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Blog by Janet Fleischman and Julia Nagel and originally posted on www.SmartGlobalHealth.org by the Center for Strategic and International Studies (CSIS). Video by Julia Nagel, Janet Fleischman, and Christopher Letendre.
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: “[C]ervical 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.”
14 Things to Know About the Life-Saving Work of PEPFAR on its 14th Anniversary
This weekend marks the 14th anniversary of PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, which President George W. Bush signed into law on May 27, 2003 as part of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003. Since then PEPFAR has saved nearly 12 million lives. Here’s a look at 14 interesting facts about PEPFAR, which has lead the progress in the global campaign to end AIDS. In 2003, at the signing of the PEPFAR legislation, less than 50,000 people in sub-Saharan Africa were on antiretroviral treatment (ART) for HIV/AIDS, now 11.5 million individuals are on ART due to PEPFAR. 99.5 percent of HIV-positive pregnant women are receiving ART, a more than 40 percent increase since the beginning of 2014. This has led to nearly 2 million babies being born HIV-free to infected mothers. Since the start of PEPFAR, new HIV Infections have declined 51 to 76 percent. Voluntary medical male circumcision (VMMC) can reduce men&rs
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7 Things to Know about PEPFAR on World AIDS Day
Today marks World AIDS Day: a day to honor those lost, celebrate the global progress made in the fight against AIDS, and commit to put an end to the disease. In 2003, at the signing ceremony for the legislation that enacted the President’s Emergency Plan for AIDS Relief (PEPFAR), President George W. Bush said, “We believe in the value and dignity of every human life. In the face of preventable death and suffering, we have a moral duty to act, and we are acting.” Since then, PEPFAR has delivered life-saving antiretroviral treatment (ART) to 11.5 million people, and nearly 2 million babies have been born HIV-free with PEPFAR support. PEPFAR’s success contributes to a coordinated global effort to end AIDS. UNAIDS reports that since 2000, 18.2 million people have access to treatment for HIV, new infections of HIV have decreased by over 1 million infections, and AIDS-related deaths have decreased by 1.4 million. There is real hope for endin