Africa, Development & Aid, Gender, Headlines, Health, Human Rights, Women's Health

HEALTH-AFRICA: Cervical Cancer Strikes Poor Women Hardest

Miriam Mannak

CAPE TOWN, Nov 15 2008 (IPS) - Of the 490,000 women worldwide who are diagnosed with cervical cancer each year, 80 percent live in the developing world. Every year, 55,000 women in sub-Saharan Africa alone develop this disease, which is ten times more likely to affect women living with HIV.

"Before the era of ARVs, we didn't see these women because they died from AIDS-related illnesses," said Linda Gail-Bekker, of the Institute of Infectious Disease and Molecular Medicine at the Desmond Tutu HIV Centre in Cape Town, South Africa. "Today we see more and more women who are HIV positive and have the other disease."

According to Gail-Bekker, the compromised immune systems of people living with HIV make their bodies more receptive to the human papillomavirus (HPV). This sexually-transmitted virus, particularly two variants known as strains 16 and 18, is the most common cause of cervical cancer.

When a person is infected with HPV, the virus over time modifies the cells of the cervix and this could lead to cancer if left untreated.

An HPV infection is diagnosed through a pap smear, a medical procedure during which cells are scraped from the outer layer of the cervix, and examined under a microscope for changes.

There are three stages to an HPV infection. It varies from woman to woman how fast HPV moves from stage one to stage three, which is the first phase of cancer. Some women have the virus without symptoms for years before cancer develops.

There are various treatments for HPV. These include freezing the abnormal cells with liquid nitrogen and removing them, or destroying them with a painless electrical current. "The sooner a woman is treated, the better," said Gail-Bekker.

Unfortunately, screening for cervical cancer in many parts of the world is inadequate, especially in developing countries. South Africa, a country with one of the world's highest HIV rates, is no exception.

"We have found out that many women across South Africa do not have access to pap smears," said Nomfundo Eland, manager of the National Women's Right Campaign run by the Treatment Action Campaign (TAC), one of South Africa's largest AIDS lobby groups.

"This is a problem, especially for HIV positive women who are more prone to develop cervical cancer," she added.

In addition, treatment is not always immediately available, Eland explained. "There is often a waiting list. We have statements by women who told us that they could only get treatment six months after their pap smears came out positive. This increases their chances of developing cervical cancer."

Eland stated that many clinics in South Africa, especially in rural areas, are not equipped to deal with cervical cancer properly: "In the Limpopo province, we have spoken to healthcare workers who do not have the means to sterilise the equipment that is used to detect an HPV infection."

Gail-Bekker told IPS that lack of knowledge is one of the main obstacles in the fight against HPV and cervical cancer. "There is little awareness. Everyone knows about HIV, but when you mention HPV, you get a lot of blank stares," she said.

One way to prevent women in the developing world from dying as a result of this preventable disease is better access to one of the two HPV vaccines that are currently distributed by pharmaceutical companies Merck and GlaxoSmithKline.

Comprising of three doses, both vaccines protect against the two most dangerous HPV strains. It is most effective to vaccinate women – and men – before their sexual debut, before an infection can take place.

"Yes, boys too," said Gai-Bekker. "Although men obviously do not get cervical cancer, they can contract the virus and infect their bed partners. Besides, HPV in men can cause other types of cancer, including anal cancer."

In South Africa – where 33,000 women have died of cervical cancer since 1997 and 7,000 develop this disease every year – the vaccines are too expensive for most people.

"In the private healthcare [system], the vaccines cost 2100 rand ($200) for the three doses that are required to protect someone. Most South Africans can't afford this, as 86 percent of the population relies on public healthcare," said Nosisa Mhlathi, policy researcher at TAC. "This needs to change if we want to save more lives."

For government to be able to distribute the vaccines via the public healthcare sector, it will have to buy them at much lower prices, Mhlathi said. Of the two companies, Merck seems more willing to do so. "It is not sure what this price reduction will be, probably 300 rand for one dose. This is not enough, as this is still too expensive for most women."

Referring to the fact that most cases of cervical cancer in the developing world, Eland asked: "What's the point of having a life-saving vaccine when nobody uses because it is too expensive?"