The potency of a vaccine against cancer-causing HPV – and the body’s ability to clear it – offers many women a fighting chance. But extinguishing this source of cervical cancer overlooks another sexually transmitted virus that’s been raging around the globe for decades: the human immunodeficiency virus (HIV). The lethal effects of HPV mixed with HIV can be like setting gasoline on fire. HPV infections in HIV-positive women last longer, progress more quickly, recur more frequently, and are harder to eradicate. Cervical cancer in HIV-positive women – many of them in lower-income countries – strikes younger, is more aggressive, and harder to cure. Women with HIV are six times more likely to die of cervical cancer. They face a particular threat in Africa, home to two-thirds of the world’s 40 million HIV cases. Without a concerted effort to overcome the dual stigma of HIV and HPV through education, appropriate medical care to all persons with cervixes, and a means to address the vulnerability of the continent’s child brides, Africa will remain at the core of the HIV-HPV inferno – undermining the quest for global cervical cancer elimination.

Chapter 15 briefly summarises the globalisation of HIV: how it disseminated beyond the borders of the former Belgian Congo, first into other African countries where it ultimately had the most devastating impact, and then into the rest of the world, thus becoming a pandemic – literally, an epidemic that affects all people.