What makes a young African doctor decide to devote her career to helping women fight HIV? Dr. Sengeziwe Sibeko is a 37-year-old medical researcher with a degree in obstetrics and gynecology from the University of KwaZulu Natal (UKZN) in South Africa, an MSc in epidemiology from Columbia University in the United States, and is about to take up a fellowship to study for her PhD at Oxford University in the United Kingdom. AllAfrica's Julie Frederikse interviewed Dr. Sibeko at the community women's reproductive health clinic run by the Centre for the Aids Program of Research in South Africa (Caprisa) in Durban.
When I did my internship back in 1998, I went to the rural northern part of KwaZulu Natal (the South African province where she lives and works) and I was really looking forward to saving lives - yet that was not what was happening at the time. People were dying. You came in each morning to see people die rather than to be able to save lives. But when I went on to do my community service (a two-year requirement for all South African medical students), I really enjoyed obstetrics and gynecology, so when I had the opportunity to specialise I knew that was what I wanted to do.
But over the five years of my specialisation, that changed too. It was no longer just about babies being born - women were coming in because they were sick and babies were dying. I found it to be a depressing situation, and this was further compounded by staff shortages due to people leaving the health system.
Given the depressing effects of Aids that you witnessed, how did you develop your passion around protecting African women from HIV?
My actual turning point came when I went overseas. I got a fellowship in 2006 (from the Fogarty International Clinical Research Scholars and Fellows). That meant that for the first time - I remember this so clearly - I was removed from the everyday numbing situation that I had been in back in South Africa.
So it was only when the National Institutes of Health (NIH) in Washington DC brought all the global health experts together, and their presentations showed me that this is how Asia is doing with the HIV and Aids situation, this is how the United States is doing, and this is you in sub-Saharan Africa - I almost collapsed! I never realised that this is the situation in the region where I'm from. It made me decide that I'm going to go home and be part of the solution.
So what did you do next?
I thought, we can't be waiting for women to come to the clinic, to be sick and to die - there's got to be a way to prevent women getting HIV in the first place. I wanted to do something major, and I saw that it must be through the public health route. So I went into Caprisa and met Dr. Quarraisha Abdool Karim. The time that I joined coincided with a conference on the potential of microbicides to fight HIV. So I thought, wow, I'm in the right place, this could save women's lives. I became the overall gynecologist of the study, so I like to think of it as my baby.
When I joined the field there hadn't been any success stories with microbicides. There were lots of negative trials and the field was almost dying. I remember talking to Dr. Henry Gabelnick (head of Caprisa's research partner, the U.S. reproductive health group, CONRAD) who is the greatest proponent of microbicides, and I told him, if you give up on this concept you give up on women. Because I see this as a woman-empowering strategy. It gives women the opportunity to be in control when they can't negotiate other safe sex practices.
Does it make a difference to your work that you come from the same part of South Africa, and Zulu community, as most of the women who take part in the different studies to find effective means to prevent HIV and other sexually transmitted infections?
Yes, I think it's important that people can identify with me. They approach me all the time and say, we're happy you can explain things in Zulu. Because they get tired of people coming from outside. Like now, I'm busy writing a paper about "sero-discordant couples", where the man is [HIV] positive and the woman is [HIV] negative. They can't use condoms if they want a pregnancy, so I am looking at the pattern of use of the gel in women who fell pregnant in our first study.
My hypothesis was that when the women came to the trial they were thinking, if I use this drug it will protect my baby. So you see, it's good when people tell you honestly what they are thinking and doing, it helps clarify your findings. My greatest strength is having been trained here, and because I'm out so often, working in the clinics, I understand the women.
It's not only about speaking the local language, does it also help that you understand Zulu culture?
It does, and there's a thing about our culture which disturbs me immensely: women are so dependent on men that it gets in the way of practicing medicine at its best. You give a contraceptive to a woman, and if her partner says it makes her too wet, she'll stop using it.
Women are not independent. I know because I have done research on gender-based violence. I did the interviews myself, and women told me, "It's okay if he beats me, I was wrong". Or "I'll put up with this abuse because I need money". Women are so reliant on men.
Are you able to respond to women's dependence on men in your continued research into multi-purpose prevention technologies (MPTs) to prevent HIV and other sexually transmitted diseases?
Yes. It means that if women don't inform the men about these MPTs, they'll talk negatively about it. So we need to address issues of male involvement in sexual and reproductive health services. It takes two people for pregnancy, or HIV transmission - so we shouldn't make the mistake of empowering women and leaving men out. Men can be the biggest hindrance if we don't involve them.