[ARCHIVED] HIV Prevention
Fight for cervical cancer prevention, diagnostics and treatment in Africa !
Today, I have been reflecting on the progress the world has made in the fight against infectious diseases. Even though there is a long road ahead, there are many achievements we can be proud of. In my country, Rwanda, we have decreased the rate of deaths due to malaria by more than 65% since 2005. We are now providing universal access to anti-retroviral therapy (ART) for all those diagnosed to be in need of treatment, a total of over 83,000 people. Rwanda currently has multiple hygiene campaigns; and has provided 60,000 Community Health Workers with antibiotics (Ampiciline), oral rehydration solution, and training on how to treat digestive and pulmonary diseases at home. Through these interventions, we are sure to continue to make progress in tackling communicable diseases.
In Rwanda, now that morbidity and mortality due to infectious diseases have both decreased, we are looking to take a step forward and tackle the other serious causes of death. According to the WHO, non-communicable diseases (NCDs) are responsible for 25% of mortality in our region of the world. For the past two years, the Ministry of Health of Rwanda has been considering various initiatives specific to NCDs. Cancer is one of the top killers among this category of disease. It is a leading cause of death worldwide accounting for an estimated 7.9 million deaths in 2007 alone. Knowing that over 70% of these deaths occur in low- and middle-income countries, where resources available for prevention, diagnosis and treatment of cancer are limited or nonexistent, I argue that it is time for us to focus on a strategy to reduce the burden of NCDs. The challenge will be to do so without reducing our energy currently put into fighting communicable diseases.
Among women, cancers of the breast, uterus, cervix and ovaries represent the most common cancers diagnosed. Until recently, there was no certain way to prevent these cancers. Yet now one of the most common causes of cancer among women in our region, cervical cancer, is preventable with a simple vaccination. As such, here in Rwanda in 2009, under the leadership of President Paul Kagame, we began to work on a plan to provide universal access for primary prevention of cervical cancer by vaccinating our girls with the HPV vaccine before any sexual intercourse. Now we have finished our strategy for national cervical cancer prevention, screening and treatment, and we are strongly pushing global leaders to help make our plan a reality.
Our program is very simple: One full package for girls (primary prevention = 3 doses of HPV vaccine before any sexual intercourse) and One full package for women (screening technology = HPV/DNA technology and access to treatment at ages 35 and 45). The best place to implement the vaccinations will be where our girls and women are living. Because we are experienced in offering our population a very high vaccine coverage, we are confident in the plan to provide universal coverage for cervical cancer prevention by vaccination. In the case of malaria and HIV, Rwanda has effectively implemented diagnostic and treatment capacities from communities to referral systems. Rwanda has introduced new vaccines and effectively achieved high coverage of these vaccines; we were the first country to introduce pneumococcal vaccine in Africa. Now we have built on our existing capacity to implement preventive, diagnostics and treatment measures at all levels of care, and have used lessons learned to ensure the same for the management of cancer. Therefore, we need the world to believe that such a medical intervention and such technologies should be accessible to Rwandan women; and to believe that we can do this just as we have successfully implemented myriad other public health programs.
Unfortunately, some influential partners contradict their mandate by trying roll us back. This situation reminds me of the late 1980s when activists proposed to make ART accessible to African people living with AIDS. Many argued against this – particularly deliberating about whether African health professionals would be able to manage such complicated treatment instead of working with them on how best to implement such an intervention in resource-poor settings. In the fight against cancer, we will build on the lessons learned from the successful HIV and malaria programs already firmly established in Rwanda. So let’s all push together to make it happen today.
What are your thoughts?
Ingrid Katz
Thank you for bringing this important issue forward. This is so critical and can become a roll model for your neighbors throughout Africa. It is champions like you that make this possible. We can only hope there are others who are willing to do the same. Thank you!
2:52 PM, 21 Feb 2011 | Permalink
Daniel Halperin
Hello,
expand commentWe of course support the need for access to the cervical cancer vaccine in developing regions.
In addition, FYI UNAIDS sent around this recent article (and commentary) yesterday (and note the conclusion that "In settings where the new HPV vaccines are still not available, male
circumcision services should be scaled up – they will contribute to prevention of cervical cancer"):
Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV negative
women: a randomised trial in Rakai, Uganda
Wawer MJ, Tobian AA, Kigozi G, Kong X, Gravitt PE, Serwadda D, Nalugoda F, Makumbi F, Ssempiija V,
Sewankambo N, Watya S, Eaton KP, Oliver AE, Chen MZ, Reynolds SJ, Quinn TC, Gray RH. Lancet. 2011 Jan
15;377(9761):209-18.
Randomised trials show that male circumcision reduces the prevalence and incidence of high-risk human
papillomavirus (HPV) infection in men. Wawer and colleagues assessed the efficacy of male circumcision
to reduce prevalence and incidence of high-risk HPV in female partners of circumcised men. In two
parallel but independent randomised controlled trials of male circumcision, they enrolled HIV-negative men
and their female partners between 2003 and 2006, in Rakai, Uganda. With a computer-generated random
number sequence in blocks of 20 ...
9:07 PM, 21 Feb 2011 | Permalink
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