Monica’€™s sister lived with HIV for years without telling anyone, not even her family. And when a lump developed in her breast she didn’€™t want to tell anyone in fear of also revealing her HIV status.

‘€œIn my community there is still a lot of stigma around HIV and even your family won’€™t accept you, or they will treat you differently,’€ she said. ‘€œAnd most people think that if you have cancer you are going to die.’€

According to Dr Irene Boeddinghaus, a Cape Town oncologist, HIV-positive patients often present late for breast cancer treatment. The cause for the late presentation is not well understood, but because HIV does not aggravate or mask the development of breast cancer, experts speculate that there may be social and economic reasons for it.

‘€œPeople don’€™t always have the financial resources to get to a health facility for minor ailments and only go when they are seriously ill ‘€“ therefore eliminating the chance of early diagnosis,’€ said Cape Town surgeon, Dr Jenny Edge. ‘€œAnd then there is also the possibility, as was the case with Monica’€™s sister, that the stigma involved with cancer may cause people to present late.’€

Apart from the social factors surrounding breast cancer in HIV-positive patients, this co-morbidity also present very specific challenges for oncologists who have to treat it.

‘€œAn oncologist can kill someone with chemotherapy if you don’€™t know that the patient is HIV-positive, therefore you have to test for it,’€ said Boeddinghaus. ‘€œYou can’€™t use the same chemotherapy for HIV-positive and HIV-negative patients as the interaction between cancer drugs and antiretroviral therapy can lead to toxicity.

‘€œOften women don’€™t even know they are HIV-positive and they get two life-threatening diagnoses at the same time.’€

According to Boeddinghaus, HIV-positive patients tolerate chemotherapy poorly. HIV also impairs systems in the body, like the immune system, white blood cell count, and bone marrow that is needed to fight cancer in the body.