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World AIDS Day: Eliminating triple threat of HIV, gender-based violence and cervical cancer

1 December 2020
By Tukiya Mutupa, Health Consultant at the Commonwealth Secretariat

This blog is part of the Commonwealth’s ‘16 Days of Actions’ series, designed to showcase multi-disciplinary national solutions in addressing violence against women and girls. These proven solutions build on the collective experience of the 54 member countries – representing one-third of humanity – which can be replicated elsewhere to create a safer world for every woman and girl. Read the full series here.

Today, people across the globe will pause to focus on one of the most persistent and vicious epidemics in our history: HIV/AIDS. Three letters that have caused unprecedented suffering and loss across generations and around our world.  

And this terrible scourge does not work in isolation. HIV and AIDS is inextricably linked to high incidents of cervical cancer cases and the cruel reality of violence against women and girls. In facing the menace of HIV/AIDS, our health systems must also respond in a multi-sectoral and integrated way to defeat all of this tragic trio.

A tragic trio

These three threats run along the fault lines of inequalities. We know that violence can negatively affect women’s physical, mental, sexual and reproductive health. In some cases, this may increase a woman’s risk of acquiring HIV as well as hamper uptake of testing and treatment. 

Women with the human immunodeficiency virus are more likely to suffer from other infections such as human papillomavirus. This means they have a much higher risk of developing cervical cancer, at a younger age and are more susceptible to recurring infection.

In fact, the Lancet Global Health Commission has reported that women living with HIV are six times more likely to contract cervical cancer than women living without the virus. In many Southern African countries, more than half of all cervical cancer cases are linked to HIV. Cervical cancer is one of the most treatable and preventable cancers, yet, many women in low and middle-income countries are still dying from the disease.

This is a grave social injustice, which activists such as Professor Groesbeck Parnham, are dedicated to fighting. Parnham, a clinical expert for the WHO Cervical Cancer Elimination Initiative, stresses that we must address the social determinants and contexts that allow the disease to thrive.

With this in mind, we must consider the risk factors for the disease, which loop back to forms of violence against women including physical violence, sexual violence and early childhood marriage. We see a vicious cycle emerging in which violence puts women at risk of cervical cancer and HIV/AIDS infection, but also prevents them from accessing screening and treatment until it is too late.

Of course, the global pandemic has created another set of challenges. It has disrupted supply chains for medication and vaccinations as well as already stretched screening and health services. COVID-19 has also exacerbated the challenge of violence against women. The data is still being gathered and the significance of these disruptions is still being measured. However, it is clear that they will have a marked impact on health outcomes and survival rates of women.

The progress so far

But how have countries been dealing with the combined challenges of violence and disease?

A study, commissioned by the Commonwealth Secretariat to review the health sector’s response to gender-based violence in Rwanda and Zambia, recommended integrating gender-based violence services into routine primary healthcare, including care for HIV and other sexually transmitted diseases, and cervical cancer programmes. This woman-centred approach, which includes cervical cancer prevention and treatment, would support vulnerable women in accessing all the services they need to protect themselves and seek treatment.

In 2018, Zambia had 1.2 million people living with HIV. The prevalence among young women was double that of young men. The country’s response included a programme which has so far led to the vaccination of 250,000 girls and the screening of one million women.

The country’s Cancer Diseases Hospital, which opened in 2007, has focused on the strategic upskilling of Zambia’s medical workforce. In fact, this hospital has become a cervical cancer treatment training hub for health professionals in neighbouring countries. This is an example of how consistent commitment and political will to eliminate cervical cancer can result in positive change.

Another story of success is Rwanda, where about one million girls received vaccinations against human papillomavirus – a major cause of cervical cancer – from 2011 to 2019. This again is the result of strong political commitment and collaboration across local governments and the ministries of health and education. They have shared their best practices with development and implementing partners, including an international vaccine organisation ‘GAVI’.

Way Forward

All these interventions made a positive impact, saving thousands of lives. According to UNAIDs, annual HIV infections, for all ages, in Zambia have declined from 60,000 in 2010 to 51,000 in 2019. This drop is due to improved treatment, medicine, therapy, services and patient awareness.

Now the next step is to ensure that the lessons from the experiences of countries like Rwanda and Zambia’s in tackling this triple threat are followed elsewhere, to protect lives and ultimately defeat these intersecting threats.

The Commonwealth continues to support member countries in their efforts to address the ongoing health challenges through potent advocacy, cutting-edge research, robust policies, bespoke training and state-of-the-art tools. A core part of our work focuses on helping countries achieve universal health coverage so that no one is left behind.

We have been forming new alliances, including partnerships with WHO and London Global Cancer Week. This will help lay the groundwork for collective action that will lead to meaningful support and better progress toward protecting women from the triple threat of HIV/AID, cervical cancer and all forms of violence.

Today, at a time when the coronavirus pandemic puts our gains at risk, we must not get side-tracked – and remain focused towards delivering a collective response to eradicating these triple threats.

The ‘16 Days of Actions’ blog series is part of the Commonwealth Says NO MORE campaign. Read the full series here, learn more about the Commonwealth’s work on ending violence against women and girls here – and join in the conversation on social media by using #CommonwealthSaysNOMORE.