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HIV/AIDS, schistosomiasis, and girls

2009; Elsevier BV; Volume: 373; Issue: 9680 Linguagem: Inglês

10.1016/s0140-6736(09)61111-9

1474-547X

Kari Stoever, David Molyneux, Peter J. Hotez, Alan Fenwick,

Adolescent Sexual and Reproductive Health

Sub-Saharan Africa is losing the war on HIV/AIDS. Although the number of AIDS-related deaths declined between 2005 and 2007 from 2·2 million to 2·0 million, more than 2·7 million people were newly infected with HIV in 2007 alone.1Committee on the US Commitment to Global Health, National Research Council, Institute of MedicineThe US commitment to global health: recommendations for the new admistration.http://www.nap.edu/catalog/12506.htmlGoogle Scholar Perhaps nowhere is this more clear than in Mozambique, where more than US$700 million has been earmarked for HIV/AIDS funding since 2004, and yet there are 1·6 million people infected—up from about 1·1 million in 2001—with 450 new HIV infections every day.2UNICEFHIV/AIDS: Mozambique.http://www.unicef.org/mozambique/hiv_aids_2967.htmlGoogle Scholar The struggle to address HIV/AIDS requires a particular focus on women and girls. In southern Africa, 57% of infected young people are female, and in many rural areas for every man that is HIV-positive, anywhere from 1·3 to 6·4 women are now infected.3Kjetland EF Ndhlovu PD Gomo E et al.Association between genital schistosomiasis and HIV in rural Zimbabwean women.AIDS. 2006; 20: 594Crossref Scopus (266) Google Scholar As infection rates for women climb, we must look beyond sexual behaviour for causation. One commonly overlooked link is infection with the waterborne parasitic worm Schistosoma haematobium, which lives in the blood vessels around the bladder, and whose eggs affect the urinary and genital system. Up to 75% of women infected with urinary schistosomiasis develop often irreversible lesions in the vulva, vagina, cervix, and uterus, creating a lasting entry point for HIV; correspondingly, research in Zimbabwe showed that women with urinary schistosomiasis had a three-fold increased risk of having HIV.3Kjetland EF Ndhlovu PD Gomo E et al.Association between genital schistosomiasis and HIV in rural Zimbabwean women.AIDS. 2006; 20: 594Crossref Scopus (266) Google Scholar Treating this worm infection early with the safe and effective drug praziquantel provides a cost-effective method to protect girls from both schistosomiasis morbidity and HIV;4Hotez PJ, Fenwick A, Kjetland EF. Africa's 32 cents solution for HIV/AIDS. PLoS Negl Trop Dis (in press).Google Scholar on the basis of clinical studies, periodic and regular treatment with praziquantel from when children are first infected should prevent the development of genital lesions—a probable risk factor for HIV infection.4Hotez PJ, Fenwick A, Kjetland EF. Africa's 32 cents solution for HIV/AIDS. PLoS Negl Trop Dis (in press).Google Scholar This is particularly true in Mozambique, where there is extensive overlap of urinary schistosomiasis and HIV/AIDS cases, as well as in Zimbabwe, Malawi, and parts of South Africa. The focus on treatment of HIV will continue to be a priority for the international community. However, there is a need to reduce the risk of transmission for young girls at risk, and we should not limit funding to disease-specific initiatives when integrated solutions are available at a minimal add-on cost. If $700 million has not reduced the number of infections in Mozambique since 2004, we suggest that providing an annual dose of praziquantel at $0·32 per person might, in the long term, have a much greater effect on the future of HIV in schistosomiasis-endemic areas.4Hotez PJ, Fenwick A, Kjetland EF. Africa's 32 cents solution for HIV/AIDS. PLoS Negl Trop Dis (in press).Google Scholar By recognising the co-endemicity of HIV/AIDS and S haematobium, as well as the benefit of integrated treatment and HIV prevention, an immediate effect on the health and future lives of millions of girls and young women can be achieved. In global efforts to expand access to antiretrovirals in co-endemic areas for urinary schistosomiasis, organisations and governments have an ethical obligation to provide access to praziquantel in parallel. By failing to embrace this opportunity now, a generation of school-age and adolescent girls will continue to be at higher risk of succumbing to HIV throughout much of southern Africa. We declare that we have no conflicts of interest.