SALDRU Researcher Wins UCT College of Fellows Young Researcher Award

SALDRU’s Dr. Brendan Maughan-Brown with UCTs Vice Chancellor, Mamokgethi Phakeng (Image: Robyn Walker)

SALDRU Researcher, Dr Brendan Maughan-Brown, received a UCT College of Fellows Young Researcher Award on 10 October 2018. According to UCT news, the award was established by the UCT Council to recognise distinguished academic work by permanent academic staff. The “award is granted annually to young academics at UCT to support their demonstrated ability of making a significant contribution to their field, and is intended for research purposes”.

The event was hosted at the Smuts Dining Hall by Vice-Chancellor Mamogkethi Phakeng, who also delivered the welcome address. Her chosen word for the event was “woke”. Award winners delivered acceptance speeches using this chosen word.

Read more about the event on the UCT News website.

Read Dr. Maughan-Brown’s acceptance speech below:

What it means to be woke to HIV and AIDS in South Africa

How very apt the word ‘woke’ is to the time we live in. With the increasing attention to the “Black Lives Matter” movement, the “Me too” movement, and the many other socio-political campaigns across the globe, being “woke” turned into a call to action for us all to pay attention to the injustices and oppression that people face. It is about seeing people more clearly and caring more deeply about their experiences.

For me, it is about moving beyond an awareness that society doesn’t treat everyone equally and using knowledge, privilege and access to resources to effect change.

The field of HIV behavioural and social science I work in is rife with examples of inequalities which prevent equal access to treatment and effective care, and help create and sustain conditions in which more poor people, more women, and more people of colour are HIV positive.

Social and economic inequalities are a key factor in the high rates of new HIV infections globally. New infections are disproportionately high among young black women living in sub-Saharan Africa. In 2016, 26% of new HIV infections in eastern and southern Africa occurred among 15-to-24-year-old women, who make up just 10% of the population. Worldwide, young women aged 15-24 are infected with HIV at rates twice those of young men.

One focal area of my research has highlighted the role that sex with older male partners plays in increasing HIV infection risk among young women in South Africa. Older men are more likely to be HIV-positive and treatment naïve, and partnerships with older men involve more condom-less sex, alcohol use, concurrent sexual partnering and transactional sex. I’ve learned that women are seeking older partners to break through social mobility barriers, and not just to ensure basic needs are met. Gender inequality in education and wealth and power, and intimate partner violence in relationships, often hinder a woman’s ability to protect herself from HIV.

We need to create different mechanisms through which women can break the barriers of social mobility, and better safety nets to ensure that women can fulfil their dreams and aspirations. We need a far greater understanding of the lived realities of young women and their decision-making around partner selection. Efforts to prevent infections among young women need to come from young women. We need to empower young women to lead research, design interventions and make policy.

Social and economic inequalities also influence access to HIV treatment. The introduction of free, public-sector antiretroviral therapy in South Africa in 2004 has been one of the great global public health success stories and resulted in the largest treatment programme in the world. Research by colleagues at UCT has demonstrated that people living with HIV in South Africa can have a near-normal life expectancy, assuming they start treatment before their immune system is severely compromised. The challenge now is to ensure that ALL people living with HIV have EARLY access to treatment and stay in care.

With the growing global awareness that it is not the availability of treatment, per se, but support to start and stay on treatment after diagnosis that is key, another focal area of my own research is linkage to care.

What I’ve learned is that for many living in poverty, awareness and motivation are insufficient to overcome the multiple structural and psychosocial barriers to treatment uptake. That even relatively large financial incentives for starting treatment may be inadequate to promote treatment access in such contexts, where levels of stigma are high, and individuals have little social support. That we can’t talk about equal opportunity for treatment for all South Africans while some people have the ease of a short visit to a private clinic without concern about privacy, involuntary disclosure and related social or financial consequences; while others from poorer neighbourhoods need to wake before dawn, spend the entire day at the clinic and repeat the process multiple times to obtain treatment.

To be woke is to be called to action.

HIV research must strive for interventions that are patient-centred, empathetic, and tailored to the lived experiences of the marginalised populations we serve and seek to help.

** Speech delivered by SALDRU researcher, Dr Brendan Maughan-Brown, on the occasion of being awarded a UCT College of Fellows Young Researcher Award on 10 October 2018.