Earlier this year, Ann Kim, a freelance journalist on a fellowship from the International Reporting Project, went to Botswana to report on AIDS, where the adult HIV prevalence is 24 percent, the second highest in the world.
She found AIDS, but she also found cancer. "Thank God I have AIDS and not cancer, because that would be a death sentence," an HIV-positive woman told her in a clinic. Botswana, a well-off country by African standards, has a health system well-equipped for dealing with AIDS, but not cancer.
In Togo, Dr. Kokou Agoudavi, the head of non-communicable diseases at the Ministry of Health, told me that Togolese cancer patients sometimes sell their houses or fields to pay for cancer treatment, which is not available in-country anyway. They have to go to neighboring Ghana, if they can afford it. He said this often happens in the late stages of cancer, when survival rates are low.
In July, the Associated Press reported that hospitals in Swaziland do not provide chemotherapy or radiation treatment and that the country's cash-strapped government announced it had run out of money to send its cancer patients to neighboring South Africa.
Cancer is on the rise in Africa and, in most cases, countries have little or no means for dealing with it. Of particular concern are the AIDS-defining cancers -- cervical cancer, Kaposi sarcoma and lymphoma -- according to Dr. Sam Mbulaiteye of the U.S. National Cancer Institute. HIV-positive Africans have a 30-90 times higher risk of Kaposi sarcoma, a 5-times higher risk of lymphoma and at least twice the risk for cervical cancer compared to HIV-negative Africans.
Yet most African languages don't have a word for cancer. Breast and cervical cancer are the two most common cancers among African women. Cervical cancer is "at the intersection of infectious diseases (HPV), reproductive health and cancer, " according to "Understanding the Burden of Cancer in Developing Countries," published by the Global Health Council, but is exacerbated by a lack of reproductive health information and access to treatment in many parts of Africa.
About 2 million women develop breast or cervical cancer every year, according to a report published last week by the Seattle-based Institute of Health Metrics and Evaluation, and much of the growth has been in poor countries, especially in north Africa, West Africa, the Middle East, Oceania, southeast Asia and Central America. The report warned that these two cancers could overtake maternal mortality as a cause of death in younger women.
At least it's finally being recognized and addressed. In April, Rwanda launched a cervical cancer vaccination program for all of its 12- to 15-years-old girls, the first comprehensive national program in all of Africa. There were already pilot projects in Kenya, Cameroon, Ghana, Lesotho, Tanzania and Uganda, according to Cervical Cancer in Action, but Rwanda is aiming for total coverage, an impressive undertaking even in a small country like Rwanda.
And last week, just ahead of the U.N. High Level Meeting on Non-Communicable Diseases (NCDs) Sept. 19-20, former President George W. Bush announced a new $75 million initiative called Pink Ribbon Red Ribbon to fight breast and cervical cancer by expanding the availability of cervical cancer screening and treatment and breast care education in Africa and Latin America over five years.
"It's time to take the next step in building on the progress that has been made over the past decade in the fight against HIV and AIDS," said Bush in a statement. "Many women who seek AIDS services also face the challenge of cancer. It's not enough to save a woman from AIDS, if she is then left to die of another very preventable disease."
Pink Ribbon Red Ribbon will capitalize on the vast infrastructure of clinics and health workers financed by the President's Emergency Plan for AIDS Relief, which Bush launched in 2003. The goals are "to reduce deaths from cervical cancer by 25% among women screened and treated, significantly increase access to breast and cervical cancer prevention, screening and treatment programs and create innovative models that can be scaled up and used globally."
In addition to the health and human impact of cancer, its economic dimensions are profound. Last year, an American Cancer Society report estimated the total economic impact from premature death and disability from cancer worldwide was $895 billion, representing 1.5% of the world's gross domestic product. In low-income countries, cervical cancer accounted for more than 10% of the economic loss, second only to mouth and throat cancer.
The High-Level Meeting on NCDs taking place this week is our biggest opportunity yet to address the scourge of cancer in Africa -- and everywhere -- in a global way.
For more information on cancer in Africa, see "Cancer Screening," a blog by Débora Miranda, a science journalism MA student at City University London who is studying cancer in Africa.
Follow David J. Olson on Twitter: www.twitter.com/davidjolson
I understand that global health initiatives are heavily dependent on funding and the interests of the funders. However, focusing on only one disease vertical at a time undermines our own work because another disease area gains in prevalence while we are trying to address the first. Instead, a more holistic approach that addresses systemic issues and attempts to improve health across all disease areas may prove to be more effective and sustainable (though by no means easier).
All lives have equal value and women facing cancer in the South have the same right to treatment as they do in the U.S., Canada or Europe.
With Pink Ribbon, Red Ribbon, George W seems to have it right this time around...