Cervical cancer kills an estimated 275,000 women every year, 85
percent of whom are in developing countries. The link between HIV and
cervical cancer is direct and deadly; HIV-infected women who are also
infected with specific types of human papilloma virus (HPV) are 4-5
times more susceptible to cervical cancer than HIV-negative women. This
has important implications for HIV programs, especially in countries
with significant HIV epidemics.
To understand the opportunities and challenges of integrating
cervical cancer screening and treatment into HIV services for women, we
traveled to Zambia, which has been at the forefront of integrating these
services. Dr. Joan Katema, provincial coordinator for the cervical
cancer screening program, explained why this integration is so critical:
"Most of the attention was drawn to HIV only... But we'd still find
that despite [women] accessing the ARVs and all the services that come
with the ART clinic, they were still dying from cervical cancer."
Attention to cervical cancer in Zambia has been heightened with the December 2011 launch of the Pink Ribbon Red Ribbon (PRRR) initiative, led by the George W. Bush Institute, the U.S. State Department, Susan G. Komen for the Cure,
UNAIDS, and several corporate partners. PRRR is designed to build off
the HIV services supported by PEPFAR to expand cervical and breast
cancer prevention, screening, and treatment. Zambia is the first PRRR
focus country, and President George W. Bush and Mrs.
Laura Bush initially launched the program there. The Zambian
government has also been very engaged in PRRR, led by the first lady,
Dr. Christine Kaseba Sata, an obstetrician and gynecologist herself. The
impact of this leadership is apparent, according to a nurse supervisor
with the cervical cancer program: "We've been encouraged a lot by our
women leaders in this country... including the First Lady.
She's been talking about cervical cancer screening and [its]
importance a lot on TV, on radio, and so as a result, we've seen that a
lot of women have reacted positively, received the message and have come
in for screening."
Since the start of PRRR in December 2011, the demand for screening
has been growing in Zambia, sometimes overwhelming the roughly 50 health
care workers who have been trained. Between September 2011 and December
2012, some 22,000 women had been screened, about a third of whom are
HIV-positive. The screening itself is simple and cost-effective,
involving soaking the cervix in acetic acid, such as that found in
common vinegar, to check for abnormal lesions. If small lesions are
found, they are removed at the clinic using cryotherapy, which is
nitrous oxide. More advanced cases are referred to either Kabwe District
Hospital or the University Teaching Hospital in Lusaka, but those sites
are still unreachable for most women across the country.
To be sure, this is only the beginning; much more needs to be done to
effectively integrate cervical cancer screening into HIV services
throughout Zambia, and to build the capacity to screen, refer and treat.
Ultimately, the HPV vaccine could be critically important in
preventing infection with the viruses that cause cervical cancer, and a
demonstration project in Zambia to evaluate the feasibility of vaccine
delivery through a school-based program for adolescent girls is
scheduled to begin in March 2013.
Yet HIV-positive women in Zambia are now learning that screening and
treatment for cervical cancer can save their lives. In the words Paxina,
an HIV-positive women who had been successfully treated: "Cervical
cancer screening can help women living with HIV and AIDS. They will stay
healthier and they will stay for a long time. Like I am. I am HIV
positive. I went for cervical cancer screening and here I am today."
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