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[afro-nets] Schistosomiasis and HIV: Study strengthens link between neglected tropical disease and HIV infection

News from the MEASURE Evaluation project

Schistosomiasis and HIV Acquisition


CHAPEL HILL, NC—A comprehensive 
review<> of secondary data sources 
has confirmed a long-suspected link between female genital schistosomiasis 
(FGS) and HIV infection for women in southern Africa. Researchers confirmed the 
link in Mozambique, finding that exposure to schistosomiasis, combined with HIV 
prevalence, increases the odds of HIV infection by three times. Researchers 
also conclude that treating young girls for schistosomiasis could avert 
millions of new cases of HIV infection at far less cost than treating HIV 
infection once it has occurred.

Schistosomiasis is a fresh water-borne parasitic infection, usually contracted 
in childhood through activities such as swimming, bathing, fishing, and 
fetching water. It affects 261 million people worldwide and is known to be 
highly endemic in sub-Saharan Africa. Domestic chores can place girls and women 
at greater risk of contracting FSG, which, the researchers say, may help 
explain the fact that only in sub-Saharan Africa are HIV infections higher 
among females than among males.

The authors, Paul Henry Brodish and Kavita Singh, conducted the study for 
MEASURE Evaluation, funded by the U.S. Agency for International Development 
(USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), a project 
of the Carolina Population Center of the University of North Carolina at Chapel 
Hill (UNC).

Researchers confirmed the link in Mozambique by investigating two high-quality 
secondary data sources on HIV prevalence and FSG: the 2009 National Survey on 
Prevalence, Behavioral Risks, and Information about HIV and AIDS in Mozambique 
(INSIDA) and the Global Neglected Tropical Diseases (GNTD) open source 
database. Their results can reasonably be applied generally to sub-Saharan 
Africa and perhaps especially to South Africa, Tanzania, and Zimbabwe, where 
field studies showed woman whose vaginal mucosal barrier tissue was compromised 
due to FSG were three times as likely as their neighbors to be infected with 

In fact, two decades of studies have indicated that HIV/AIDS can be exacerbated 
by co-infection with neglected tropical diseases (including schistosomiasis), 
which weaken immune systems, increase susceptibility to other infections, and 
lower the effectiveness of antiretroviral therapy (ART).

The study’s findings also offer a significant potential cost savings for 
governments and global donors, as treatment for FSG would cost significantly 
less than treating HIV infection. The authors cite estimates that de-worming 70 
million African children twice a year for a decade would cost about $112 
million, versus an estimated $38 billion PEPFAR would expend in the same period.

These results are additional evidence supporting the link between neglected 
tropical diseases (NTD) and HIV and the need to scale up treatment for NTD and 
for increased access to improved water sources. The authors suggest further 
studies are necessary in other locales where there is high HIV prevalence and 
endemic NTDs.

The researchers say the study is limited by its indirect assessment of exposure 
to FSG (S. haematobium) and that the availability of mass drug administration 
in various survey regions is not known. However, both of these limitations 
would tend to make it more difficult to draw an association between FSG and HIV 

The study is also significant on a global scale as the Sustainability 
Development Goals (SDG), USAID’s goal of an AIDS-free generation (AFG), and 
prevention of mother-to-child transmission of HIV (PMTCT), will be that much 
more attainable if HIV infection can be curtailed in sub-Saharan Africa—where 
60 percent of new cases are female and mostly young.

For more information

MEASURE Evaluation is funded by USAID to strengthen capacity in developing 
countries to gather, interpret, and use data to improve health. The project 
creates tools and approaches for rigorous evaluations, providing evidence to 
address health challenges. MEASURE Evaluation strengthens health information 
systems so countries can make better decisions and sustain good health outcomes 
over time. The information provided here is not official U.S. government 
information and does not necessarily represent the views of USAID, PEPFAR, or 
the U.S. government. Visit<>.

MEASURE Evaluation is funded by the U.S. Agency for International Development 
(USAID) under terms of Cooperative Agreement AID-OAA-L-14-00004 and implemented 
by the Carolina Population Center, University of North Carolina at Chapel Hill 
in partnership with ICF International, John Snow, Inc., Management Sciences for 
Health, Palladium, and Tulane University. The views expressed in this e-mail do 
not necessarily reflect the views of USAID or the United States government.

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