Given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of ART with its concomitant metabolic complications, evidence has shown that HIV-infected adults on ART have a much higher risk of developing other chronic illnesses such as cardiovascular diseases, diabetes, chronic obstructive lung diseases as well as kidney disease. Other HIV/AIDS comorbid diseases on the increase include common female cancers such as cervical and breast cancer as well mental illness and substance abuse. Two thirds of premature deaths (between 30-70yrs) are linked to exposure to NCD risk factors such as smoking, alcohol, poor diet and physical inactivity and poor healthcare services. Since the advent of ART, HIV-infected women are no longer dying from opportunistic infections, but are living long enough to develop and die from cervical and breast cancer.
In South Africa, breast cancer and cervical cancer remain the most common cancers amongst women. According to the HPV Information Centre, the estimated number of new cases of cervical cancer in South Africa is over 7,000 per annum with an age-standardized rate of 31.7/100 000 . The estimated number of deaths among women in South Africa from cervical cancer is approximately over 4200 each year. This higher prevalence of cervical cancer and pre-cancer disease is also due to co-infection of patients with HIV and the human papillomavirus (HPV), which is the causal agent for cervical cancer. 60-80% of HIV-infected women in sub-Saharan Africa are infected with the HPV virus, placing them at substantially increased risk for cervical cancer.
The risk of cervical cancer in HIV-infected women has been found to be three times higher than in HIV-uninfected women globally. This calls for a scale up of efforts to reduce the risk of invasive cervical cancer through screening programs targeting HIV positive women with the ultimate goal of expanding the services to HIV uninfected women. On the other hand 50% of HIV transmission takes place among those aged 15–24 and 5 000–6000 young people become infected every day because of poor access to health services and commodities, early sexual debut, sexual coercion and violence and growing up without parents and abuse.
For those on ART, adherence may further be compromised due to partial or non-disclosure by their parents or caregivers, usually a grandparent, as well as lack of psychosocial support. Awareness and education programs for adolescents and young adults on risk factors for STIs, common cancers and the effects of smoking and alcohol use are not sub optimal in South Africa.
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