Eswatini begins to tackle the highest cervical cancer rates in the world with one-stop shop approach to sexual health services

Eswatini is tackling the world's highest cervical cancer rates with an innovative healthcare approach. By providing integrated HIV, sexual health and screening services, the country aims to combat stigma and improve access to vital health services for women. 

Eswatini's cervical cancer crisis 

Eswatini has the highest incidence of cervical cancer globally. Cervical cancer, primarily caused by the Human Papillomavirus (HPV), remains a leading cause of cancer-related deaths among women worldwide, particularly in low- and middle-income countries. 

Exacerbating this issue is Eswatini's high prevalence of HIV, which stands at 24.8% among individuals aged 15-49. Women in this age group are disproportionately affected, with an HIV prevalence of 30.3% compared to 19.9% in men. Additionally, Eswatini faces a significant burden of schistosomiasis, a parasitic infection affecting an estimated 230,000 people. Female Genital Schistosomiasis (FGS), a condition linked to the disease, may increase susceptibility to both HPV and HIV. 

Despite these challenges, there is a troubling lack of data on the prevalence of FGS and HPV in Eswatini. Moreover, uptake of preventive screening services for cervical cancer remains low, partly due to stigma, fear, and limited knowledge about sexual and reproductive health (SRH) diseases. 

Stigma and social barriers 

The stigma surrounding SRH issues poses a major barrier to healthcare. Cultural taboos and the fear of social judgment often deter women from accessing necessary services. Sibongile Motsa from the Lubombo region of Eswatini shares her fears: 

"It’s painful because friends cannot be trusted. They know if you go across there it means you are now taking antiretroviral tablets. And now this cancer, they will surely say the disease has overcome me. My marriage will end, and my husband will just find another healthy woman." 

This sentiment is echoed by Thuli Mamba, diagnosed with pre-cancer lesions and treated with thermal ablation. She was advised to abstain from sexual intercourse for six weeks. Her concern was not just about her health but the potential for social ostracism: 

"I left home saying I am just going for family planning, I cannot tell anyone this. They will point at me … gossip about me." 

A one-stop-shop solution 

In response to these challenges, the National Cancer Control Program (NCCP) in Eswatini has launched an innovative "one-stop-shop" model for SRH services. This proof-of-concept initiative integrates all SRH care services, aiming to reduce both systemic barriers in healthcare delivery and social determinants of health. 

By offering comprehensive care under one roof, this approach improves access to quality healthcare, reduces the stigma associated with seeking treatment for specific conditions, and saves women time and costs by minimizing the need for multiple visits to different healthcare centres. 

Mrs. Xolisile Dlamini, Director of the NCCP, emphasizes the importance of such initiatives: 

"The highest cervical cancer incidence and mortality are in low- and middle-income countries. This reflects major inequities driven by lack of access to national HPV vaccination, cervical screening and treatment services, and socio-economic determinants. Persistent HPV infection is crucial for women living with HIV, as they are six times more likely to develop cervical cancer. Therefore, every woman should present herself for screening since it's so effective." 

The road to equitable healthcare 

To achieve equitable healthcare access, health systems must address both the systemic and psychosocial factors that prevent women from seeking care. One-stop-shop SRH services offer a promising solution, especially in low-resource settings. 

By integrating services and reducing stigma, Eswatini is taking a crucial step toward improving women's health outcomes and setting an example for other countries facing similar challenges. 

About the writer

Alice is an early-career researcher, pursuing her PhD in Behavioral Medicine. An Obama Leader 2023, Commonwealth Alumni 2012 and Science Journalist Fellow. She is experienced in public health leading community-based and corporate health response programs in HIV-AIDS, lung health and gender equity.

HIV in focus 

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from our focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them. 

*Some names have been changed