The film, which is part of the BBC's ongoing "Kill or Cure?" series, takes a look at the problems of treating and preventing cervical cancer in Africa. The half-hour documentary follows women's health advocate and member of the Ugandan parliament Sarah Nyombi as she travels across the country and gets a firsthand look at the landscape of cervical cancer in Uganda.
UICC took the opportunity to talk to the Hon. Sarah Nyombi and Dr. Emmanuel Mugisha, from PATH, about some of the issues raised in the documentary including the potential for vaccination support from the GAVI Alliance and improving the general awareness of cervical cancer prevention and treatment in Africa.
Interview with Hon. Sarah Nyombi, MP Uganda Parliament, and Dr. Emmanuel Mugisha, PATH Uganda.
In the documentary that aired on BBC, you discussed that women believe they are ‘bewitched’ because they do not know what they are suffering from. How do you attempt to dispel these myths?
Hon. Sarah Nyombi: There is a deliberate effort to sensitise people about cervical cancer, its causes, signs and symptoms. The government is also encouraging women aged 25 years and over to get screened for cervical cancer, whether they feel okay or not. There are also survivors of cervical cancer who come out and talk to people so that they can see that the disease is real and a medical issue, not a bewitching curse.
Also in the documentary, you say that unlike HIV/AIDS, condoms will not always prevent HPV. What are other ways to prevent cervical cancer if the vaccination is widely unavailable?
Dr. Emmanuel Mugisha: True, a condom is less effective in preventing HPV because HPV can be transmitted by any sexual touch, not just penetrative intercourse, and a condom does not cover the entire private area. There are then two main ways of preventing HPV infection: abstinence for life or vaccination prior to the beginning of a woman’s sexual life. For women who have already been infected, we can prevent cervical cancer through screening for the signs of pre-cancer, which involves visualisation of the cervix to see if there are abnormal cells. If abnormal cells are present, they are then destroyed before they develop into cancer.
What are ways to raise awareness about cervical cancer since most women do not know that cervical cancer effects over half a million women each year?
Hon. Sarah Nyombi: We are using all possible methods including: community dialogues, radio talk shows, television presentations, messages in print media, personal testimonials, and posters and flyers with messages on screening and treatment. There have also been awareness walks, as you can see at the end of the film, all of which have been very successful in raising awareness and spreading the message that cervical cancer is real and affecting women of all walks of life.
Dr. Emmanuel Mugisha: It is true that each year cervical cancer affects half a million women across the world, yet this is one of the cancers that can easily be prevented. Women (and men too) need to know this, and the only way to prevent it is, as I mentioned, abstinence, vaccination, or screening and treatment. This message needs to be disseminated amongst the global community at all times and by everyone, young and old, educated or not, rich or poor.
A good example of how the message is spreading is that, for example, parents in our vaccination programmes first received information on cervical cancer from their children who had been given this information at school and discussed it with their parents. Most of the parents then made sure that their daughters were vaccinated.
It is said, in the documentary, that some people fear that giving young girls a vaccination for a sexually transmitted infection will encourage them to engage in sexual activities. How do you combat this potential stigmatism in Uganda and the rest of Africa?
Hon. Sarah Nyombi: I feel that all that is needed is continued and relentless sensitisation and awareness campaigns so that people can appreciate the facts. This goes a long way to dispelling myths and rumours.
Dr. Emmanuel Mugisha: You know, we really have not seen this problem, even though we thought we might. And it has been the same in India, Peru and Vietnam where we have other HPV vaccination programmes.
Uganda is at a different level to some other countries of how it looks at major health problems, which stems from the nation’s HIV/AIDS experience. They now like to be open and discuss the issues with an open mind. For example, based on our background research where we asked whether parents would be concerned if their children receive information about HPV vaccinations as a vaccine against a sexually transmitted infection or not, to our surprise, they indicated that they are happy for their children to be exposed to the topic and issues as it relates to preventing a sexually transmitted infection. And when we sensitised the communities, we made everything clear that this vaccine is against HPV, which is a sexually transmitted infection, so people are quite positive in their reaction if they know it will help them. This again is based on the fact that there has been a lot of sensitisation about HIV/AIDS in schools and so this kind of information is not a shock to them. Remember that many of these parents have seen their children die from HIV/AIDS, and to them, anyone, innocent or not can catch such infections. So for them all they want is prevention.
You talked in the documentary about the GAVI Alliance, an organization who helps give funding for medicines used across the world. How will their aid help Uganda and Africa with the HPV vaccination?
Hon. Sarah Nyombi: If we can get GAVI to subsidize the costs of the vaccine for poor countries like Uganda, then nations like ours will be able to make it available to all eligible girls. Without GAVI, it may prove difficult, as the vaccine is very expensive.
Dr. Emmanuel Mugisha: Yes, this vaccine is very expensive and it is certain that at the current price, Uganda cannot afford to vaccinate its entire population. So organizations like GAVI can help negotiate better prices and procure the vaccine in large quantities to supply to low-income developing countries at subsidized prices. GAVI has in fact been very good about helping Uganda in the past. We in the developing countries are very unfortunate; we have a huge health problem but very limited resources to combat it.
In your experience as an MP, what are the political actions that can be taken in Africa to improve comprehensive cervical cancer prevention?
Hon. Sarah Nyombi: It would go a long way if all countries in Africa could have a systematic programme to combat cervical cancer through proposing sufficient budgets. There is the urgent need for a comprehensive approach to addressing cervical cancer from primary to secondary prevention as well as palliative care. The Members of Parliament themselves need to push hard, and ensure that all parliamentarians are informed on these important issues.