Women and girls in sub-Saharan Africa accounted for two out of three new HIV infections in 2021. Women living with HIV are six times more likely to develop cervical cancer than those living without it.
These are powerful and distressing statistics, which show very clearly that to meet the 2030 goals of ending the AIDS epidemic and the World Health Organization’s (WHO) ambition to eliminate cervical cancer as a public health problem, we urgently need to prioritize women’s health across our continent.
Why are these two diseases so closely related? A weakened immune system means that women with HIV are less likely to be able to clear infections with HPV, which is the virus that causes cervical cancer. In fact, HIV infection halves the time it takes for precancerous cells to turn into cervical cancer.
Cervical cancer is both preventable and curable when detected early, through highly effective HPV vaccines and high-performance screening tests or tools, leading WHO to suggest it may be the first cancer in the world to be eliminated.
But as awareness of the impact of vaccination and the value of screening has improved, the disruption to health services due to the COVID-19 pandemic has sidelined many women’s health programs, including vaccination campaigns against HPV and screening initiatives. Today, cervical cancer remains the deadliest cancer (https://bit.ly/3XLsgsh) among women in low-income countries, because women in these countries simply don’t have access to these life-saving measures.
More and more communities and organizations are identifying opportunities to address cervical cancer and HIV/AIDS together. Last year, WHO updated its guidelines on cervical cancer screening and treatment to include specific recommendations for women living with HIV. As Winnie Byanyima, executive director of UNAIDS recently acknowledged, “it is unacceptable to say that we saved a woman’s life by allowing access to antiretroviral therapy only for HIV, if we then let her die of cervical cancer… [we are] building bridges between HIV and cervical cancer programs and bringing the two communities together because we know connections save lives.”
Those links include integrated control strategies, research and access programs, joint case management, and awareness raising and cooperation between the two disease communities to make the best use of the resources we have at our disposal.
As far as HIV is concerned, the introduction of the self-test was an important step in the fight against the disease. The lessons of that experience, combined with the explosion in diagnostic technology triggered by the COVID-19 pandemic, mean that for cervical cancer we are now much closer to new approaches to early detection and cervical screening services, including self-sampling which can be conducted more privately and comfortably (at home, for example). By monitoring the COVID-19 testing landscape, FIND has identified at least 27 point-of-care molecular tests with potential for HPV testing, many of which are already in use for HIV diagnosis.
Indeed, to meet WHO’s goal of screening more than 70% of all eligible women for cervical cancer in LMICs at least twice in their lifetime, there are significant opportunities for partnerships with HIV programs. Increasing this “double duration” screening alongside HPV vaccination could enable 100% of countries to achieve elimination, reducing cervical cancer cases by 97%, saving countless lives and healthcare costs.
First, we need to integrate cervical cancer into community-led approaches to advocacy and education, to break down barriers around stigma for both diseases and increase demand for screening and testing. Second, we need to prioritize and accelerate the adoption of new female-focused technologies that are coming through the pipeline, especially those that can enable self-sampling. And third, we need to increase access to affordable diagnostics so that anyone who needs a test can get one, whether for HIV or cervical cancer.
To be successful, these measures require committed leadership from government leaders, who must prioritize the control and elimination of cervical cancer alongside HIV, seeing it not as a cost but as an investment in the future of their nations.
In addition, community leaders, policy makers, donors, civil society and the private sector must provide strong support to scale up cervical cancer programs and integrate them into health systems alongside HIV services.
On this year’s World AIDS Day we were called to “equalize” (https://bit.ly/3B0eKYe) to address the inequalities that are holding back progress in eradicating AIDS. We must heed this call and urgently unite to free women from the burden of both diseases.
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