21 February 2014

I have been here for over two months now. As you know I am funded by the German Academic Exchange DAAD and the Canon Collins Foundation. The combination of the two is ideal for me and I can become entirely focused on my research, without a care in the world. Nonetheless, I still have to rein in on my spending and so I have tried to be very judicious and budget wise about all that I do. For some reason though, I still fear that this is ‘too good to be true’ and that I may loose my funding – for no other reason than it exceeding my expectations. Well I feel a great deal better after writing this and so let me begin to reflect on how I can best use the funding.

I have a funding component of grant from the DAAD specifically for my Master’s thesis. I just remembered that I had it today, when I was reflecting on my meeting with professor Jennifer Moodely, head of the cancer research division of the UCT Clinical Research wing of Groote Schuur hospital. We discussed some fascinating projects she will be working on including how to make use of cellphone messaging communicating the importance of cervical screening to women: what do these women know about cervical cancer and how does that knowledge impacts on their health seeking behaviour?. She also works a great deal at the interface of basic science and epidemiology, collaborating with scientist Anna-Lise Williamson on projects. These range from the types of Human Papiloma Virus (HPV) that infect women and their transmission. At the moment there are no buns in the oven on the basic science side of things, but there some other interesting areas.

One of them is understanding how the prevalence of the two main cancer causing HPV types (16-18) will change once the massive immunisation against these types becomes common practise. Girls who have not yet had sex, prior to sexual debut, are the targets of the HPV vaccine that the South African government is scaling up and the consequence thereof is a likely shift away from 16 and 18 as the scourges of cervical cancer. But will cervical cancer disappear? Or will this just clear the field for other HPV types, such as 31, that are cousins of 16 and 18? Or does the vaccine afford ‘cross protection’ it vaccinates against 16 and 18 and as a bonus, against 31 and the other cancer causing ones? Therefore, it is necessary to know what the prevalence of these HPV types is now, at the time when the scale up is just happening and compare it with what will come years later. If we know how these two virus infections are distributed among sexually active girls now, we can compare the distribution to decades from now, when we expect these viruses to be virtually wipe off the face of South African women.

The other questions deal with acceptability of the HPV vaccine among the parents of the young girls, the teachers of the girls and of course the girls themselves, even if they are just 9 or 10 years of age. Were I a young girl, I would ask why am I being vaccinated against this and boys are not? Good question.
As the nurse that examined me today at the student health services today said, it is important to point that apart from women, men are also vulnerable, especially because anal cancer follows the same ‘pathobiology’ (course) as cervical cancer in women. Then there is penile cancer and is it really that much rarer? According to Stephen Hawes’ in 2010 in Windhoek, HPV just does not stay for long in the penis. Again these are all averages and need to be qualified by findings.

But suffering in men is not worse than suffering in women, so it’s worth to start with cervical cancer.
I believe I am going to take Jennifer Moodely’s option of doing a project from start to finish. It’s not just because I have the funding to do it – that does play a part, after all I have the funding and I should spend it – but I really do want to have the ‘A-Z’ experience.
Her requirement would be that I get at least 70% in all my classes.
I am now a scholar, so I take up the call and do more than just an analysis of an existing dataset.

P.S.

I had no idea that the earlier a woman is infected with HPV, the more likely it is for her to get cervical cancer! The nurse who examined me, Joy, let me know of a personal friend she has, 27 years of age, and she has cervical cancer. HIV negative, but she had sexual debut at age 16. No wonder the paper ‘Determinants of sexual activity and its relation to cervical cancer risk among South African women’ (2007) is so important. They did a case control study on age of sexual debut and number of lifetime partners for data originally collected for a study on hormone use and contraceptives. Nurse joy gave me a pamphlet that she gives out to female students. On that pamphlet it asserts that sexual debut before the age of 18 is risk for cervical cancer, because the cervix is not fully mature.

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About writinghealth

Wannabe Epidemiologist? Wannabe med anthro person? I guess. Christian, scientist (not Christian scientist), i mean like I studied molecular biology. I am doing a Masters of Public Health, at the University of Cape Town.
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