Cervical cancer is the most common cancer among women living with HIV. The likelihood that a woman living with HIV will develop invasive cervical cancer is up to five times higher than for a woman who is not living with HIV. The overall risk of HIV acquisition among women is doubled when they have had a human papillomavirus (HPV) infection.
So, what can be done? This is one of the questions that will be discussed at a number of events addressing cervical cancer at the 2019 Women Deliver conference, which will take place in Vancouver, Canada, from 3 to 6 June.
Like HIV, cervical cancer is a disease of gender and other inequalities. These two interconnected diseases starkly expose the links between inequity and social and health injustice. Ninety per cent of 311 000 cervical cancer deaths globally per year occur in low- and middle-income countries, with the highest burden borne by sub-Sahara African countries that have the highest burden of HIV. In Zambia, rates of cervical cancer are almost 10 times higher than in Australia, for example, and women are 10 times more likely to die of cervical cancer in eastern and southern Africa than they are in western Europe.
Cervical cancer is preventable and curable if diagnosed and treated early. Effective methods of primary prevention of cervical cancer, notably the HPV vaccine, are available, but not to everyone. Currently, just 10% of girls in low- and middle-income countries access the HPV vaccine, compared with 90% in high-income countries.
Scale-up is happening and efforts to prevent and treat cervical cancer are showing dramatic results in areas where programmes have been rolled out at sufficient scale. Australia is set to become the first country in the world to eliminate cervical cancer by successfully implementing a combined approach to HPV vaccination and cervical cancer screening and early treatment at a wide scale. In Scotland in the United Kingdom, where the immunization programme was introduced some 10 years ago, there has been a 90% decrease in precancerous cells, which has led to a dramatic reduction in preinvasive cervical disease. Remarkable achievements, which should be universal.
“To save a woman’s life by ensuring that she has access to antiretroviral therapy for HIV, yet she dies from cervical cancer, is unacceptable,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme. “UNAIDS’ focus is on breaking down silos and building bridges between HIV and cervical cancer programmes because we know that synergies save lives.”
Despite their increased risk of cervical cancer, women living with HIV do not receive regular screening or treatment for cervical cancer, even with the World Health Organization (WHO) recommended simple, low-cost visual inspection or effective simple, early treatment methods.
According to recent large studies, only 19% and 27% of women living with HIV aged 30–49 years in Malawi and Zambia, respectively, have ever been screened for cervical cancer.
A smart investment is to integrate cervical cancer screening and treatment services into HIV and sexual and reproductive health services. HIV platforms are ready-made entry points for low-cost cervical cancer services and wider health service coverage for young women and girls.
An important lesson learned from the AIDS response is that civil society and communities have to be at the centre. Networks of women living with HIV and women’s rights and youth movements are formidable allies. They have fought for an AIDS response rooted in human rights, social justice and sexual and reproductive health and rights and can mobilize, advocate and create demand for services. Civil society must also keep us on track to end stigma and discrimination, including in health-care settings. Communities can also provide direct services for HIV, cervical cancer and other diseases.
Shared responsibility and country leadership and ownership are critical. With collective efforts of governments, communities, donors, the private sector, innovators and researchers, important synergies can be made, and lives saved.
UNAIDS is working with partners to ensure that policies are informed by evidence, that ambitious targets are set and that adequate levels of human and financial resources are available. UNAIDS is using the political and programmatic platforms of the Fast-Track approach as part of the initiative to scale up the prevention and treatment of cervical cancer and HIV.
UNAIDS is working in partnership with initiatives such as WHO’s global call to action towards the elimination of cervical cancer and is part of a renewed Partnership to End AIDS and Cervical Cancer with the United States President’s Emergency Plan for AIDS Relief and the George W. Bush Institute.
“It is high time to make both AIDS and cervical cancer history!” added Dr Hader.
