HIV/AIDS, schistosomiasis, and girls

Editorial: Lancet Correspondence

Sub-Saharan Africa is losing the war on HIV/AIDS. The struggle to address HIV/AIDS requires a particular focus on women and girls. In many rural areas for every man that is HIV-positive, anywhere from 1·3 to 6·4 women are now infected.

As infection rates for women climb, we must look beyond sexual behaviour for causation. One commonly overlooked link is infection with the waterborne parasitic worm Schistosoma haematobium, which lives in the blood vessels around the bladder, and whose eggs affect the urinary and genital system. Up to 75% of women infected with urinary schistosomiasis develop often irreversible lesions in the vulva, vagina, cervix, and uterus, creating a lasting entry point for HIV; correspondingly, research in Zimbabwe showed that women with urinary schistosomiasis had a threefold increased risk of having HIV.

Treating this worm infection early with the safe and effective drug praziquantel provides a cost-effective method to protect girls from both schistosomiasis morbidity and HIV; on the basis of clinical studies, periodic and regular treatment with praziquantel from when children are first infected should prevent the development of genital lesions—a probable risk factor for HIV infection.

The focus on treatment of HIV will continue to be a priority for the international community. However, if $700 million has not reduced the number of infections in Mozambique since 2004, we suggest that providing an annual dose of praziquantel at $0·32 per person might, in the long term, have a much greater effect on the future of HIV in schistosomiasis-endemic areas.

By recognising the co-endemicity of HIV/AIDS and S. haematobium, as well as the benefit of integrated treatment and HIV prevention, an immediate effect on the health and future lives of millions of girls and young women can be achieved.

Read the Lancet article in full