Cervical cancer, little-known killer of HIV-positive women

Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.

"I was experiencing a bad smell from my private parts and I wondered whether it was because I was HIV-positive; I could not keep quiet any more and I shared with one of the nurses and she referred me to the doctor," Mworia told IRIN/PlusNews. "I did not even know there was anything called cervical cancer, which I was informed can kill very easily."

According to the UN World Health Organization (WHO), some 2,635 Kenyan women are diagnosed with cervical cancer every year, with 2,111 dying from the disease, making it the most prevalent cancer among women in the country. About 38.8 percent of women in the general population are estimated to harbour cervical human papillomavirus (HPV) infection - a leading cause of cervical cancer - at any given time.

High risk, low knowledge

For cervical HPV infection to progress to cancer, certain co-factors must be in place, including smoking, long-term hormonal contraceptive use and co-infection with HIV. However, medical professionals strongly recommend that all women over the age of 21 be screened for cervical cancer.

"Women who are HIV-positive have weak immune systems and this makes them very susceptible to persistent human papillomavirus that develops into cancer of cervix," said Lucy Muchiri, a senior lecturer in human pathology at the University of Nairobi's College of Health Sciences and a member of the sub-Saharan Africa Cervical Cancer Working Group.

"It takes a relatively shorter time for the HPV virus to develop into full-blown cancer of the cervix for women who have the HIV infection … It would take relatively longer in women who are not infected with HIV."

Pap smear tests - which check for changes in the cells of the cervix - are available at most district health facilities in Kenya, but according to WHO, fewer than 6 percent of women access them.

"I think many women die from the disease for a number of reasons - one is ignorance because knowledge about the disease among women and in the general population is very low and it is mistaken for other diseases," she said. "It is appalling that despite most cancer-related deaths in women happening because of cervical cancer, it is the least talked about or even known by people, including women."

According to Francis Kimani, director of medical services at the Ministry of Health, Kenya is planning a screening programme for early detection and treatment of cervical cancer as well as a widespread education campaign.

Education gap

"I think our best bet is to carry out education to let people know about the disease and that early detection of it can be very helpful," Kimani told IRIN/PlusNews. "It is true that not many people - especially in rural areas - know about the disease."

Studies have shown that HPV is higher among women who have multiple sexual partners and unprotected sex.

"Maybe to prevent it in the first place, the same methods used in combating HIV, like condom use, abstinence and keeping to one faithful partner, should be encouraged in this case too," Muchiri suggested.

''It is appalling that despite most cancer-related deaths in women happening because of cervical cancer, it is the least talked about or even known by people, including women''

She noted that the government also needed to invest in making the HPV vaccine - which protects against four major types of HPV, including two types that are responsible for 70 percent of cervical cancers - widely available in public hospitals.

Vaccine availability

The Kenya Pharmacy and Poisons Board approved the sale of an HPV vaccine in the country in 2007, but its availability is extremely limited and it is still prohibitively expensive for most Kenyans.

"HPV is a sexually transmitted virus and with the vaccine in place, it is important to encourage parents to take their young girls between the ages of nine and 15 to be vaccinated before they debut into sex," she said.

A recent study by the local NGO, Centre for the Study of Adolescence, found that four in 10 Kenyan girls had sex before the age of 19, many of them as early as 12.

"Once they [women] become sexually active, it is important to encourage [them] to go for Pap smear tests or visual detection of the pre-cancerous lesions but even vaccination at this stage is still feasible so long as one has not contracted the virus," Muchiri added.