March 31, 2016
A comprehensive review of secondary data sources has confirmed a long-suspected link between female genital schistosomiasis (FGS) and HIV infection for women in southern Africa. A researcher from the UNC Gillings School of Global Public Health was one of two co-authors of the resulting article, titled “Association Between Schistosoma haematobium Exposure and Human Immunodeficiency Virus Infection Among Females in Mozambique,” published online March 14 by the American Journal of Tropical Medicine and Hygiene.
Researchers confirmed the FGS-HIV link in Mozambique, finding that exposure to schistosomiasis, combined with HIV prevalence, increases the odds of HIV infection by three times. Researchers also concluded that treating young girls for schistosomiasis could avert millions of new cases of HIV infection at far less cost than treating HIV infection once it has occurred.
Schistosomiasis is a water-borne parasitic infection, usually contracted in childhood through activities such as swimming, bathing, fishing, and fetching water. It affects 261 million people worldwide and is known to be highly endemic in sub-Saharan Africa. Domestic chores can place girls and women at greater risk of contracting FGS, which, the researchers say, may help explain the fact that only in sub-Saharan Africa are HIV infections higher among females than among males.
Kavita Singh Ongechi, PhD, research associate professor of maternal and child health at the Gillings School, wrote the paper with Paul Henry Brodish, PhD, applications analyst at MEASURE Evaluation, where Singh is senior technical adviser for maternal and child health. The co-authors conducted the study for MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), a project of the Carolina Population Center, where Singh is a faculty fellow.
The researchers confirmed the link in Mozambique by investigating two high-quality secondary data sources on HIV prevalence and FGS: the 2009 National Survey on Prevalence, Behavioral Risks and Information about HIV and AIDS in Mozambique (INSIDA) and the Global Neglected Tropical Diseases (GNTD) open source database. Their results can reasonably be applied generally to sub-Saharan Africa and perhaps especially to South Africa, Tanzania and Zimbabwe, where field studies showed women whose vaginal mucosal barrier tissue was compromised due to FGS were three times as likely as their neighbors to be infected with HIV.
In fact, two decades of studies have indicated that HIV/AIDS can be exacerbated by co-infection with neglected tropical diseases (including schistosomiasis), which weaken immune systems, increase susceptibility to other infections and lower the effectiveness of antiretroviral therapy (ART).
The study’s findings also offer a significant potential cost savings for governments and global donors, as treatment for FGS would cost far less than treating HIV infection. The authors cite estimates that de-worming 70 million African children twice a year for a decade would cost about $112 million, versus an estimated $38 billion PEPFAR would expend in the same period on ART.
These results provide additional evidence supporting the link between neglected tropical diseases (NTD) and HIV and highlight the need to scale up treatment for NTD and increase access to improved water sources. The authors suggest further studies are necessary in other locales where there is high HIV prevalence and endemic NTDs.
The study is also significant on a global scale as the Sustainability Development Goals, USAID’s goal of an AIDS-free generation and general prevention of mother-to-child transmission of HIV, will be that much more attainable if HIV infection can be curtailed in sub-Saharan Africa—where 60 percent of new cases are female and mostly young.
This article was originally published by MEASURE Evaluation.