Cervical cancer is preventable and treatable if diagnosed early and treated promptly.
Yet in South Africa, it remains a leading cancer killer among women.
Today, with powerful tools at our disposal, elimination is within reach.
By prioritising HIV-positive women, expanding protection to those who never received HPV vaccination, and applying regional best practices, South Africa can accelerate progress toward eliminating cervical cancer as a public health threat.
We stand ready to support the development and execution of policies, programmes, and partnerships that advance these goals and to work with national and regional stakeholders to ensure no woman is left unprotected.
This is not merely a health agenda; it is a moral and socioeconomic imperative that requires decisive policy action, sustained funding, and coordinated action across sectors.
Recently, Gavi’s inclusion of higher-valency HPV vaccines is an important development in the global HPV prevention landscape and a relevant consideration for countries across sub-Saharan Africa as they continue to strengthen cervical cancer prevention efforts.
The partnership between the public and private sectors, along with civil society and communities, is critical if the world is to realise a comprehensive approach to eliminating cervical cancer, especially as 2030 looms large and considering where South Africa stands in relation to the WHO’s 90-70-90 targets.
This approach must be rooted in the integration of healthcare services, leaning on primary health care delivery models and the involvement of communities, if significant progress is to be made.
Central to this approach is a sharp focus on two critical groups: women living with human immunodeficiency viruses (HIV) and the cohort of women who never received the human papillomavirus (HPV) vaccination.
These groups bear a disproportionate burden and warrant targeted interventions within South Africa’s national strategy.
South Africa has significantly more women living with HIV than men, with approximately 5.2 million women compared to 2.6 million men, making a total of around eight million people with HIV, with women bearing a disproportionate burden, especially among young people.
This number represents people, and more importantly, people at an increased risk of cervical cancer.
With the national HPV vaccination programme, which targets adolescent girls aged nine to 15, having started in 2014, this means that all other unvaccinated women remain at risk of developing cervical cancer, particularly women living with HIV (WHIV), who are six times more likely to contract the disease.
Given the sub-optimal levels of screening, the risk of late-stage presentation and higher mortality remains high, with cervical cancer presenting as the highest cause of cancer-related mortality amongst women in South Africa.
The World Health Organisation (WHO) advocacy calls for a dedicated strategy for WHIV in cervical cancer prevention.
South Africa’s current HPV vaccination and screening architecture must adapt to guarantee that HIV-positive women receive prioritised access to vaccination (where appropriate), screening, and treatment.
This is aligned with the push to transition to HPV DNA testing as the primary screening modality and the emphasis on a life-course approach to prevention and care.
A policy that explicitly centres HIV-positive women within the elimination strategy will accelerate progress toward the 2030 targets.
Recently, it has been shown via a modelling study that vaccinating women with HIV initiating or on anti-retroviral therapy (ART) aged 10-45 years old would reduce new cases by 4.7% overall, or by 10% among WHIV between 2024 and 2120.
Two neighbouring countries, Botswana and Eswatini, have implemented strategies to vaccinate and protect women living with HIV, offering practical examples from which South Africa can take some lessons:
