Statement from Jhpiego President and CEO Dr. Leslie Mancuso

29 January 2009

Baltimore, Maryland—Imagine being diagnosed with a preventable disease in a country where access to quality health care services is not available to you. Not because you live in a remote area or because people don’t care, but because the training was not available for the skilled healthcare providers treating you.

Now imagine being an HIV positive woman in this country.  You may have another preventable disease that can also kill you and you don’t even know about it—cervical cancer.

As a leader in international health, I see these women facing this situation far too often. Globally, 473,000 new cases and more than 250,000 deaths due to cervical cancer are reported each year. More than 85 percent of those cases occur in low resource countries where fewer than 5 percent of women have ever had a Pap test. These same women, who are the backbone of their families and  countries are not just facing HIV/AIDS, but are also suffering from another disease that many do not even know they have—cervical cancer.

Women living with HIV are particularly vulnerable to human papillomavirus (HPV) infection and as a result are at high risk of developing cervical cancer. According to a recent study in the Clinical Infectious Diseases, “low and middle-resource countries, where women have been hit hardest by the AIDS epidemic, have historically also had a high prevalence of human papillomavirus (the virus that causes cervical cancer).” In HIV positive women, HPV develops faster and progresses quicker to cancer. The problem is that these women are not usually screened for cervical cancer when they are in HIV/AIDS treatment programs. While we are literally saving the lives of women with HIV with antiretroviral therapy and other care services, they are at risk of dying from an easily preventable cancer.

The irony is that there are innovative low cost solutions to this problem. We can screen and treat these women before they are diagnosed with cancer and it doesn’t cost much. However, there needs to be a skilled workforce trained to do the job.

For more than ten years, my organization has been working with low-resource countries around the world to provide them with low-cost, effective solutions to help women get screened. These innovations include visual inspection using acetic acid or better known as the V.I.A approach. VIA is a simple technique that uses vinegar to detect precancerous lesions on the cervix, and can be followed by treatment to freeze the lesions in the same visit (cryotherapy).  Evidence shows that this simple, low-cost approach can have an important impact in reducing mortality rates from cervical cancer.

As we pause this month to commemorate women suffering from cervical cancer, we recognize that it is an international health challenge that affects all of us. Our goal should be to keep women around the world healthy and productive—not just for their families, but for their countries.  It takes an integrated approach to women’s health to do this, including the testing and treating women for HIV as well as cervical cancer.  We can save women’s lives today.

Leslie Mancuso, PhD, RN, FAAN is the President and CEO of Jhpiego, an affiliate of The Johns Hopkins University in Baltimore