On the front lines of the AIDS epidemic for decades, Dr. Olive Shisana—President and CEO of South Africa-based Evidence Based Solutions and co-chair of the 2016 International AIDS Conference—will be the first to tell you that not only do Black Lives Matter, it’s essential that Black people demand and expect more targeted social and cultural interventions and support to put an end to the epidemic in their communities.
Black AIDS Institute: We’re back in Durban after 16 years. What still remains that we need to work on?
Olive Shisana: I think what still remains for me are really having social, cultural interventions that are targeted to Black people of African descent. We don’t have anything like that in many, many parts of the world, particularly in Africa. We are in Africa, but seldom do we hear people say, “I have actually worked with Black people,” or “I’ve worked with Black women and know the sort of problems of Black women, therefore these are the targeted strategies that we’re doing”. I don’t hear many people saying, “I’m going to conduct research that’s focusing on Black people and their needs and their challenges—why they become infected with HIV.” We talk about this as a generalized epidemic. And if it’s generalized it means they’re not targeted interventions. And that’s where I feel is a beginning.
BAI: We feel that we need to be looking at this conference from the frame of Black Lives Matter. What role do you think we need to play in making sure race and racism needs are centered as issues that we speak of when we talk about this epidemic?
OS: First of all I think the problem is that we as Black people have never come out to say “I’m Black and I’m at risk for HIV.” We’ve not done that because we think it will stigmatize us. How can you treat something you don’t see? You’ve got to see it in order to treat it. So that is where I think we are having problems. Race, class and gender need to be looked at collectively because when it is understood that Black people are generally on the lower socio-economic rank of society; that they are the ones less likely to have jobs; that they’re the ones more likely to end up in jail and on the fringes of society, then HIV is seen in a different context. All of these factors make Black people very much at risk for HIV. Even when you look at issues related to transactional sex, which is trending right now in terms of how to start preventing HIV, you’ll find that for Black women who engage in risky sexual health with rich men it is because of their poverty. It’s survival and that’s what’s putting them at risk. I don’t think that just getting medicine to everyone is going to really wipe up this epidemic among Black people. I think we need a combination of strategies that will lift them socio-economically.
BAI: At the Women Now! Summit here in Durban, just prior to AIDS2016, we talked about what transactional sex looks like among people of various socioeconomic groups, including the idea of staying in a relationship or marriage because you are concerned about your ability to provide for yourself or your children. What are your thoughts?
OS: Transactional sex in the Black community has to do with nothing else other than the lack of socio-economic resources. If you think about it, if you are a Black woman in South Africa, you are less likely to marry because there aren’t many men that you can marry. Where are the mates? They are in jail or are involved in drugs because they did not have the same socio-economic benefits other people had due to education. Or, they are dead—many men die early compared to women. Many are forced to migrate to urban areas, leaving women behind in the rural areas because there are no jobs.
So because there are not many marriageable men many Black women wind up not being able to marry. In South Africa we have about only 24 percent of the Black population that’s married. When we don’t marry the risk of HIV is very high. I’ve done scientific studies that have actually demonstrated that if you are single, Black, unmarried and co-habitating, your risk of HIV is very high—about 4.5 percent per year in South Africa compared to about .55 percent for people that are married. Being married protects you against HIV because in an open relationship where you’re just co-habiting it’s possible for someone to bring the infection from the outside into the relationship.
If you are single and have one monogamous partner for some time, then when that relationship ends you start another relationship. The lifetime number of relationships you’ve had determines the risk of you getting infected with HIV. Wherever you live, your probability is much higher as you change partners over time—and I’m not even talking about multiple sexual partnerships. I’m just talking about being serially monogamous, being single and having sex. It does put one at risk for HIV.
BAI: The theme of this year’s conference is Access, Equity, Rights Now. Can you talk about that within the context of South Africa as well as globally?
OS: The reason we chose this theme is because in order for us to end AIDS by 2030 we need to make sure that 90 percent of the people who are HIV positive know their HIV positive status. Then 90 percent of those who are HIV positive ought to be in treatment. And of that 90 percent, 90 percent must be virally suppressed. How are we going to do that if we don’t allow everyone who is at risk of HIV to be treated with dignity, respect and lack of discrimination? If we discriminate against people, are they going to come in to be tested? Are they going to come in and take their antiretroviral treatment? We are worried because the majority of people living with HIV are not yet getting ARVs.
The other thing we are concerned about in terms of equity is that we’re leaving too many people behind. Those people who live in the fringes of society—the gay community, injection drug users, Black women, transgender people and the sex workers must be brought right to the center so that they also are able to reap the benefits of prevention and treatment and care. In our country Black sex workers have a much higher HIV prevalence and human rights compared to White ones. Many of the human rights violations we’re seeing globally are against people because of their sexual orientation or because they use drugs or because they are considered inferior as human beings, like Black people in many parts of the world. We are denied our human rights and we cannot deal with this epidemic effectively until we actually deal with human rights issues.
BAI: What do you think is the key to Black people successfully fighting these issues – human rights, racism, poverty and other factors — on so many fronts?
OS: We need to have better linkages for Blacks all over the world. This global network of Blacks who are working in HIV, I think, is a critical one in the sense that they can help show us some commonalities among all of us regardless of what space we occupy. Whether we’re in the Caribbean, in Canada, the U.K., Africa—whatever part of the world—we share similar concerns. We need to work harder at working together. Let’s not see each other as African American or African—let’s see all of us as people of African descent. We can better approach the challenges we face by doing joint research between Black people wherever they are, sharing our strategies, implementing them and overcoming them. We want is more African Americans, and Africans, and Africans of the diaspora in general, to really share experiences and lift one another. We can’t go up without working together and sharing; in other words, by developing our capacity together.