Dr. Samu Dube helps empower women to protect themselves from HIV

As a young doctor in her home country of Zimbabwe, Dr. Samu Dube was pressed into service as a roving detective one day to search for the father of a patient. A young girl suffering from kwashiorkor, or acute malnutrition, had arrived at Mpilo Hospital with her mother, seeking help from Samu’s supervisor, Dr. Ikeogu. The girl’s mother was penniless and unemployed, and the father of the child had disappeared, leaving her mother no money for food.

“The father shall be found!” Dr. Ikeogu promised the girl’s mother. After a day in pursuit, Samu and her supervisor tracked the father down and admonished him for abandoning his family. Their efforts worked: six months later, the girl returned to Mpilo Hospital with her mother, well nourished and receiving support from her father.

Disrupting the status quo

That experience showed Samu how dedication, commitment, and a willingness to seek solutions both within and beyond hospital walls can change the face of health care delivery.

“I grew up thinking, ‘I am going to become a doctor,’” Samu says. “That focus changed when I saw how health care was structured in many African countries, especially in Zimbabwe. It has deviated from a preventative to a curative approach.”

“In Africa, we need to disrupt the current health care system and institute new ways of thinking.”

As a clinician, she felt unable to close the “tap of the misery” she saw each day and address problems at their root. “In Africa, we need to disrupt this current health care setup, invest more in prevention, and institute new ways of thinking,” she says. “I thought to myself, ‘As long as you only concentrate on clinical medicine in a corner of a hospital, you are not going to make a huge difference at the population level.’”

A focus on women

Today, as the Africa program leader for the Global Campaign for Microbicides, based in South Africa, Samu’s change-making focuses on women—and giving them the ability to protect themselves from acquiring a sexually transmitted HIV infection. 

Samu came to the Campaign following eight years as a public health physician and several years working with nongovernmental organizations in the field of HIV/AIDS. She first encountered PATH while serving as a co-investigator on HIV prevention trials at the University of Limpopo, including those for a vaginal microbicide—a product that women could use vaginally to protect themselves from HIV.

Working for the Global Campaign under PATH was a way to join her interests in technology and advocacy for advancements in public health. Samu feels both personally and passionately connected to her work.

“I still have relatives being buried today because of HIV,” she says. “If women have power to protect themselves from HIV, we would be able to bring down mortality and morbidity, positively feeding into the cycle of economic growth in Africa.”

Microbicide? Bring it on

With proof-of-concept of a vaginal microbicide under its belt, the Global Campaign works to generate more support for research and eventual licensure of microbicides. Samu leads those efforts in east and southern Africa.

This includes advocacy with governments, donors, community-based organizations, nongovernmental organizations, and men and women. Because women are the end users, Samu believes their voices are the key to advancing microbicides. “If women don’t demand [a microbicide], governments won’t make it available.”

The Campaign converses with women across South Africa and Zimbabwe to measure how much they want the microbicide and how they can access it if it becomes available. According to Samu, more than 60 percent of women interviewed in South Africa say that they want it.

Even if licensure does take place in the next couple of years, however, there will still be challenges in bringing the product to women.

Expanding the spectrum

One challenge is to better understand the household dynamics of what makes a woman vulnerable to HIV, says Samu. Another is to bring women’s voices to the advocacy table.

Amending government priorities to support access to microbicides is also difficult. “You go to a meeting and they tell you what a priority is to them and you can’t argue against that. How do you increase the size of the pie in a continent of growing priorities?”

There is also what Samu calls the “conflict of technology.” “Many stakeholders want to escalate programming on existing prevention technologies, like the female condom, and bringing new ones amidst that is a challenge,” she says.

To Samu, however, it is not a matter of one or the other. “You can’t say this or that—you should say both. How do you make sure they are all accessible?”

Photo: PATH.