New Advocacy to Address Cervical Cancer in Women Living with HIV

indiaaidsalliance 24 April, 2013

Alliance India’s Koshish programme advocates for policies and strategies on sexual and reproductive health (SRH) and rights for people living with HIV (PLHIV) in India. The programme is implemented in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

During community consultations with PLHIV in these four states, the Koshish team noticed that women living with HIV (WLHIV) had low awareness of cervical cancer and seldom go for testing. HIV-infected women with advanced immunosuppression (CD4 count < 200 cells/µL) are particularly vulnerable to infection with human papillomavirus (HPV) that leads to cervical cancer.

As the availability of ART has increased, it has given greater hope to WLHIV to live healthier and longer lives. With improved survival, it has become even more imperative to address cervical cancer risk as a priority. Early detection of cervical cancer is possible through a Pap smear test. While not available at primary health centres, the test should be available at every government district hospital’s gynecological departments. Unfortunately, access is limited due to non-availability of kits or lack of trained lab technicians. Typically WLHIV are referred for the test only if doctors think the woman is vulnerable, basing their decision on certain symptoms.

HIV programming needs to integrate Pap smear testing into routine care. Koshish has been actively pushing for regular Pap smear test for WLHIV at civil hospitals. Our partners in Maharashtra, Mamta and the Maharashtra Network of People Living with HIV/AIDS (NMP+) have been successful in motivating Pap smear testing in five implementing districts, Nagpur, Amravati, Kolhapur, Ahmed Nagar and Thane.

In Ahmed Nagar, the team organises a health camp on the first and third Saturday of every month. In these camps, 25 women are screened for cervical cancer. In Thane, the civil surgeon has arranged for a monthly camp for 30 women. The camps in Kolhapur have begun and are being organised on Tuesday and Saturday, while in Nagpur the camps are being successfully held with support from the Indian Cancer Society. In Amravati district, the civil surgeon has issued a circular instructing routine Pap smear testing for WLHIV. Of the WHLIV tested for cervical cancer so far, nearly 10% have tested positive.

The risk of cervical cancer remains high in developing countries due to a lack of prevention and screening programmes. Under Koshish, partners have already started advocacy with decision-makers at State AIDS Control Societies to make annual Pap smear testing a mandatory part of the care for every WLHIV over 30 years of age who is on ART. Data collected from each state will support national level advocacy with decisional-makers at India’s National Health Mission and the National AIDS Control Organisation to ensure that prevention of cervical cancer among WLHIV is a priority. Koshish is committed to empowering PLHIV in India with advocacy tools to promote policies and strategies to improve their lives and build them as the natural leaders of these efforts.

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India HIV/AIDS Alliance works closely with PLHIV in India through its Koshish Project which strengthens civil society organizations and networks that represent and work with PLHIV and other marginalized groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual and reproductive health and rights of PLHIV in India. This project is funded by the European Commission and is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.