Sheila Tlou: A giant in Africa's AIDS response
Healthcare was not Professor Sheila Tlou’s first passion, but the impact her career has had on Africa and particularly, on how to holistically address HIV, has been profound.
“… My philosophy … is that my life is not worth living if I do not use it to change the lives of others. Make one person smile a day,” says Tlou. “Life has treated me well. I look back and I am fortunate to have a mother and father who are both still alive. Why would God give me all this love and why would I not give it back? I have been blessed and I need to give back.”
Today Tlou is the Director for the Joint United Nations Programme on HIV/AIDS (UNAIDS) Regional Support Team for Eastern and Southern Africa, but she says her passion was initially drama and acting. “I went to a Catholic school which had its primary objective as exercising the African mind. I did Latin, Greek and French — all at the same time — and simply loved these languages.
“After form five I was interviewed for a scholarship and the man who interviewed me said that he could see that I wanted to study drama and languages. He asked me why, and said to me that I was living in a developing country that did not need languages, and told me I can do anything I want in the sciences, and preferably something in health sciences.
“He gave me three brochures and told me to return the following day and tell him where I wanted to apply. The choices were schools in Zambia or Uganda — the latter was not an option for my father because of his opinions on Idi Amin. Then there was Ethiopia, which became my first choice.
“Then I received a scholarship to do nursing in the United States and I decided to head there, knowing that I could also take elective subjects and do acting as a member of the community. I went to New Orleans and registered for drama and public health courses. While having a community-orientated base, I continued acting on the amateur stage.”
From drama to politics to nursing, Tlou, also the United Nations Eminent Person for Women, Girls, and HIV/AIDS in Southern Africa, has had a varied and dynamic career history. Since 2010 when she joined UNAIDS, she has provided leadership and inspiration in the regional response to HIV and ensures technical support to UN country teams in 21 countries across the region.
Tlou holds a PhD in Nursing Sciences and postgraduate certificates in women’s health and gender studies from the University of Illinois in Chicago. She has written many publications on gender and HIV, for which she has received multiple national and international awards.
She was a professor of nursing and director of the World Health Organisation’s (WHO) Collaborating Centre for Nursing and Midwifery Development in Primary Health Care for Anglophone Africa at the University of Botswana.
A former member of parliament and minister of health of Botswana, she led a forward thinking and focused HIV prevention, treatment, care and support programme, which is still referred to as a model today. Tlou has been involved in the AIDS response since 1985 and founded the Botswana chapter of the Society of Women and AIDS in Africa. She was also instrumental in treatment programmes and in bringing out new interventions for children.
As chair of the Southern African Development Community (SADC) and the African Union Ministers of Health, she provided leadership in the adoption of the SADC Malaria Eradication Programme, the SADC HIV/AIDS plan of action, and the Maputo plan of action on sexual and reproductive health and rights. She also represented eastern and southern Africa on the board of the Global Fund for AIDS, Tuberculosis and Malaria.
On the HIV stage, Tlou has played a leading role. In the 1980s, Botswana was already proving to be one of the most affected countries in the world, but the country’s response was ahead of the trend.
“Our president Festus Mogae raised the alarm in 1990, saying that we faced extinction and that if nothing was done, the virus would spread and maybe leave Botswana with a population of less than 10 000 people. He was the first president in Africa who started providing free antiretroviral (ARV) treatment to his citizens — he was a very smart president.”
Botswana now has the third highest HIV prevalence in the world, but has been an example for sub-Saharan countries, leading the way in prevention and treatment programmes, through which prevalence has declined from 24.6% in 2005 to 22.2% in 2015. There has also been a dramatic decrease in new HIV infections and AIDS-related deaths.
“Regionally, one in four women are infected with HIV, but among pregnant women, mortality rates have dropped,” says Tlou. “We know it affects women more than men. In 1988 at an international conference on AIDS in Stockholm, we formed the Society for Women with AIDS.
“Around that time, there was a lot of denial in Africa, so even our President Quett Masire did not want to talk much about HIV, despite the fact that people were dying.
“I went on radio telling people to take care of themselves and discussed the topic of sex, which initially my father questioned, he would say to my husband ‘Why do you allow your wife to talk about sex on the radio?’ But I wanted to ensure that people were educated and [I wanted] to try and stop the discrimination.
“AIDS is no longer a death sentence, but we are seeing a lot of complacency, people not taking their antiretroviral drugs and at same time seeing discrimination, because for some reason people forget where they came from — life is a sexually-transmitted condition.
“Response, healthcare strength and reaction varies from country to country. When Botswana started giving [out] ARVs in 2001, South Africa was still doing beetroot and garlic. By 2004, I had 10 000 patients on ARV treatment and by 2008, 80% percent on ARVs. I am seeing a change in attitude. In Botswana, the stigma went down because it was aggressive in [terms of] treatment, but there remains stigma in South Africa. The primary message is around prevention.”
Tlou explains that between now and her retirement in mid-2017, UNAIDS is doing its four-year rotations, so by March next year, she will have some new faces around. She said it is quite a challenge to suddenly put someone from Geneva in the middle of Sudan, for example; the culture shock and working with new partners can be quite daunting.
“Each country will have new people and over the next six months I need to get people up to speed so that each person knows what they are doing from now to 2020. One objective is to get all the UNAIDS country directors and National AIDS Council directors together for two or three days, so that in each of the 21 countries we know what we need to do, and by 2020 we have reached 90-90-90.”
The 90-90-90 treatment targets are that, by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.
Asked about the future of AIDS, Tlou says that this region is the only region that has registered a decline in HIV. “We can see [that] mother-to-child transmission of HIV is coming to an end. For the region, we are making great progress in AIDS, with one or two [countries] lagging behind, but in others we can look towards the end of the AIDS epidemic as a public health threat by 2030.
“The caveat is that we must maintain and increase the resources [presently available] to HIV. There are changes in Europe with the refugee crisis and changes in the US with a new president. Who may say, how much [resources there will be]. There are a lot of caveats, but I am hopeful on that one.
“My future is varied, with a lot of writing to do. There is the history of HIV through my eyes. I have also been an academic, a civil society activist, an international servant and politician all rolled into one, and that is a story that needs to be told. Then there is the story of my marriage in my book Adventure in Paradise, about the partnership with my late husband of 30 years, Thomas. His story also needs to be told.
“We never write the life of someone loved from the beginning. We need good stories in Africa. In between writing I am hoping to have some adventures like a professorship and teaching. I work well with ministers and heads of state and am going more into advocacy. Politics is not really an option, but I do see lots of other exciting possibilities,” concludes Tlou.
A previous version of this article contained a draft of the article with messages that were not approved by UNAIDS. The Mail & Guardian apologises for the error.