IN CONVERSATION WITH DR SUCCESS BOUANGUI
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South Africa continues to face a growing cervical cancer crisis, driven by low screening rates, late diagnoses, high HIV prevalence, and limited access to life-saving treatment and vaccination.
The country’s cervical cancer rate ranges between 22.8 and 27 cases per 100,000 women, far exceeding the global average of 15.8 per 100,000. It remains the leading cause of cancer-related deaths among South African women, with over 10,700 new diagnoses and more than 5,800 deaths reported each year.
HIV and Cervical Cancer: A Dangerous Intersection
Women living with HIV are six times more likely to develop cervical cancer than their HIV-negative counterparts. This increased risk stems from a weakened immune system, which reduces the body’s ability to fight off Human Papillomavirus (HPV)—the virus responsible for cervical cancer.
“When HIV isn’t well managed, the immune system struggles to clear HPV infections,” explains Dr Mark Faesen, a gynaecologist and fertility expert at the Clinical HIV Research Unit (CHRU). “These persistent infections can lead to pre-cancerous lesions and, eventually, cervical cancer.”
HPV is one of the most common sexually transmitted infections globally. Faesen notes that more than half of sexually active young people will contract HPV within three years, and of the nearly 150 known HPV types, three—HPV 16, 18, and 45—are responsible for roughly 80% of cervical cancer cases.
Once a high-risk HPV infection becomes persistent, it cannot be removed from the body. The virus can also infect surrounding areas such as the vulva, leading to long-term health complications.
Faesen adds that factors such as poor immune health, multiple sexual partners, frequent exposure to the virus, co-infections with other STIs, and smoking all increase the risk of developing cervical cancer.
Prevention Through Vaccination and Screening
Despite the grim statistics, cervical cancer is preventable—and effective vaccines are available to protect against high-risk HPV strains.
The World Health Organization recommends HPV vaccination for girls aged 9 to 14, ideally before they become sexually active. Vaccination is also encouraged for young women up to the age of 20, and for those over 20, two doses six months apart are advised.
South Africa introduced school-based HPV vaccination in 2014 for girls aged nine and older. However, ensuring that every eligible child receives the vaccine remains a challenge.
“There are still logistical hurdles in reaching all the children who need the vaccine,” Faesen says.
Screening and Follow-Up Gaps Persist
According to Professor Sinead Delany-Moretlwe of the Wits Reproductive Health & HIV Institute (Wits RHI), although the introduction of HPV vaccines has been a major step forward, more work is needed across the screening and treatment pathway.
“Getting women screened, tested, and treated remains a big problem,” she says. “There are multiple steps in the process, and people often don’t return for follow-ups.”
Health experts agree that to curb cervical cancer rates in South Africa, a more comprehensive and coordinated approach is required—one that combines early vaccination, regular screening, strong HIV care, and accessible treatment options for all women, especially those most at risk.
The country’s cervical cancer rate ranges between 22.8 and 27 cases per 100,000 women, far exceeding the global average of 15.8 per 100,000. It remains the leading cause of cancer-related deaths among South African women, with over 10,700 new diagnoses and more than 5,800 deaths reported each year.
HIV and Cervical Cancer: A Dangerous Intersection
Women living with HIV are six times more likely to develop cervical cancer than their HIV-negative counterparts. This increased risk stems from a weakened immune system, which reduces the body’s ability to fight off Human Papillomavirus (HPV)—the virus responsible for cervical cancer.
“When HIV isn’t well managed, the immune system struggles to clear HPV infections,” explains Dr Mark Faesen, a gynaecologist and fertility expert at the Clinical HIV Research Unit (CHRU). “These persistent infections can lead to pre-cancerous lesions and, eventually, cervical cancer.”
HPV is one of the most common sexually transmitted infections globally. Faesen notes that more than half of sexually active young people will contract HPV within three years, and of the nearly 150 known HPV types, three—HPV 16, 18, and 45—are responsible for roughly 80% of cervical cancer cases.
Once a high-risk HPV infection becomes persistent, it cannot be removed from the body. The virus can also infect surrounding areas such as the vulva, leading to long-term health complications.
Faesen adds that factors such as poor immune health, multiple sexual partners, frequent exposure to the virus, co-infections with other STIs, and smoking all increase the risk of developing cervical cancer.
Prevention Through Vaccination and Screening
Despite the grim statistics, cervical cancer is preventable—and effective vaccines are available to protect against high-risk HPV strains.
The World Health Organization recommends HPV vaccination for girls aged 9 to 14, ideally before they become sexually active. Vaccination is also encouraged for young women up to the age of 20, and for those over 20, two doses six months apart are advised.
South Africa introduced school-based HPV vaccination in 2014 for girls aged nine and older. However, ensuring that every eligible child receives the vaccine remains a challenge.
“There are still logistical hurdles in reaching all the children who need the vaccine,” Faesen says.
Screening and Follow-Up Gaps Persist
According to Professor Sinead Delany-Moretlwe of the Wits Reproductive Health & HIV Institute (Wits RHI), although the introduction of HPV vaccines has been a major step forward, more work is needed across the screening and treatment pathway.
“Getting women screened, tested, and treated remains a big problem,” she says. “There are multiple steps in the process, and people often don’t return for follow-ups.”
Health experts agree that to curb cervical cancer rates in South Africa, a more comprehensive and coordinated approach is required—one that combines early vaccination, regular screening, strong HIV care, and accessible treatment options for all women, especially those most at risk.
