition, e.g., anal stenosis. 5. Plans to move within 12 months after enrollment.