Cervical cancer is silently claiming the lives of thousands of South African women each year, driven by a dangerous combination of late diagnoses, low screening rates, high HIV prevalence, and limited access to prevention tools such as vaccines and effective treatment. Despite being entirely preventable and treatable in its early stages, cervical cancer remains the leading cause of cancer deaths among women in the country.
According to recent figures, South Africa’s cervical cancer rate lies between 22.8 and 27 per 100,000 women—a staggering figure compared to the global average of 15.8 per 100,000. Every year, more than 10,700 women are diagnosed with the disease, and over 5,800 succumb to it.
The HIV-Cervical Cancer Link
A key driver behind South Africa’s cervical cancer crisis is its high HIV prevalence. Women living with HIV are six times more likely to develop cervical cancer than HIV-negative women. The virus weakens the immune system, making it harder for the body to clear Human Papillomavirus (HPV) infections—the primary cause of cervical cancer. As a result, these infections are more likely to persist and progress to precancerous lesions.
“HPV is the most common sexually transmitted infection,” says Dr. Mark Faesen, a gynaecologist and fertility expert with the Clinical HIV Research Unit (CHRU). “More than half of young people are infected within three years of becoming sexually active.”
HPV comes in nearly 150 types, but three—HPV 16, 18, and 45—are responsible for nearly 80% of all cervical cancer cases. Once a high-risk HPV infection becomes persistent, it remains in the body for life. Without effective immune response or treatment, it can eventually lead to cancer—not just in the cervix, but in other areas such as the vulva.
Dr. Faesen warns that weak immunity, multiple sexual partners, co-infection with other STIs, smoking, and repeated exposure to HPV all increase the risk of developing cervical cancer.
Vaccination and Prevention: A Missed Opportunity?
Cervical cancer is one of the few cancers that is preventable with a vaccine. The World Health Organization (WHO) recommends HPV vaccination for girls aged 9 to 14, ideally before sexual activity begins. South Africa introduced HPV vaccination in public schools in 2014, targeting girls aged nine and older.
Yet challenges persist. “Delivering vaccines to every eligible child remains a logistical challenge,” says Faesen. Many children in rural or under-resourced areas miss out on these life-saving interventions.
According to Professor Sinead Delany-Moretlwe of Wits Reproductive Health & HIV Institute, although South Africa has made strides with HPV vaccination, screening and treatment efforts remain fragile and underdeveloped.
“Getting women screened, tested, and treated remains a big problem. Many people don’t return for follow-ups,” she says.
Broken Screening Systems
Screening is vital to early detection. HPV screening can detect high-risk virus strains before abnormal cells even develop, offering an earlier and more accurate intervention opportunity than traditional Pap smears, which look for abnormal cervical cells.
Yet screening coverage is shockingly low. The current system relies almost entirely on women voluntarily visiting primary healthcare clinics, says Salome Meyer of the Cancer Alliance, a coalition of cancer-focused organisations and advocates.
“There are no large-scale outreach screening campaigns. The system misses too many women,” Meyer warns. Currently, only 57% of eligible women are screened—far below the 70% WHO target required to eliminate cervical cancer as a public health threat by 2030.
Rural areas are particularly affected. “Referral systems are under immense strain. Clinics are far apart, infrastructure is poor, and healthcare workers are overwhelmed,” says Faesen.
Many healthcare providers in public clinics are stretched thin by multiple health demands, making it hard to prioritize cervical cancer screening—especially for women living with HIV, who face both higher risk and lower access to consistent care.
What Must Be Done
Experts agree that tackling cervical cancer in South Africa requires urgent and systemic change.
“We need to raise awareness across all sectors of society, streamline referral systems, and expand the number and capacity of referral centers,” Faesen says. “This way, we can catch the disease in its precancerous stages and stop it before it becomes life-threatening.”
Meyer echoes this call: “We cannot continue to let the burden fall on individual women to seek out care. We need community-level interventions, mobile screening units, and public education campaigns to raise awareness and reach the most vulnerable.”
HPV vaccination coverage must also expand beyond the school setting to catch girls who are out of school and young women who missed early vaccination. For adults over 20, WHO recommends two doses spaced six months apart.
Ultimately, South Africa has the tools to fight cervical cancer—it just needs the political will, public commitment, and health system strengthening to deliver them effectively.
If the country is to meet the WHO 2030 cervical cancer elimination goal, these changes must come fast. The lives of thousands of women depend on it.