Each year, more than 2 million women are diagnosed with breast or cervical cancer, yet where a woman lives, her socioeconomic status and agency largely determines whether she will develop one of these cancers and will ultimately survive. In regions with limited resources, fragile or fragmented health systems, cancer contributes to the cycle of poverty. There are proven and cost-effective interventions for both these common cancers, yet for so many women access to these is beyond reach. These inequities highlight the urgent need for sustainable investments in the entire spectrum of cancer control, from prevention to palliative care, and in the development of high-quality population-based cancer registries, in low-and middle-income countries. In this first Series paper we describe the burden of breast and cervical cancer with an emphasis on global and regional trends in incidence, mortality and survival, and the impact, particularly among socioeconomically disadvantaged women in different settings.

Efforts to help women empower themselves through vocational training, employment opportunities and social groups need to consider the potential unintended consequences for these women, such as an increased risk of domestic violence. The study findings suggest that the effectiveness of anti-dowry laws may be limited without additional strategies that mobilize women, families and communities to challenge the widespread acceptance of dowry and to promote gender equity. Longitudinal studies are needed to elucidate the complex causal relationships between 'love' marriages and domestic violence.

ObjectiveThe authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex.DesignAn unblinded, individually randomised and controlled trial.Setting10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania.ParticipantsThe authors enrolled 2399 participants, aged 18–30 years, including adult spouses.InterventionsParticipants were randomly assigned to either a control arm (n=1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n=660) and high-value conditional cash transfer (eligible for $20 per testing round, n=615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling.Main outcome measuresThe primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12.ResultsAt the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported.ConclusionsConditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively.Trial registration numberNCT00922038 ClinicalTrials.gov.

Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.