Namibia is a country where health statistics are hard to come by. Even though that cancer treatment facility kept counts, these numbers appeared in stacks of register books that it seems no one had ever tallied. So far, there is no information on the proportion of cancer patients that are HIV positive in Namibia and yet there is a whole body of literature attesting to how infection with HIV increases the risk for cancer. As an epidemiologist, I would bring expertise to this understudied vulnerability that people living with HIV have in Namibia.
One of my specific interests is the impact of HAART on the incidence of cervical cancer among HIV positive women. Attending a talk organised by the HIV Clinicians Society of Namibia, I learnt that it is unclear whether HAART protects against cervical cancer in HIV positive women by allowing them to clear HPV infection at a greater frequency than women not on HAART. What I am interested in understanding is whether poor adherence to HAART or an inherent non-protective effect of HAART, is responsible for lack of a reduction in the cases of cervical cancer among HIV positive women in Namibia. The lack of reduction in cases I refer to is based on anecdotes of clinicians on the ground, given that data of cancer patients by HIV status has not been compiled in Namibia. Hence, I am interested in collecting these data to understand how effective the current measure of HAART is in combating cervical cancer among HIV positive women. In addition, I hope to benefit from classes on health policy at the School of Medicine, so that I may acquaint myself with issues surrounding implementation and costing, as these issues would be germane in predicting the efficacy of the HPV vaccine, HAART, cervical screening or a combination of interventions, in combating cervical cancer in Namibia.
On the 1st of December 2012 I attended an event called ‘blue ribbon day’ to raise awareness about cancer among men. I came with my red ribbon of World AIDS day and I had initially asked to talk about how the red ribbon connects to the blue one, but the organisers did not want any speeches. Had I been given the floor, I would have spoken about the detection of HIV among gay man in 1981 and that since then there have been cancer cases around the world because of HIV infection. I would have said that one cannot speak about cancer in men and limit it to prostate and testicular cancer, because that would miss anal cancer among men who have sex with men – the true analog of cervical cancer in women. I would highlight that in Namibia, we need to bring HIV into the discourse surrounding cancer, and we need to admit that we have neglected the ways HIV and cancer intertwine. This is type of public engagement I aim for as a researcher, even if it necessitates dealing with uncomfortable assumptions about cancer.