I was fortunate to meet Jabu Sithole, a 45-year-old woman from Eswatini who understands the gravity of cervical cancer. Jabu and her mother live with HIV and have been diagnosed with cervical cancer.
Last year, Jabu had a hysterectomy and is now cancer-free. Jabu was able to get the help she needed because her cancer was found early, and her job covered the costs of her surgery. Her mother hasn’t been as fortunate. Jabu’s mother had to prematurely end cancer treatment because the government stopped paying for the chemotherapy she so desperately needs due to resource constraints.
Women living with HIV are at higher risk for cervical cancer, a disease that disproportionately affects women in countries with limited resources, and a high prevalence of HIV, women like Jabu and her mother.
Go Further, a partnership between the George W. Bush Institute, the President’s Emergency Plan for AIDS Relief (PEPFAR), UNAIDS, and Merck, works to prioritize women living with HIV in cervical cancer programs.
The rate of new cases of cervical cancer among women in the Go Further countries (Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, Zambia, and Zimbabwe) is eight times higher than in the U.S.
With 3.8 million women living with HIV in these countries; the partnership is working closely with governments and implementing organizations to scale screening and treatment services rapidly. In just over one year of implementation, over 567,000 women living with HIV were screened for cervical cancer; 86 percent were first-ever screenings.
The integration of cervical cancer screening and treatment into HIV care has been a critical factor in Go Further’s ability to scale quickly. PEPFAR built a well-functioning model for care delivery in sub-Saharan Africa upon which additional health services have been successfully delivered, including for cervical cancer.
PEPFAR has supported cervical cancer screening and treatment since 2006, but its $53 million commitment over the past two years represents an exponential increase in funding.
Congress’s continued support of PEPFAR has allowed women to not only survive HIV but to thrive throughout their lifetimes.
Congress should maintain full funding for PEPFAR and allow the program the flexibility it needs to build on its success by integrating services into the HIV platform, including for cervical cancer, and following a public health approach, like PEPFAR’s DREAMS program. It’s not only the right thing to do, but it protects the investments U.S. taxpayers have made in PEPFAR over the past 17 years.
As we build additional services into the PEPFAR platform, we are making progress towards ensuring broad access to quality health care. Integration is a strategy for advancing access, but full integration of all key health services is not immediately realistic everywhere.
While layering services need to be done as quickly as possible, it should begin where it is most immediately achievable. Integrating cervical cancer into HIV care is not only an area where integration is feasible but reaches the women most at risk.
Coordination between HIV/AIDS and cervical cancer should be reflected not just in implementation but among organizations working for improved health outcomes at all levels, whether civil society and community groups or large multilateral and global partnerships.
An excellent place to start is for organizations that typically have not formed partnerships to work together — including those working on non-communicable diseases, like cervical cancer and infectious diseases, like HIV.
These partnerships must expand to ensure we meet needs across the continuum of care, and those holding the purse strings should recognize the value and ethicality to care for women wherever they are in their health journey. If we screen for a disease, we’ll find it. We have to make sure we have viable options for treating it.
A crucial part of integrating services and building partnerships is working with the community. The best information, most innovative thinking, and most sustainable methods of integrating and delivering services come directly from the communities that are intended to benefit from them. Communities’ leadership is vital to achieving the health outcomes we are all reaching for.
When I spoke to Jabu, she told me, “HIV is a thief, it can steal my life and attack the weak part of me. I want you to know that it is important for us to have those checkups so that we can get treatment before it is too late.” But she is also optimistic, saying, “I dream of a prosperous future for my children. …I also have to be productive for my community to be a healthy community. …With a healthier community, the government would be healthier too.”