Since the 2000s, we have known that female genital schistosomiasis (FGS) is likely the most neglected gynecologic condition and HIV/AIDS cofactor across sub-Saharan Africa. To date, the global health and HIV/AIDS communities have not used the opportunity to prevent new HIV/AIDS infections through highly cost-effective schistosomiasis control and elimination in Africa. But recently, this situation may be shifting toward the better.
An analysis of information released by the World Health Organization reveals that the concepts of blue marble health extend beyond neglected tropical diseases to also include “the big three diseases”: HIV/AIDS, tuberculosis, and malaria.
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The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. Read the rest of the article here (you have to register but it’s free and takes only a minute)
Over the years I have written a lot (and beaten the drum pretty hard) about the importance of female genital schistosomiasis (FGS), its devastating effects on young women, and its key role in promoting HIV/AIDS transmission in Africa. FGS occurs when the eggs of Schistosoma haematobium are deposited in the uterus, cervix, and vagina of girls and women living in the major affected areas located in southeastern Africa and Francophone West Africa and Nigeria. A number of clinical studies have documented how the trapped eggs and resulting granulomas cause pain and contact bleeding, and ultimately shame, marital discord, and even depression. Two independent epidemiological studies (led by groups from Oslo and Weil Cornell Medical College) have linked FGS to multifold increases in acquiring HIV. While the exact mechanism for this is still unclear, presumably the schistosome eggs and granulomas produce sufficient ulceration and bleeding to facilitate virus entry leading to HIV infection.
Effective management of HIV/AIDS may require the control of NTDs. The past successes in integrating directly observed therapy for tuberculosis , co-trimoxazole chemoprophylaxis, and nutritional support into HIV/AIDS programming indicates it is also possible to incorporate NTD preventive chemotherapy in HIV/AIDS treatment regimens. A full consideration of NTD control will require meaningful cooperation from the public health community.
By preventing urogenital schistosomiasis in sexually active females through simple and low-cost methods, we have an innovative and timely opportunity to reduce and possibly interrupt HIV/AIDS transmission throughout many rural areas of sub-Saharan Africa.
More than 90% of the world’s 207 million cases of schistosomiasis occur in sub-Saharan Africa, making this condition (as well as hookworm infection) one of the most common neglected tropical diseases in the region. Based on additional information that schistosomiasis causes chronic anemia and inflammation associated with severe disability among children, adolescents, and young adults, the disease burden resulting from schistosome infections in Africa may actually rival better known conditions such as HIV/AIDS, tuberculosis, and malaria.