Did you know that 95 percent of cervical cancer is caused by a certain type of Human papilloma Virus? For those who don’t know much about this potential killer virus, it is worth noting that it is mostly spread through unprotected sexual intercourse. The bad news is that any sexually active woman or girl can contract HPV. However, those at a much higher risk of contracting the virus are those who are HIV positive, smokers, those who engage in sexual relations at an early age, and those who have had multiple births among others. That said, the good news is that the HPV virus, which prefers living in areas around the cervix, vagina, anus, and oral region can be avoided through safe sex and vaccination. It is worth noting that you are twice as likely to contract HIV if you are carrying the Human papilloma Virus than other persons who have no HPV. As a result, the burden of two viruses exposes women to cervical cancer by five times. This is because the HIV virus weakens the immune system, decreasing the body’s ability to clear the Human papilloma Virus that causes cervical cancer by 90 percent. This is different for HIV negative women whose HPV can clear over time. A person suffering from cervical cancer experiences severe pain and creates fear within family members due to its familiar predisposition. The highest rates of cervical cancer appear at ages between 30-34 years. But not all is grim. Cervical cancer vaccination and screening at an early stage have proved to be lifesavers. In 2011, Rwanda became the first African nation to implement a national HPV vaccination program, conceived to protect girls aged up to 15 years. However, after trying out this campaign in all schools, in 2015, it was decided that a routine vaccination of 12-year-olds only was more viable. Since then, HPV vaccination coverage in Rwanda has increased from 6 percent to 99 percent. HPV vaccination coverage at a population level is a key indicator in the fight that we have waged against the future burden of cervical cancer, which is by far the most common cancer type in women in Rwanda. By 2019, cervical cancer had killed a whopping 29,800 women in our country. Of these, 940 died in 2019. So why is vaccination important? HPV vaccination reduces the risk of developing other cancers transmitted by HPV like oral pharyngeal, anal, vulva cancers and anal-genital warts. Women living with HIV are recommended to screen for cervical cancer using either verbal, visual inspection where the healthcare provider tests for precancerous or cancerous lesions or the presence of HPV using molecular DNA testing. Healthcare providers advise women to look out for signs of cervical cancer including vaginal bleeding after intercourse, bleeding between periods or after menopause, watery, bloody vaginal discharge that is heavy and has a foul smell or pelvic pain or pain during sexual intercourse. Early screening of HPV for all women with high risk of contracting HPV can help in the detection of the disease at an early stage, and aid timely intervention. While vaccination can be given to young women aged up to 26 years, the benefits for those aged 27-45 years are much lower because they have possibly been already exposed to the HPV. Vaccination is also recommended to people who are exposed to HPV because the vaccine protects other species of HPV which might be responsible for other cancers. The HPV vaccine is given in a series of shots. To be fully protected, young people who start the vaccine series before their 15th birthday need two doses. Those above 15, especially those who have compromised immunity, need three doses. For expectant women and girls, HPV vaccination should be delayed until after pregnancy although there is no evidence that vaccination will affect pregnancy or harm the fetus. The community needs to be aware of available services and trained staff need to be maintained through financial incentives, funding for availability of HPV DNA testing kits, equipment and trained doctors to manage chemotherapy prescription, disease management and radiotherapy for cervical cancer treatment. Every year, over 300,000 women die of cervical cancer worldwide. 90 percent of these deaths are from low- and middle-income countries where they leave orphans, widowers, and countries deprived of productivity years. With these numbers above, let us make it our responsibility to ensure that we practice safe sex and to advise each other to go for cervical cancer screening at the nearest health centers. It is important to remember that effective early detection of cervical cancer and vaccination are both critical. When done in a timely manner, both can provide women and girls with the greatest protection against cervical cancer by 90 percent. Dr. Julius Kamwesiga is Medical Director, AIDS Healthcare Foundation (AHF.
