LVCT Health

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Dec 2021

Integrating Female Genital Schistosomiasis into HIV services

Sitting on the beautiful shores of Lake Victoria and admiring the beautiful sunsets, one cannot help but imagine what this Africa’s largest lake and world’s second-largest fresh water has to offer for the people who live around it.  Your mind will first click to the economic benefits such as tourism and fishing before proceeding to how it provides water for household and agricultural use to the community, not forgetting about the young boys and girls who like to swim, wash clothes and utensils on the shores of the lake.

But as the old adage states, “Every rose has its’ thorn” and this lake is no exception. The invasion of the water hyacinth on Lake Victoria is posing another problem not only to the fishermen but also the community who depend on it. The invasive weed coupled with human activities is now putting them at risk of contracting bilharzia.  According to the research conducted, the lake is becoming a fertile ground for parasites such as snails that cause schistosomiasis, commonly known as Bilharzia or ‘Layo remo’, as the locals refer to it.

Schistosoma mansoni and Schistosoma haematobium are the common species that are responsible for causing intestinal and urogenital schistosomiasis in Kenya. The chronic infection with urogenital schistosomiasis often leads to severe inflammation of the reproductive system, causing genital

schistosomiasis.

In this article, we focus on Female Genital Schistosomiasis (FGS). Female Genital Schistosomiasis (FGS) falls under one of the diseases that has been neglected over the years, yet its impact is quite huge on the community affected. The disease is caused by deposit of the S. haematobium eggs in the cervix and the lower female genital tract leading to one having lesions/ulcerations in the cervix, abdominal pain, blood in urine and cancer. Furthermore, the eggs deposited in the ovary and fallopian tube end up causing infertility. With symptoms being similar to some of the Sexually Transmitted Infections (STIs), there has been innumerable cases of misdiagnoses in the past due to inadequate training and health care workers being unaware of the disease. The geographic overlap of the distribution of FGS and HIV has made epidemiologists more curious on the role played by FGS in HIV transmission. Looking at recent studies, we were struck by evidence showing that, women and girls with FGS had a three-to-four-fold increased risk of horizontal HIV transmission in Schistosomiasis endemic areas.

‘Can this be one of the reasons why the HIV prevalence in Homa Bay, is four times higher than the Kenyan HIV national prevalence?’

‘What are some of the factors causing the prevalence of FGS in Homa Bay County to be quite high? ‘

An Adolescent learning about FGS Photo credit: Schistosomiasis Control Initiative

These questions led a team of researchers from LVCT Health carry out a study to   identify the real issues on the ground. At the beginning of

the study, we found out at that even though most people living in Homa bay knew about schistosomiasis, most were not aware of FGS. This was quite alarming since most of the ladies presented with the symptoms of FGS which were usually diagnosed as STIs. Due to stigma, has been a rift between infected persons and the community. Most of them did not understand what they were going through. They were scared to talk about presence of blood in urine, discharge and abdominal pain. In some cases, it led to divorce or separation among couples which some attributed to pain experienced during sexual intercourse.

Through the study, health care workers were trained on FGS, symptoms, prevention and management techniques as one of the mitigation strategies. The LVCT Health team also educated and sensitized the community through the Community Health Volunteers (CHVs), on FGS, prevention, symptoms and what to do when they present such symptoms. However, since old habits definitely die hard, this was not an easy task at all. Part of the prevention techniques involved, convincing the community to build more toilets, avoid urinating in the lake, washing outside the lake and avoid swimming in stagnant water.

Snails collected from Lake victoria

The community members were educated to seek medical attention as soon as they present with FGS for proper diagnosis and correct treatment.  A mass administration of the drug in community was a technique that was also employed. Working with Health Workers in Homa Bay County, LVCT Health build their capacity identify FGS lesions. The health workers were also encouraged to screen for FGS during routine cervical cancer screening. Moreover, they asked to enquire whether clients or any member(s) in their households were seeing blood in their urine.

These efforts have strengthened the capacity of CHVs and Mentors in a community-based HIV prevention intervention to deliver health education about FGS and schistosomiasis as they administered other HIV prevention services.

The milestones achieved during this implementation research will definitely be instrumental in the reduction of the FGS burden, especially in Homa Bay County. Our donors and partners largely contributed to this success.

The study was funded by the Taskforce for Global Health (Grant #215D).

An excerpt by Brenda Kisia

Research Department, LVCT Health

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