Cervical Cancer and Women Living with HIV: A Call to Action Sethembiso Promise Mthembu ICWSA

 Linkages between Cervical Cancer and HIV  What are some of our concerns?  Some recommendations: Call to Action Introduction

 Linkages scientifically proven  Women with HIV between 5-9 times more likely to have CAC ( Denny et al, (Chirenje, 2005), (Franceschi & Ronco, 2010)  Higher rates of HIV infection in CAC patients (Schoeman, Van Wyngardt, Horn, Goedhals & Jourbert, 2006)  Defined as HIV related OI by CDC and later WHO (CDC 1993) Cervical Cancer and HIV

 Cervical Cancer one of the biggest killers of women in Southern Africa  Research suggests that CAC deaths might be greater than maternal mortality (Hale, 2009) o DoH estimates about 3,000 in CAC and 1,600 per annum in maternal mortality (NDoH, RSA)  Stats on CAC are hard to find as you would not have these unless you diagnose cancer  Anecdotal reports: Women in communities and hospices Cervical Cancer and HIV

 Previously a disease of older women; o NOW Younger Women in their 20’s  Women living with HIV will still die of cancer even if AIDS treatment is available Cervical Cancer and HIV

 Marginalised disease (Arnolu, 2008)  Traditionally older women  Outside reproductive brackets – out of women as mothers framing of women’s health  STIs  About women’s private parts - essentially an STI. What are some of the concerns?

 Defined as AIDS OI through court action – resistance?  Missed by HIV/AIDS SRH Integration (contraceptives integration really)  Not covered by AIDS Policy and AIDS money – missed by Global Targets What are some of the concerns?

 Piece-meal Pap Smears and Screening – not coupled with treatment of abnormal smears; not coupled with treatment of cancer  Alternatives to Pap Smears not speedily explored by some countries  Palliative care not integrated in AIDS care/home care  Positive women excluded in vaccine research  Vaccines replacing integrated CAC care programmes- prevention is the cure? What are some of the concerns?

Policy  Integration of Cervical Cancer in Global AIDS Policy  Global policies should be translated into national AIDS and Cancer Policies  AIDS Money should be leveraged to resource cervical cancer – as a must  Integration and involvement of HIV (Women Living with HIV) in Global Cancer Policy Call To Action

Resourcing  Health systems strengthening agenda – need to resource cervical cancer  It is possible to resource cervical cancer  Resource women’s health Call To Action

Programming  Cancer research and programming should include women living with HIV  Full integration of Sexual and Reproductive Health in AIDS – not just piece-meal (which as been pap smears, in some instances VIA) Call To Action

 Cancer programming should explore using models /methods for greater outreach to women, with particular focus on cervical cancer and HIV integration  Quality assurance in service delivery should be of utmost priority, loss to follow-up should be reduced Call To Action

 Raising awareness on policy and community level is also critically important  Training of health care workers in this integration area for nationwide scale-up is also essential  Systems strengthening for delivering this critical service are also important Call to Action

 HPV Vaccine is not cancer treatment or cure  There is a need to programme and scale up treatment of abnormal smears - and also cervical o Curing cervical cancer should be part of this agenda  Community Care for HIV should take care of cancer: there should be collaboration and upscale of palliative care and AIDS home based care Call To Action

Programme  Cervical cancer is painful, AIDS care should be able to provide pain relief to the women who have HIV and cancer  Public and community awareness on HIV and cervical cancer is essential and critical Call To Action

 Thank you very much for your audience!  Let us all work towards reducing the incidence, pain, loss of life due to cervical cancer in women living with HIV now!  It is possible! Appreciation