OTIMATI, South Africa — A team of Norwegian infectious disease experts may have found an explanation for a startling statistic: while the majority of AIDS victims around the world are men, in Africa almost 60 percent are women.
After extensive research at a public health clinic in South Africa’s rural Kwazulu/Natal Province, the specialists believe that African women’s susceptibility to HIV is greater because of a chronic and often undiagnosed parasitic disease called genital schistosomiasis, or “schisto.” Women become exposed to the disease by parasitic worms in river water.
The disease causes fragile sores in the women’s vaginal canal, which also may serve as the entry point for HIV, according to Dr. Eyrun Kjetland, the team’s leader.
In addition, the worms and eggs in the body are drawn toward the CD4 cells, which are crucial for their role in guarding the immune system. Yet, due to the disease, these are the cells attacked by HIV.
“It’s a huge women’s health issue,” said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. “[Schistosomiasis] is arguably the most important cofactor in Africa’s AIDS epidemic.”
Kjetland said a drug that only costs eight cents per pill can kill the worms. However, the team has not yet determined whether the medicine will also heal the sores.
Nonetheless, the theory has gained support by major donors, such as The Bill and Melinda Gates Foundation, the UN, the National Institutes of Health and the Danish and Norwegian governments. However, two major agencies in the fight against global AIDS—the Global Fund to Fight AIDS and the President’s Emergency Plan for AIDS Relief—demand more evidence before taking funding from other campaigns.
“A lot of women who have HIV don’t have schisto, and vice versa,” said Dr. Eric Goosby, the former coordinator of Pepfar. “It’s complicated.”
Furthermore, some AIDS experts question the theory since HIV also affects urban women far from infested water.
In Africa, an estimated 200 million people have been exposed to schistosomiasis, with the most cases in Nigeria, Tanzania, the Democratic Republic of Congo and Ghana. The disease, while not lethal, can also cause anemia, stunted growth and learning problems in children. For women, the disease creates “sandy patches” in the vaginal area.
Women with the patches are three times as likely to be infected with HIV compared to their neighbors, based on studies by Kjetland in both South Africa and Zimbabwe and by Dr. Jennifer Downs of the Weill Cornell Medical College in Tanzania.
In an essay written by Hotez, titled “Africa’s 32 Cents Solution for HIV/AIDS,” he explained how 70 million children across the continent could be dewormed twice a year for 10 years for only $112 million.
In contrast, Pepfar is expected to spend $38 billion for their campaigns during the same period of time. Both Prepar and the Global Fund to Fight AIDS currently have campaigns related to condoms, drugs and circumcision.
“Everyone has heard of genital mutilation and obstetric fistulas,” Hotez said. “But mention this, and the headlights just go dim.”
Hotez currently heads an effort at the Sabin Vaccine Institute to create a vaccine to treat schistosomiasis. Furthermore, several other vaccines are currently in development. However, he said it will be at least five to 10 years before testing is complete.
Besides potentially causing AIDS in women, schistosomiasis also traps people in extreme poverty by stagnating child development and economic productivity.
While only a theory, this latest explanation for the high percentage of women AIDS victims in Africa is a step in the right direction in the fight against the disease. If proved to be correct, it has the potential to prevent thousands of infections each year.
Photo: The Independent