Before I came to ONE, I worked for an organization called the Global Network, which worked to raise the profile of neglected tropical diseases (NTDs), disabling and debilitating diseases that impact more than a billion people around the world but receive very little public attention and funding. One of the most interesting things I learned in my time at the Global Network was how one NTD, schistosomiasis (also known as snail fever) took a particular toll on women.
Global distribution of S. haematobium Infection in Africa (As Well As S. japonicum and S. mekongi Infections in Asia) from the World Health Organization.
Schistosomiasis in anyone is problematic — it causes stunted growth and anemia and frequently leads to blood in the urine, intestinal damage and even cancer. But one type of schistosomiasis (S. haematobium) in girls and women can cause additional problems, including the development of rough, mucosal patches in the genitals.
Because of these patches, females who are sexually active are more likely to experience contact bleeding, and are thereby more susceptible to acquiring HIV. In fact, a study in Zimbabwe showed that women suffering from genital schistosomiasis were 3 times more likely to become infected with HIV than their counterparts who did not have schistosomiasis.
Having studied HIV/AIDS for years, I was astounded to learn of a potential risk factor for HIV in women that I had never even heard of before and that had received virtually no attention from policymakers. But I was also heartened, because treatment for schistosomiasis — thanks in part to drug donation programs — is just 32 US cents per person, per year. For all the other worthy investments we make in AIDS prevention and treatment that are often tens and hundreds of dollars per year, certainly we can afford to tack on some additional loose change to control an NTD while also mitigating a potential risk factor for HIV in women!
As much as this seems like a no-brainer, there are still barriers to ensuring coverage for the women who need it. Partners of the Global Network, including the Schistosomiasis Control Initiative in the UK, are doing great work around the world to get praziquantel (the drug to treat schistosomiasis) to millions of people in need, but the drug remains in short supply globally. More research and on-the-ground pilot programs need to be conducted as well, to confirm linkages of causality between schistosomiasis and HIV and to show how HIV and NTD integration in the field can work.
We have no reason to delay treatment, even as this research is continued, however. In fact, as I write, millions of women and children are receiving treatment — including praziquantel — across Rwanda thanks to a partnership between Columbia University’s Access Project and the Rwandan Ministry of Health, and that’s progress worth celebrating for both HIV and NTD prevention.
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