Preventing HIV through treatment of neglected tropical diseases could save billions
By Paul Brodish, MEASURE Evaluation
I recently viewed a short video from The New York Times with Dr. Eyrun F. Kjetland discussing her work on female genital schistosomiasis and HIV. It’s hard to watch the video, looking into the faces of these young school girls, and argue we should not act on what is becoming evident: Among girls and women, genital schistosomiasis increases the likelihood of later infection with HIV.
Dr. Kjetland’s thesis parallels my own research, published this year in the American Journal of Tropical Medicine and Hygiene. Our research investigated this association in Mozambique by linking two geo-referenced, high-quality secondary data sources on HIV prevalence andSchistosoma haematobium: the AIDS Indicator Survey, and the Global Neglected Tropical Diseases open-source database, respectively. We constructed a schistosomiasis exposure covariate indicating women reporting “unimproved” daily drinking water sources and living no more than 2-to-5 kilometers from high-endemic global positioning system coordinates in the GNTD. In logistic regression analyses predicting HIV-positive status, we show that exposure increases the odds of HIV-positive status by three times, controlling for demographic and sexual risk factors.
Treatment for female genital schistosomiasis (de-worming 70 million African children twice a year for a decade) would cost significantly less than treating HIV infection once it has occurred. Which leads one to wonder: The U.S. President’s Emergency Plan for AIDS Relief alone spends about $3.8 billion every year for a decade to combat HIV infection in sub-Saharan Africa. Now, suppose that one spent $11.2 million — million, not billion — every year for a decade to helpprevent HIV infection.
Maybe that would topple conventional wisdom. But, can we let that stop us from making this investment in prevention? The June 16 observance of the Day of the African Child offers a moment in time to seriously consider it, to mitigate the fact that domestic chores place girls and women at greater risk of contracting genital schistosomiasis — one explanation for why, only in sub-Saharan Africa, are HIV infections higher among females than males.
Our paper, “Association between Schistosoma haematobium Exposure and Human Immunodeficiency Virus Infection among Females in Mozambique” details our comprehensive review of secondary data sources, confirming that exposure to schistosomiasis, combined with HIV prevalence, increases the odds of HIV infection. We conclude that treating young girls with parasitic-fighting drugs such as praziquantel could avert millions of new cases of HIV at far less cost than treating HIV.
The number of voices is growing. Two decades of studies have indicated that HIV and AIDS is exacerbated by co-infection with neglected tropical diseases (including schistosomiasis), because they weaken immune systems, increase susceptibility to other infections, and lower the effectiveness of antiretroviral therapy. Others have argued for better links between parasite control and global HIV and AIDS programs, among them the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Peter Hotez, MD, PhD and Megan Whitham, MD made that explicit suggestion in Obstetrics & Gynecology, citing a modeling study in Zimbabwe that indicates mass treatment of schistosomiasis would be highly cost-effective, even cost-saving.
In 2014, schistosomiasis was estimated to affect 220 million people in sub-Saharan Africa, and a report the same year in Malawi  stated that “Schistosomiasis ranks second only to malaria among the parasitic diseases affecting humans with regard to the number of people infected and the risk of becoming infected globally.”
The mounting evidence of a daily risk for girls in Africa, the observance of the Day of the African Child this month, and the New York Times video that shows the faces of girls at risk, compel attention, consideration, and, I think, concrete action.
For more information: Paul Brodish, MSPH, PhD, and Kavita Singh, MPH, PhD, conducted the study for MEASURE Evaluation, funded by the U.S. Agency for International Development and the President’s Emergency Plan for AIDS Relief, a project of the Carolina Population Center of the University of North Carolina at Chapel Hill.
Reprinted with permission from Science Speaks on June 16, 2016.
 Brodish, P., & Singh, K. (2016). Association between Schistosoma haematobium exposure and human immunodeficiency virus infection among females in Mozambique. American Journal of Tropical Medicine and Hygiene, 15-0652. Retrieved from http://www.ajtmh.org/content/early/2016/03/10/ajtmh.15-0652
 Ndeffo Mbah M., Poolman, E., Atkins, K., Orenstein E., Meyers, L.A., Townsend, J., Galvani, A. (2013) Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa—the case of Zimbabwean women. PLoS Neglected Tropical Diseases, 7:e2346. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23936578
 Makaula, P., Sadalaki, J., Adamson, S.M., Sekeleghe, K., Jemu, S., Bloch, P. (2014). Schistosomiasis in Malawi: a systematic review. Parasites & Vectors, 7:570. Retrieved from http://www.parasitesandvectors.com/content/7/1/570