Dr Thembisile Xulu, the newly appointed CEO of the South African National AIDS Council (SANAC), describes herself as an empath and very ambitious.

She stems from a line of formidable women. When Xulu was seven years old, her mother, Sisana, a single parent, joined the armed struggle in Swaziland. 

The young Xulu was raised by her two great-grandmothers – Gogo Victoria, a nurse, and Gogo Ruby, a seamstress. Her grandmothers also managed a trading store in the Durban township of Inanda, where Xulu says she learnt to count change and treat people with respect – skills that may come in handy in her new position.

“So, from a very young age, I took part in stocktaking and counting change,” she recalls. “There were older people working with me in that shop; there were things that they could learn from me, like how to count change. But they could only learn from me if I was a child that they felt comfortable sitting with and listening to. 

“So, I learnt back then, in order to be respected, you need to show respect first. And, my goodness, it’s something I’ve carried with me for the longest time. It’s probably biblical as well. You know, I treat other people, no matter who they are, how I want to be treated.”

Over Zoom, Xulu’s speech is spiced with eye-rolling exclamations, like “Goodness!” More than once she refers to herself in the third person as “Dr T”. She jokes, describing herself as “tamed KwaZulu-Natal migrant labour, in Joburg searching for gold”.

‘To inspire and drive the bus’

Xulu, 46, took over as chief executive officer of SANAC on 1 October. She is speaking to Spotlight on the second day of her new job. Apart from a great ambition to rise to the top, the interview also reveals her humility.

“When I sit in a room, I don’t necessarily regard myself as the smartest,” she says. “In fact, mostly I’m not. I thrive when I manage people who are smarter than me. My job is to inspire and to drive the bus. 

“But I need team members holding the GPS to say ‘Driver, this thing is not going the right way, we need to go there or there.’”

The role of SANAC

Among other things, SANAC is the forum through which South Africa’s national strategic plan (NSP) for HIV, TB and STIs is developed. Currently, the 2017–2022 plan is in effect – mapping the measurable goals set for the country’s fight against these three infections. Xulu will oversee the development of a new plan starting later this year. 

She inherits the CEO position from Dr Sandile Buthelezi, who, in May, on becoming director-general of the National Department of Health, admitted to Daily Maverick that he only partially stabilised “disruption and infighting” at SANAC.

Going forward, how does Xulu see SANAC’s role and relevance?

“SANAC is mainly meant to coordinate the national response to HIV, TB and STIs,” she says. “There are multiple players that are key, from donors to civil society to the private sector. And SANAC is the body that makes sure that, even though we might all be doing different things, the direction has to be towards one common objective, as stipulated in the NSP.”

She adds that even though SANAC has established capacity in securing international funding – it hosts South Africa’s Global Fund Country Coordinating Mechanism – this is a growth area which she hopes to strengthen through better donor coordination.

“When resources come in, SANAC must advise how these resources are used,” she says. “We must then track the performance and be able to report back to donors and government and other entities that are interested. We need to identify where the shortfalls are; where we are going wrong. 

“And then we need to put together plans to implement corrective action. And while we course-correct, there are budgets that need to be discussed and approved.”

Asked how SANAC can be improved, Xulu asks for more time to assess the organisation. “It’s only been a day,” she says. “I haven’t even met the stakeholders. I haven’t sat with the board since my appointment. I would hate to say anything that is not founded. 

“You know, I haven’t had a chance to engage with civil society. I will do that soon. There will come a time when I’m bold enough to give an honest assessment.”

Making a difference

Xulu takes over the reins at SANAC on the back of 16 years at HIV treatment non-profit organisation Right To Care. Before that, she did perinatal HIV research at the Chris Hani Baragwanath Hospital in Johannesburg.

On branching from HIV as a clinician into HIV as a public health issue, she says, “What happened was, we were doing clinical trials on new drugs. We didn’t know what the new drugs were going to do to anyone. So, one piece of advice I would give to young women partaking in the study was not to fall pregnant. We would give them access to contraceptives. 

“But human beings are human beings, and lo and behold, there would be two or three women who are pregnant. And as I said to you, I regard myself as an empath. It really just got to me, because when somebody falls pregnant on a drug that you don’t know the effects of, it looks like you are not doing your job,” Xulu explains.

“So, I decided at that point that, you know what, I love my job. I love HIV. I love TB. But I can’t do one-on-one medicine. So, I still wanted to make a difference, but it had to be on a policy level, on a management level. So, that’s when I got my supervisor to write a motivation for me to go to Wits [University] to do a master’s degree in public health. And I enrolled.”

Xulu started at Right to Care in 2004. Three years later, she became the director. “At Right to Care, I did everything. I could run grants, I could manage finance, I could manage NGOs, I could manage clinics. And then when Right to Care International started, I was made managing director, which meant I had the blessing of starting Right to Care Lesotho, Right to Care Malawi, Ukraine, Myanmar, Haiti, Dominican Republic, you know, so I was just given endless opportunities.”

Family and medicine

Xulu says it was her great-grandmothers who instilled her passion for healthcare.

“They were quite sickly,” she says. “One was hypertensive, the other diabetic with a chronic ulcer on her left ankle. And as a result, by the time I was in fourth grade, I used to take a day off school every month, going to King Edward Hospital to queue at the MOPD [medical outpatient department] for them to see the doctor, and then to queue at the pharmacy for them to collect medication. 

“When my mum left for Swaziland, she left the grannies her car… they had a driver who would drive them and me to the hospital. They would wait in the car while I’d be sitting in the queue. When it was just about their turn, the driver would go call them,” Xulu recalls.

“When Gogo’s feet were swollen, I was the one who would boil water and put her feet in it. The two of them lived together until they passed on. And I think that’s where my love for medicine started because I would say to them, ‘Gogo, when I grow up, I am going to fix your foot, or whatever.’”

At Inanda Seminary, Xulu excelled in maths, biology and physics. She studied medicine at the University of KwaZulu-Natal, where her mum was a manager in student affairs, which helped subsidise her fees. 

“By the time I got into second year, I was working in hospitals, including Prince Mshiyeni Hospital in Umlazi, for extra money. And then I got a bursary from the province. So, I was funded by Natal province from second year until final year,” she says.

It wasn’t always easy. 

Xulu recalls a time during her studies when they lived in a one-bedroom flat. Her mum and two young brothers slept on a double bed, with her on a single bed. But she persevered, doing her community service at Prince Mshiyeni, then staying an additional year to complete a diploma in obstetrics.

“I’d run into a woman in the market, or at the Spar or Checkers,” says Xulu, “and she would just pick up her shirt and she would say ‘Doctor, look, your scar has healed.’” Xulu recalls the joy of handing mothers their babies and telling them their newborn is fine. “This is something I set my heart on.”

Today, Xulu is divorced with two daughters aged 12 and 18, who live with her in the Johannesburg suburb of Ruimsig. In keeping with their family tradition of matriarchy, Xulu’s mother, 67, now lives with her and is helping to raise the girls.

“The 18-year-old… she’s very artsy,” says Xulu. “A girly girl. She likes looking pretty, make-up and that. Whereas the 12-year-old is a bit like me, you know, tomboyish… as people say, she’s a fighter.”

Xulu recalls how her youngest was almost expelled from school. “When she was in Grade 1 – I think her sister was in Grade 5 – she punched a boy who was bullying her sister. And I was called to a meeting to discuss the fact that she needs to be expelled. 

“I was called in the morning at eight, but I had theatre or something that morning, so I asked to come in the afternoon. By the time I arrived, I was lucky that two other parents had reported the same boy for bullying. And the boy got expelled.”

Speaking from SANAC’s Pretoria office, Xulu says when she’s not working she likes to relax with a romantic novel. She just ordered the fourth book by Zulu writer Dudu Busani Dube, called Iqunga. 

“It got delivered yesterday,” says Xulu. “Dudu writes about a taxi cartel. It’s three brothers, one falls in love with a doctor, the other one falls in love with a journalist… you know. But the guys are so romantic.”

The interview draws to an end. Ahead of Xulu is a day filled with meetings – not to mention the considerable challenge of steering the ship at SANAC. DM/MC 

This article was produced by Spotlight – health journalism in the public interest. Sign up for our newsletter.