Bilharzia hampers Aids fight


South Africa's rural women are at the heart of the country's HIV/Aids pandemic, but according to a University of KwaZulu-Natal research team bilharzia is making them even more prone to contracting Aids.

While doctors were aware of bilharzia, few were aware of the damage it caused to female genitalia, Dr Eyrun Kjetland told a press conference in Durban on Thursday.

"Women are at increased risk of contracting HIV because of bleeding and the damage caused to the genitals," she said.

While infection rates are hard to determine, Kjetland believes that as many as five million South Africans are infected with bilharzia and of those at least two million are women who have suffered damage to the genital tract caused by the disease, known in Zulu as isichenene .

Bilharzia is described by the World Health Organisation (WHO) as a neglected disease and is known by its scientific name of schistosomiasis.

It originates from a parasitic larvae that enters the skin through contact with fresh water. The parasites grow into worms that then pair up with the female worm, releasing as many as 500 eggs a day.

Some of the eggs are passed out of the body in the faeces or urine while others become trapped in body tissues, causing immune reactions and progressive damage to organs.

The worms can be killed fairly easily with a single dose of the drug praziquantel, but the eggs remain and the human body has to find a way to get rid of the eggs.

And it is the eggs in the women's genital tract that are causing untold problems, with women much more susceptible to bleeding during sexual intercourse. Some women experience irregular menstrual bleeding and vaginal pus discharge. Even girls as young as 10 may suddenly suffer the same symptoms as a result of the disease.

"Doctors know bilharzia, but very few know the damage it can do to female genitals. The early stages are difficult to see with the naked eye. During gynaecological exams on women with bilharzia, it is often misconceived as cancer or a sexually transmitted infection."

Sometimes it is diagnosed as endometriosis, which can lead ultimately to a hysterectomy.

Kjetland said she believed that women who had suffered damage to their genitals as a result of bilharzia were three times more likely to contract HIV when having sex with an HIV-positive partner.

But proving those numbers is difficult and the extent to which Bilharzia assists the spread of HIV is a scientific experiment that none are ethically prepared to undertake.

"It's like in court when you have so much circumstantial evidence that there is an elephant in the room," said Dr Pamela Mbabazi from the WHO's Department of Control of Neglected Tropical Disease.

Mbabazi, Kjetland and a number of leading African doctors and researchers are meeting at the university to compile a booklet that would make doctors and other medical practitioners aware of the disease and its effect on the genitals.

Dr Motshedisi Sebitloane, the head of the university's gynaecology department, said: "Most of the 290,000 doctors and nurses in South Africa rely on blood urine as a symptom for urinary bilharzia and only a handful are aware of genital bilharzia and its effects."

South Africa's director of Communicable Disease Control, Tsakani Furumele, said that improved sanitation, clean drinking water and chlorinated swimming pools, and a campaign to prevent people from using rivers was needed to prevent the spread of the disease.

"Our aim is to have the booklet in every clinician's office within two years," said Mbabazi.


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