The 8th Africa Stop Cervical, Breast and Prostate Cancer Conference focusing on ending Cervical Cancer held in Windhoek, Namibia, from 20 to 22 July 2014 with over 1,200 participants including host country Head of State and Prime Minister; 18 first Ladies and Spouses; 30 Minister’s; over 40 senior parliamentarians including Speakers / Deputy Speakers of Parliaments, Committee Chairpersons and members; other categories of senior policy and decision makers; development partners and agencies; non-state actors and civil society.
Evidence, data, information and analysis was provided for the conference on request of host first Lady’s office by Africa Health, Human & Social Development Information Service (Afri-Dev.Info) and Africa MNCH Coalition, and also provided basis for urgent post conference recommendations and action. Production of the evidence and knowledge material was supported by UNFPA, PMNCH and AWDF underlining the links between Cervical Cancer, SRHR, HIV/AIDS, Adolescent and Maternal Health – and necessary policy and investment action.
The conference communiqué by policy, decision, and opinion makers and participants committed to the following amongst others:
- Redouble efforts to mitigate misconceptions attached to cancer and integrate cervical, breast and prostate cancers; HIV and AIDS; maternal and child health programmes;
- To promote the development /implementation of evidence based sound health policies and programmes to combat cervical, breast and prostate cancers;
- Advocacy for adequate human, technical and financial resources for universal access to HPV vaccinations, treatment and care for cervical, breast and prostate cancers;
- Promote awareness / dissemination of accurate health information working together with religious, traditional, community leaders, civil society organizations and media;
- Support efforts of Governments to enhance participation of African research institutes, universities, civil society, private sector and other relevant stakeholders to support cancer prevention and treatment programmes in Africa;
- Provide Stewardship as First Ladies/Spouses, Parliamentarians and Ministers to intensity awareness and efforts towards ending cervical cancer and AIDS by 2030;
- Collaborate with bilateral, multilateral partners, and the private sector to ensure availability of technical and financial support in prevention, control and treatment of cervical, breast and prostate cancers;
Afri-Dev & Africa MNCH Coalition Presentations / Recommendations on Key Risk Factors, Considerations and Action for Effective Multisectoral Implementation of Outcomes:
In the evidence material produced for the conference; and in two key conference presentations on Political will for “Multisectoral Policy and Investment for Awareness, Prevention and Treatment of Cervical Cancer’ and ‘Incorporating Cervical Breast and Prostate Cancer in the Post 2015 Development Framework’ – Rotimi Sankore Coordinator of Afri-Dev and Editor of Afri-Dev.Info underlined multisectoral factors, action points and recommendations which were warmly welcomed by participants and organisers.
- Category A Risk Factors For Action – Regarding Intersection Between HPV, HIV And AIDS, Cervical Cancer And Sexual & Reproductive Health & Rights.
- Cervical Cancer is unique because it is a non-communicable disease triggered by several risk factors connected to Sexual and Reproductive Health – especially the HPV virus, and its vicious interaction with HIV and AIDS
- Many countries that have high rates of cervical cancer mortality and morbidity are also burdened with high rates of HIV. Recent findings show that HPV infection doubles the risk of acquiring HIV in women. (This is particularly pertinent to countries in Eastern and Southern Africa, and also countries like Nigeria with 2nd highest global number of people living with HIV)
- Evidence has also demonstrated that HIV (and weakened or suppressed immune systems) significantly increases the risk of persistent HPV infections, which in turn can lead to cervical cancer. Additionally, the development of cervical cancer is much faster in HIV-positive women. Women infected with both HIV and HPV are also more likely to develop cervical cancer.
- The top 20 countries in Africa variously with the highest Age Standardised Rate (ASR), Cumulative Risk, and highest absolute numbers of cervical cancer, also include between 12 and 13 of the countries with the highest numbers of women living with HIV of between 100,000 and 3.4m.
Given that overall there are over 23 million people living with HIV in Africa approximately half of whom are girls and women (out of a global total of a global total of 34 million) – urgent preventive action in affected countries is crucial to avoid an out of control epidemic of cervical cancer in the coming decades. This includes universal access to SRHR information, services and commodities.
- Category B Risk Factors For Action – Regarding Intersection Between HPV, Cervical Cancer, Sexual & Reproductive Health, Adolescent Pregnancies, High Fertility Rates, Family Planning And Maternal Health.
- Cervical Cancer is additionally unique because although a non-communicable disease, several key risk factors are connected to Sexual and Reproductive Health and Rights Issues – especially Underage Sex, Adolescent Pregnancy, High Fertility Rates, and Poor Access to Family Planning – all of which individually and collectively impact on Maternal Health.
- The WHO recommends that girls start receiving the HPV vaccine between the ages of 9 and 13 years to ensure immunization before sexual exposure. For girl children or adolescent girls exposed to early sex, especially those institutionally forced into under age ‘marriages’ and repeated premature sex – the benefits of the HPV vaccine are reduced or nullified.
- Additionally girl children / Adolescent girls forced into under age ‘marriage’ fall into several other high risk categories for cervical cancer – of adolescent pregnancies, higher number of live childbirths / high fertility rate – as they become pregnant earlier, and have more children at a younger age – if they survive pregnancy related mortality. Even for older women, higher number of live childbirths/high fertility rate increases risk of cervical cancer.
- Delaying commencement of sexual activity; avoiding adolescent / underage and repeated birth; and family planning are therefore strong consideration’s in the fight against cervical cancer – options which are hardly open to girl child ‘brides’, vulnerable to intimidation and sexual violence.
- The top 20 countries in Africa variously with the highest Age Standardised Rate, Cumulative Risk, and highest absolute numbers of cervical cancer, also include between 11 and 12 of the countries with the highest child ‘marriage’ (between 35% and 63% of girls forced into under age ‘marriage’; or countries with a total fertility rate of between 4.3 and 6.3).
- Demographic Patterns, Future Perspectives, and Risk Factors
1. As Africa’s population is predicted to double from current 1 billion to about 2 billion by 2050, with the youngest global population, demography is very likely to have an impact on prevalence and mortality from cervical cancer. The time to act is now.
Next Steps / Considerations for Prioritising Action
Based on the above factors, and the following country and regional trends and considerations, Afri-Dev, Africa MNCH Coalition and partners recommended that to build on the impetus and momentum from the conference – urgent innovative actions need to be undertaken on the links between Cervical Cancer, SRHR, HIV/AIDS, Adolescent and Maternal Health.
This should include engaging parliamentarians; ministers; senior officials from the following sectors: Health, Gender/Women, Youth, Education, Planning & Economic Development, Finance; also including all women members of parliament, cabinet, directors permanent secretaries, women leaders, opinion and decision makers.