By: Adama Mariama Sesay
According to the WHO Global Strategy towards eliminating cervical cancer as a public health problem, indicated that cervical cancer is the most common cancer among women living with HIV.
Sierra Leone has a population of 1.89 million women (15 years and older) who are at risk of developing cervical cancer. Every year, an estimated 299 women are diagnosed with cervical cancer and 242 die from the disease. Cervical cancer ranks as the second most frequent cancer among women in Sierra Leone and the second most frequent cancer among women between 15 and 44 years of age. To access the HIV epidemic context and response from a gender base perspective in maternal mortality, Sierra Leone has one of the world’s highest maternal mortality rates, at an estimated 1,120 deaths per 100,000 live births (2017).
The total fertility rate is 4.2 children per woman (2019 DHS). In 2017, Sierra Leone reported a contraceptive prevalence of 22.5% among women aged 15 to 49. The use of modern contraceptive methods of family planning is somehow appreciable, with less than half (43.8%) the percentage of women age 15-49 years currently married or in-union who have their need for family planning satisfied with modern contraceptive methods (MIC 2017). Twenty-one percent of women aged 15-19 have started childbearing, with rural teenagers being more likely to have stared childbearing than urban teenagers (29% versus 14%) (2019 DHS). Sierra Leone has one of the highest teenage pregnancy rates in Sub-Saharan Africa.
In many countries, rates of mental health problems are higher among both people vulnerable to acquiring HIV acquisition and for negative health outcomes among people living with HIV at each step in the HIV care continuum. Many Sierra Leoneans have experienced traumatic events that are associated with negative mental health outcomes (Betancourt et al, 2015). These include a decade-long civil war that ended in 2002, the 2014 Ebola outbreak, and recurrent floods. WHO estimates that 10% of 7 million Sierra Leoneans have mental health disorders.
Tuberculosis is one of the most common co-infections in people living with HIV and a common cause of HIV-related deaths. According to WHO, of the 17169 TB cases notified in 2018, 53% were men, 33% women and 14% children aged 0-14 years. In the same year, the estimates of HIV-TB incidence per 100 000 population was 38 (25-55). TB in pregnant women living with HIV increases the risk of maternal and infant mortality by almost 400%. (WHO, 2019).