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Wanderlust: Botswana, where cancer is the new AIDS

Unprotected sex used to cause AIDS. Now it causes cancer.

Crystal Mhone, a 27-year-old patient, whose name was changed to protect her privacy, tested positive for cervical cancer and had surgery on her cervix last month. She has been HIV-positive since 2007 and because here, cervical cancer is classified as one of the AIDS-defining illnesses, she is no longer considered an HIV patient. Because of her cervical cancer diagnosis, she is an AIDS patient now. She doesn’t remember where she got infected or by whom.

When she was asked how many sexual partners she’s had – a routine question during gynecological visits – she replies with a disarming, “You mean in total? Or now?”

Dr. Mimi Raesima, one of the medical officers working with Dr. Masire, said that multiple partners, especially the prevalence of concurrent partners, as well as inter-generational sex, is a huge obstacle in their efforts to curb the cervical cancer epidemic.

“If my husband has several girlfriends and I have several boyfriends at the same time, and all of them have multiple lovers, the number of lovers we are effectively sleeping with is staggering,” she said.

In Botswana, such arrangements are quite common. Men often claim that the shortage of male population here requires local men to have more than one girlfriend. Otherwise, there would be a lot of lonely women. Because most of Africa still doesn’t provide a lot of professional opportunities for women, especially “lonely” ones, a woman is often forced into transactional relationships with multiple men, who in turn help cover her household expenses – from her mobile phone bills to her often distant and expensive doctor visits.

Dr. Raesima said that many patients think that if they already have the HPV virus, they don’t have to worry about it anymore. “Once you have it, you haven’t won. You can always get reinfected by other strains,” she said.

Some 40 different strains of HPV are transmitted through sexual contact and unlike HIV, condoms are only 70 percent effective in preventing HPV transmission. Vast majority of cervical cancers in the West are caused by the HPV virus 16 and 18. Not surprisingly, the HPV vaccines, available in the developed world, prevent infection with the HPV types 16 and 18.

The vaccine isn’t readily available in Botswana yet because it’s expensive and because there’s no definitive research proving that strains 16 and 18 are the most common types of HPV in Africa, too.

“Data is king,” repeats Dr. Masire.