Cancer, HIV fight need more effort

Over the past 10 years, Ugandans appear to have lost focus, as a new study shows that the HIV prevalence rate has again shot up, Chris Kiwawulo writes

Back in the days, cancer was a strange infection. Since there are many types of cancers, some of which present as tumors, local communities could not understand the cause of the incurable illness and, therefore, linked it to witchcraft, just like any other strange diseases.

Cancer refers to a number of various diseases that result from uncontrolled growth of a group of body cells, which never mature and since they are of no function in the body, they result in a swelling (tumor).

It was until the Uganda Cancer Institute (UCI) was founded in 1967, as the Lymphoma Treatment Centre that many patients with such swellings on their bodies got to know what they were suffering from.

The centre, with 20 beds, helped to treat childhood lymphomas, predominantly Burkitt’s lymphoma, the most common childhood lymphoma in Uganda which is endemic in tropical Africa.

In 1969, the institute expanded to a total of 40 beds, when the Solid Tumor Centre was added to focus research on Kaposi’s sarcoma and liver cancer.

During the 1960s and early 1970s UCI was a leading international medical research centre, in its areas of specialisation. UCI established collaboration with the National Cancer Institute (NCI), in Bethesda, Maryland, USA.

Following the expulsion of Ugandan Asians by the late President Idi Amin in 1972, nearly all NCI’s scientists left.

Prof. Charles Olweny, a Uganda researcher, interrupted his studies at NCI in the USA and returned to become the first Ugandan director of UCI. In 1982, following the overthrow of Idi Amin, Olweny was forced to leave Uganda for security reasons, leaving the leadership of UCI in the hands of Prof. Edward Katongole- Mbidde.

When Katongole-Mbidde left UCI to become the director at the Uganda Virus Research Institute (UVRI) in 1995, Dr. Jackson Orem took over the helm at UCI to date. Orem says cancer is not a new disease in Uganda as documentation by missionary Dr. Sir Albert Cook, the father of modern medicine in Uganda, describes cases between 1897- 1904 as cancers.

Orem says the fact that Uganda’s cancer was curable (Burkitt Lymphoma) received the attention of researchers worldwide, and NCI saw an opportunity to collaborate with Makerere University resulting in the establishment of UCI in 1967.

According to the World Health Organisation (WHO) estimates, there will be 60,000 cancer cases in the country at any time.

“This is alarming given that there is no new investment in cancer treatment facilities. 85% of patients with cancer are from the rural areas without access to specialised cancer care.

Only 4% cases of cancers diagnosed currently present for treatment at the UCI meaning 96% die without getting treatment,”Orem explains.

He enumerates factors like lifestyle changes such as consumption of tobacco which causes lung cancer, consumption of alcohol which causes liver cancer, viral infections and environmental changes as some of the factors that have led to the increase in cancer.

The high cancer death in Uganda is due to late diagnosis due to poor access to services, he notes, adding that this is compounded by lack of information and traditional beliefs which make patients rush to traditional healer’s personnel.

“Our medical training is skewed towards infections; hence cancer comes as an afterthought, a contributory factor to late referral,” Orem observes.

As an intervention, Orem suggests that screening for and vaccination against Hepatitis B and cervical cancer be included in routine programme. Breast cancer screening and treatment should be made available at lower level health centres.

“Treatment must be made accessible countrywide through a network of centres coordinated by a national centre of excellence with referral conduits for patient follow-up and surveillance,” he suggests.

Uganda Cancer Research Foundation

In October 2006, a group of Ugandans founded the Uganda Cancer Research Foundation (UCRF), but only registered the foundation in 2008. The not-for-profit organisation was started to introduce sustained action against cancer at the grassroots.

Among the founders was the Buganda Queen Sylvia Nagginda, Chief Justice Benjamin Odoki, Archbishop Cyprian Lwanga and Dr. Martin Aliker.

UCRF has launched several programmes the Luweero School Cancer Education Programme to sensitise the public about cancer. Similar programmes have since been rolled out to the neighbouring Nakasongola and Nakaseke districts.

In 2010, UCRF did a survey of cancer cases seen in five hospitals (Lacor, Soroti, Mbale, Jinja and Mbarara) over the past 10 years and found more than 5,000 cases of which more than three quarters received only pain killers.

The most common cancers in Uganda are; cervical, breast, lung, liver ovary, lymphoma, prostate, cancer of the bowel and Kaposis sarcoma.

Link between cancer and HIV Ironically, Kaposis sarcoma has been associated with HIV/AIDS. Orem says 60% of the current increase of cancer can be attributed to HIV infection, but cancer is not refl ected in the funding of HIV such as Global Fund and the US. President’s Emergency Plan for AIDS Relief (PEPFAR).

He notes that cancer treatment in Uganda is expensive costing on average $1,500 (about sh3.7m) for drugs (yet the per capita income of average Ugandan is $320 (about sh793,600).

“Cancer, therefore, is an example of inequity in health care adversely affecting vulnerable groups such as women, children and people living with HIV,” Orem notes.

HIV history in Uganda

The first cases of HIV were detected in the fishing village of Kasensero in Rakai district in early 1980s. Because the disease made the patients very thin, Ugandans coined the name slim for the sickness, which up to date is well known.

In the initial years, , many patients presented with and succumbed to Kaposis sarcoma, not knowing it was related to AIDS.

Many people who were dying of HIV/AIDs would develop herpes, skin rash and wounds, would lose hair, weight, and develop diarrhea and sores on the skin, in the mouth and on the lips.

Strengthening HIV intervention

In 1986 when President Yoweri Museveni took over power, he brought the AIDS epidemic to the attention of the world. He was the first African president to come out openly and tell the world that there was a problem and as a result Uganda initially made good strides in dealing with HIV.

Overall HIV prevalence increased rapidly through the 1980s and early 1990s. The Government then aggressively ran a campaign under the famous strategy: ‘ABC’ which is; Abstinence, Be faithful and Condom use.

This helped to reduce the HIV prevalence rate from over 30% to a national average of 6.4%, a feat which won President Museveni several accolades worldwide. Many Ugandans have over the years participated in national and international anti-HIV vaccine trials although positive results are yet to be found.

Is Uganda losing focus?

But over the past 10 years, Ugandans appear to have lost focus, as a new study shows that the HIV prevalence rate has again shot up. The 2011 Uganda AIDS Indicator Survey (UAIS) report showed that HIV prevalence had gone up to 7.3% as of September last year.

The survey showed that in the last five years, the number of people living with HIV rose from 1.8 million people to 2.3 million in the last five years. Over 130,000 new HIV infections are recorded in the country each year.

The rise has been blamed on complacency as a result of the presence of ARVs on the virus since the drugs make people live longer and appear normal without any of the signs that used to appear in the 1980s, which people used to fear. An estimated 560,000

Ugandans are eligible for anti-retroviral therapy, but only half the number get them, the study revealed.

The study also showed that circumcised men have a lower HIV prevalence of 4% compared to their uncircumcised counterparts at 6%. The survey estimated that only 24% of Ugandan men are circumcised

What can be done?

With a circumcision target of 80% of men, the health ministry, together with partners like USAID, have rolled out the adult male circumcision programme to reduce infections. But experts have warned that circumcision should not encourage men to engage in risky sexual behaviour as it is only 60% effective, meaning that circumcised men can still contract the virus.

According to Reproductive Health Uganda, there is need for provision of HIV prevention and care services specifically targeted to meet the needs of commercial sex workers to reduce the prevalence rate. The organisation is of the view that a programme be designed to ensure that sex workers get voluntary counselling and testing to let them know their status, be taught about condom use and other sexual and reproductive health services. Since many sex workers are peers, they can easily identify their colleagues through their networks and reach them with messages on HIV prevention and care.

The US has, since 2004, invested over $1.7b towards the fi ght against HIV in Uganda, according data from the US embassy in Uganda. Working with the Government, civil society, community and faith-based groups, other donors and our implementing partners, PEPFAR, has made a major contribution to saving lives.

“We have increased HIV testing and counselling, advanced more mother-to-child transmission programmes and upped the number of safe male circumcision. Further, the US supports 314,000 of the 330,000 Ugandans currently receiving life-saving antiretroviral treatment,” a statement from the embassy said. But the US says it cannot be the entire answer to Uganda’s HIV epidemic much as they support Uganda’s leadership.

The US therefore urges the Ugandan government to fullfil its commitment under the Abuja Declaration of committing 15 percent of its budget to health so as to make better strides towards achieving an “AIDS free generation.”