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CANCER AND HIV IN AFRICA

Targeting the Link Between HIV and Cervical Cancer

When the Bristol-Myers Squibb Foundation launched its groundbreaking SECURE THE FUTURE initiative to address the HIV epidemic in sub-Saharan Africa in 1999, HIV was a veritable death sentence. Today, thanks to the Foundation's work mobilizing communities and an increase in national and international resources to educate the population and build a health care infrastructure to address HIV, women who are infected with the disease are living longer and healthier lives.

That's the good news. The bad news is that women living with HIV in Africa are now more likely to die from cervical or breast cancers than they are from HIV. What's worse, awareness of breast cancer among women who may be at risk is low and the potentially lethal consequences of cervical cancer are generally unknown.

The link between HIV infection and cervical cancer is high: Women who have cervical cancer are twice as likely to be HIV-infected, and HIV-positive women develop cervical cancer 10 years earlier than women who are not infected.

Leveraging the legacy and infrastructure it helped build in Africa, SECURE THE FUTURE is now working to raise awareness about both breast and cervical cancer and is helping to support a number of programs throughout Africa that are rallying communities in the effort.

These programs led to a partnership with Pink Ribbon Red Ribbon (PRRR) http://pinkribbonredribbon.org/, a coalition led by the George W. Bush Institute, USAID, UNAIDS and Komen for the Cure. The Bristol-Myers Squibb Foundation is a founding corporate member of the PRRR coalition. PRRR combines public and private investments to leverage HIV platforms to expand the availability of cervical screening and treatment and breast care education, especially for women most at risk of developing cervical cancer in developing nations.

In Tanzania, cervical cancer is the leading cause of cancer-related death. The country has one of the highest cervical cancer burdens in the world. According to the World Health Organization, the incidence of cervical cancer in Tanzania is significantly higher than the rest of the world: 40.6 per 100,000 compared to 16 per 100,000 elsewhere.

In partnership with PRRR, several organizations are working together in Tanzania to increase community awareness, capacity and treatment for cervical and breast cancer and to advocate for policy changes for breast and cervical cancer services.

The Medical Women Association of Tanzania (MEWATA) http://www.mewata.org/; Tanzania Marketing and Communications http://www.tmarc.or.tz/l/projects/cervical-cancer-project/; Tanzania Youth Alliance http://www.tayoa.org/tayoa/;  and Mbeya HIV/AIDS Network-Tanzania have received funding and technical support from the Foundation to work with community and faith-based organizations to raise awareness about cervical cancer and improve access to screening and prevention in the Mbeya, Mwanza and Iringa regions.

The groups have developed social networks of community leaders and linked them with health centers and women's groups, provided transportation to screenings, established helpline services and advocate for national and regional support that will fund cancer services and interventions at the community level.

MEWATA, a non-governmental organization of women medical and dental practitioners, has been taking a lead in addressing the problem of cervical and breast cancers in Tanzania. Through the support of the Foundation's SECURE THE FUTURE initiative, MEWATA in collaboration with Wanawake na Maendeleo (WAMA) Foundation, met with members of Parliament and regional and district health management teams to advocate for allocating resources for breast and cervical cancer screening services. During a mass screening campaign for breast and cervical cancers in Mwanza, more than 5,200 women were screened for breast cancer and 3,800 women for cervical cancer.

"The Bristol-Myers Squibb Foundation has been a valued member of Pink Ribbon Red Ribbon since its inception, keeping a focus on the community component of the continuum of cancer care," says Doyin Oluwole, M.D., MRCP, FRCP, FWACP, executive director, Pink Ribbon Red Ribbon, George W. Bush Institute. "In Tanzania, additional community-based health providers have been trained, allowing us to expand screening and treatment services and save the lives of more women and girls. We look forward to continuing our partnership as we strengthen capacity at the community level in Tanzania and make plans to engage in Ethiopia and other countries."

In another project funded by the Foundation, the Swaziland Breast and Cervical Cancer Network (SBCCN) http://www.breastcancernet.org.sz/, a non-governmental organization, is training teams of community members called Rural Health Motivators to raise awareness and early detection of HIV, breast and cervical cancer in communities across the country. The organization, in collaboration with the Ministry of Health, operates three breast cancer clinics and four cervical cancer screening points throughout the nation.

One of these is in Ngculwini, a traditional Swazi community ruled by a chief with a team of elders. Ngculwini has an estimated population of 30,000, of whom 9,000 are women. The SBCCN worked with community leaders, schools and churches to create a cervical cancer awareness campaign and in May 2013, won the endorsement of Chief Mgebiseni Dlamini for establishing a cervical cancer screening clinic.

"Swazis have a strong respect for their traditional structures, so it was important that we involved members of the community and collaborated with and received the endorsement for cervical cancer screening from Chief Mgebiseni," says Lena Preko, program manager, SBCCN. "It engendered community acceptance and participation."