Two thirds of women living with HIV in Uganda have never been screened for cervical cancer, preliminary results from a study by Makerere University School of Public Health says.
The World Health Organisation (WHO) in its 2021 new edition of guidelines on screening and treatment to prevent cervical cancer said screening should be prioritised for women living with HIV aged 25–49 years and says when tools are available to manage women living with HIV aged 50–65 years, those in that age bracket who have never been screened should also be prioritized.
Makerere University School of Public Health experts say the low rates are worrying because these women are at a very high risk of contracting the Human Papilloma Virus (HPV) that causes cancer of the cervix, yet if screened and identified early, they can be cured of the life-threatening disease.
Dr Agrey Bameka, a Gynaecologist based at Jinja Regional Referral Hospital while speaking to health journalists during a monthly media Café organised by their umbrella organisation HEJNU on Friday said the government has started a policy for screening and treatment right from the low levels of the health system -Health Center IV level where if they find a lesion, they are supposed to burn it immediately.
But, he says, many women have been skipping cervical cancer screening whenever they go for HIV medicine refills or viral load tests.
Women living with HIV have a six-fold increased risk of cervical cancer compared with women without HIV. This elevated risk is manifested throughout the life course, beginning with an increased risk of acquiring human papillomavirus (HPV) infection, which is responsible for the majority of cervical cancer cases.
Bameka says that in every family planning clinic there should be cervical cancer screening. For instance, when women come to have IUDs inserted they should be tested using acetic acid which is really cheap.
With the risk of acquiring HPV being higher than getting infected with HIV, Bameka says they are contemplating integrating cancer screening into their family planning services.
Dr Joseph Matovu, a Researcher based at Makerere University School of Public Health says they have resolved to test if training women who have ever screened for cancer can enable them to lure their peers into testing and help drive more women into screening.
The Makerere University School of Public Health study is targeted to reach 800 women with screening services by April 2023, covering the Busoga region with plans of extending to other areas if the idea works.
So far, Matovu says women are expressing fear to test with a lot of misconceptions in the community including rumours that one’s uterus can be removed and that the private parts can be widened by the machine affecting their sex life.
Matovu says this places the responsibility on health workers to be vigilant and offer as much information as possible to women as they visit health facilities. He says even as only three out of ten of their respondents report having screened, 97 per cent of them acknowledge going through the health facilities without being informed about this service.
Dorah Mutoni an outreach officer at a sex workers’ support NGO, Alliance for Women Advocating for Change (AWAC) said women fear the outcomes of the test since they are already battling an equally tough disease HIV.
At the organization, Mable Simiyu an HIV Prevention Officer says they have started a programme of linking their HIV positive clients to cervical cancer screening services following an outcry from a government health facility they partner with to offer services. Even then she says they have had cases of clients running away after being told that they will be screened for cervical cancer too.
The cervical cancer burden and mortality rates are still very high. According to data from the Uganda Cancer Registry, 3915 women were newly diagnosed with cancer of the cervix in 2020. Also, 2160 succumbed to the disease the same year.
Women living with HIV have more rapid progression of high-risk HPV infection to pre-cancer lesions and subsequently to cervical cancer, and also reduced likelihood of regression of pre-cancer lesions, and higher rates of recurrence following treatment.
Cervical cancer is the fourth most common cancer in women says the WHO. In 2020, an estimated 604,000 women were diagnosed with cervical cancer worldwide and about 342 000 women died from the disease.2 Globally, an estimated 5% of all cervical cancer cases are attributable to HIV. However, these statistics vary enormously by region.
In nine countries with high HIV prevalence, the proportion of cervical cancer attributable to HIV is 40% or higher, whereas it is less than 5% in 122 countries with much lower HIV prevalence.
According to experts, once one gets infected with HPV, the virus that causes cervical cancer, it may take a sufferer up to two years to develop signs of cervical cancer.