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» » Cervical cancer - the monster that will not respect ART

Dr Angeline Mapanga and Sister Tafadzwa Chimwanza pose with journalists at a sensitization workshop in Harare recently.

Theresa Takafuma

What started as an intuition for Angeline Chiwetani (45) of Chitungwiza ended up saving her life from one of the most common cancers in women—cervical cancer.
Back in 2015 Chiwetani, who has been living with HIV for 23 years, was a fairly fit woman, thanks to the Antiretroviral Treatment (ART) she is taking.
She would not have suspected that something sinister, yet very unpredictable to the naked eye was taking place on her cervix, which had started developing lesions that over time were going to develop into cervical cancer.
As an HIV activist, Chiwetani had attended numerous local, intercontinental and global HIV forums, where the message kept growing louder and louder; women living with HIV were four to five times more at risk of cervical cancer.
Her intuition to get screened for cervical cancer continued to budge her until she eventually complied.
"I had information about cervical cancer and the increased risk women living with HIV have, but like anyone else, I hesitated several times," Chiwetani said.
"I wanted to speak from an informed point of view and to walk the talk when encouraging other women to go for regular cervical cancer screening," she added.
Chiwetani finally summoned the courage to go for screening at a clinic in Seke, Chitungwiza, where it was discovered that she had precancerous lesions on her cervix.
"I was traumatized at first, and I told the nurses that I wanted to process the news first before I return for treatment. It took me nearly two weeks but I had to summon enough courage to go for the removal of the lesions," Chiwetani said.
"I then started cryotherapy, which is basically the removal of the lesions on my cervix. The process was very painful and I do not want to remember that part of my healing journey," she said.
Chiwetani, who later went back for check-up in 2017, was found in the clear and says she deeply encourages women, especially those living with HIV to go for regular cervical cancer screening as they are four to five times at risk of developing cervical cancer.
In a presentation at a recent media sensitisation workshop in Harare, Organization for Public Health Interventions and Development (OPHID) country  director Dr Tinashe Chinyanga said that Zimbabwe has more than half a million women on antiretroviral treatment, who should be encouraged to go for cervical cancer screening since they are at more risk.
"The mere fact that these women are on antiretroviral treatment means that they are conscious of their health and wellbeing, and should therefore be encouraged to go for regular cervical cancer screening," Dr Chinyanga said.
OPHID technical director Dr Angeline Mapanga also told participants that Human Papilloma Virus (HPV), the virus that causes cervical cancer does not always clear on its own in women living with HIV, and could later cause lesions on the cervix, which if not removed will develop into cervical cancer for women between 30 to 49 years of age.
"While HPV does what we call spontaneous regression—which means clearing on its own in younger women, it is not always the case with women living with HIV, and that calls for regular cervical cancer screening for them," Dr Mapanga said.
"Cervical cancer is an AIDS defining cancer, as it also is the most common cancer in women in developing countries where Zimbabwe is found. We encourage preventive health seeking behavior in women because the earlier precancerous lesions are discovered on the cervix the easier and less costly it becomes," said Dr Mapanga.
Presenting on the Zimbabwean experience with Visual Inspection with Acetic Acid and Camera (VIAC), Sister Tafadzwa Chimwanza from United Bulawayo Hospitals (UBH) VIAC centre said women are often misled by the misconceptions of what happens during screening, hence the fear of being examined.
"There are myths about certain objects being inserted in a woman's genitalia during cervical cancer screening, and that is one of the reasons why women end up hesitating to come for screening," Chimwanza said.
"A lot of issues are at play, which includes some women inserting herbs in their genitalia and the fear that during screening they will be discouraged to use them, but the good news is that some women who would have been suffering in silence about certain problems that are not necessarily cervical end up getting help," said Chimwanza.
The Zimbabwe Cervical Cancer Prevention and Control Strategy (ZCCPCS) which is running from 2016 to 2020 states that there is an unknown but heavy cervical cancer burden, with HIV enhancing chronic HPV infection which is thus a huge contributing factor for cervical cancer.
Meanwhile, OPHID has a USD$1million grant to support cervical cancer programmes in Zimbabwe, working in 24 districts in five provinces.
The organization is also working with JF Kapnek Trust in Midlands in Masvingo provinces, and is targeting to screen 58 147 women living with HIV from 30 to 49 years of age between October 2018 up until September 2019.

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