Women's Leadership in Global Health in East Africa: In Historical Perspective

As progress in HIV treatment and care developed globally during the 1990s, the public health gaze began to shift towards HIV prevention for uninfected women as a complement to the already existing HIV system of care in Africa. Formative public health research conducted by Western scientists had identified women as particularly vulnerable to HIV infection. Pre-exposure Prophalaxis (PrEP), a daily, low level dose of tenofovir and emtricitabine, was initially a promising HIV prevention tool. By 2010, substantial evidence from multiple clinical trials conducted in the global north demonstrated that PrEP effectively prevents HIV infection when taken daily. Soon thereafter, clinical trials offering PrEP to HIV uninfected women began in Eastern and Southern Africa.

While public health professionals from the West strongly encouraged uptake and adherence to PrEP, initial clinical studies found that African women deemed to be at “high risk” of HIV acquisition chose not to adhere to PrEP regimens. This paper explores the nuanced critiques that African women –research scientists and clinical trial participants alike—made, and continue to make, of the global public health discourse about social vulnerability and HIV risk, daily PrEP as a tool of HIV prevention, and of neocolonial power structures in public health. We argue that these critiques have generated promising HIV prevention innovations, and more broadly, have had substantial impact on how public health knowledge is produced in Africa.