The Kenyan government is taking steps to incorporate screening for cervical cancer - one of the biggest killers of women of child-bearing age - into HIV care, but health workers say low awareness means the uptake of this vital service is low.
Studies show that HIV infection increases women's risk of human papillomavirus (HPV) infection, a leading cause of cervical cancer.
"When we as health workers talk to many women, you realize that HIV-negative women believe cervical cancer only affects those who are HIV-positive and they miss the opportunity for screening because they believe they are not at risk, while HIV-positive women will at times decline screening because they fear they will be found to be positive for the disease," Collins Wambasa, a clinical officer at western Kenya's Nyanza Provincial General Hospital, told IRIN/PlusNews.
Cervical cancer screening is included as part of routine care for HIV-positive women under the country's national guidelines for HIV care. However, screening levels remain low; according to the UN World Health Organization, just 3.2 percent of Kenyan women aged 18-69 are screened for cervical cancer every three years, compared with 70 percent of women in the developed world.
In 2007, the government began rolling out cervical cancer screening at selected HIV care centres using a method known as visual inspection with acetic acid, which studies say is an efficient and cost-effective method of screening. The test is performed by a trained health worker who washes a woman's cervix with acetic acid - a key ingredient in vinegar - and gauze; any pre-cancerous lesions turn white and can be seen with the naked eye under a halogen lamp.
The more common Pap smear test requires more highly trained health providers, access to equipment and supplies, a cytology laboratory, arrangements for communicating results to screened women and a facility for confirming diagnosis.
Joyce Ndisi, a 33-year-old HIV-positive mother of two, recently visited the Nyanza Provincial Hospital for her routine care, where clinicians told her she would require another cervical cancer screening. "It was very simple - I didn't even feel any pain because they didn't put that metal spoon [spatula] inside me... Now I won't fear coming for it because it is very easy," she said.
"The main limitation to cervical cancer screening is the lack of awareness of cervical cancer as a significant health threat to women in the general public and in the healthcare sector," said Elizabeth Bukusi, a senior research officer at the Kenya Medical Research Institute and co-author of a 2011 article on cervical cancer screening for HIV-positive Kenyan women.
|The main limitation to cervical cancer screening is the lack of awareness of cervical cancer as a significant health threat to women|
According to a 2011 study conducted in Eldoret, in Kenya's Rift Valley Province, on the perceptions of risk and barriers to cervical cancer screening, 35 percent of the participants did not think they were at risk of cervical cancer and felt no need to screen for the condition. In this study, 22.1 percent of the respondents mentioned fear of abnormal results as the reason they would not want to be screened for cancer while 11.4 percent mentioned cost. Just 12.3 percent of the participants reported having been screened at least once before.
Bukusi cautioned that health workers needed to emphasize the importance of repeat screening. "No currently available screening technique is 100 percent sensitive, and women are at risk of cervical cancer throughout their lives, so screening at regular intervals is necessary," she said.
Charles Okal, the Provincial AIDS and STI Coordinator in Nyanza, says the use of simple techniques for cancer screening and the integration of screening in HIV care settings had seen the number of women screened and treated rise over time.
"Making cervical cancer screening part of routine HIV care for women has made it easy to get more women to screen and get treated for the disease," he said. "But it is also important to note that HPV prevalence within the population will decline over time so long as we step up our efforts to make people take up such prevention methods such as condom use, male circumcision and reduction in sexual partners."
According to WHO, cervical cancer ranks as the second most frequent cancer among women in Kenya; about 39 percent of women in the general population are estimated to harbour a cervical HPV infection at any given time.