By Charlotte Ntulume

As the world marks Women’s Month, The Legacy spotlights Dr. Flavia Matovu Kiweewa, a Makerere alumna whose work is advancing HIV prevention. A lecturer at the School of Public Health and Director of Research at the Makerere University–Johns Hopkins University Research Collaboration, her journey, from medical student to global health researcher, is shaped by curiosity, mentorship, and a deep commitment to improving women’s lives. In this conversation, she reflects on her path, the communities that inspire her work, and the promise of new HIV prevention innovations.

Q: To begin, could you share some of your fondest memories of your time at Makerere?

A: My time at Makerere University was a transformative experience; one that shaped not just my career, but also the very foundation of my life and professional vision. Looking back, my fondest memories fall into three categories: Moments of affirmation, lasting connections, and mentorship.

One of my proudest moments was receiving my admission to Makerere Medical School on government sponsorship. It was a tremendous honour and a direct result of the support and sacrifice of my family and community. That moment made me realise the scale of the opportunity before me.

Another unforgettable moment was being awarded the Association of the Royal College of Physicians Prize for Best Student in Internal Medicine in 2001. I vividly remember receiving that award from then Vice Chancellor, Professor John Ssebuwufu. It wasn’t just recognition; it was the joy of seeing long nights of study, dedication, and passion affirmed. It reinforced a powerful lesson; that diligence and critical thinking truly do open remarkable doors.

But my deepest memories are of the people. My classmates became lifelong friends, and it was at Makerere that I met my husband. I was in my fourth year when we met, and he was a year ahead of me. Sharing those intense years, the long clinical rotations and the shared dream of becoming doctors, forged a bond that has shaped our life together.

I also recall the lecturers who didn’t just teach but challenged us to question assumptions, think like researchers, and aspire higher. They instilled curiosity and a sense of purpose.

Makerere didn’t just give me a degree; it gave me the courage to lead, the humility to serve, and the network to collaborate.

Q: That foundation clearly shaped your journey. How has Makerere, and collaborations such as the one with Johns Hopkins University, supported your growth as a researcher?

A: Makerere University gave me a strong foundation not only in Medicine, but also in rigorous scientific inquiry. The training was demanding but deeply rewarding, and it built my confidence while opening doors to collaborations that would shape my career.

The Makerere University–Johns Hopkins University (MU-JHU) Research Collaboration became the space where that foundation was stretched and tested. It gave me opportunities to engage in groundbreaking HIV prevention and treatment research, and the mentorship and collaborative spirit there helped me transition from a student excelling in internal medicine to a researcher influencing public health policy and practice.

Q: Over the years, what have been some of the most rewarding aspects of your work?

A: The rewards almost always centre on impact and people.

The most fulfilling moments come when the data we collect directly informs national and global health guidelines. Seeing our findings reflected in Uganda’s national antiretroviral therapy guidelines or adopted by the World Health Organisation (WHO) is the ultimate translation of research into real-world change.

Working on HIV prevention among adolescent girls and young women is particularly meaningful. This group faces disproportionate risk, and every young woman who remains HIV-negative because of a tool we helped validate is a victory for her family and her future.

Q: What have been the most difficult aspects, and how do you maintain motivation in spite of them?

A: Working in research in Uganda often means navigating settings where resources are limited, yet the needs are immense. What keeps me motivated is remembering why we do this work: the young women who entrust us with their stories, the mothers who want a healthier future for their children, and the communities that look to science with hope.

My motivation is also sustained by the resilience of our teams and partners. Research is long and demanding, from preparation to implementation to generating results, but the dedication of everyone involved, from clinical staff to community liaisons, keeps us moving forward.

Moments of genuine partnership with communities and stakeholders continue to renew that sense of purpose. They remind me why this work matters and why it is worth persevering.

Q: That connection between science and lived realities seems central to your work. Your earlier BONE: CARE study also focused on women’s health. How did that shape your research vision?

A: The BONE: CARE study was a defining element of my research trajectory. It shifted my focus from simply controlling HIV to understanding the full picture of a woman’s health over her lifetime, particularly the intersections of HIV, reproductive health, and long-term outcomes.

We found that combining a common contraceptive, Depo-Provera, with certain HIV treatments weakened bone density in young women much faster than expected. It was a wake-up call. While HIV medicine saves lives, the combination of two necessary and widely used interventions was creating a silent but serious problem.

This work reshaped my research vision in three ways: To treat the whole person, not just the virus; to reflect women’s real-life choices; and to ensure research translates into policy and clinical practice.

This journey continued with the BONE STAR study, where switching to a newer, bone-friendlier HIV regimen led to significant recovery in bone density. Seeing that transition; from identifying a problem to demonstrating a solution, and then influencing national guidelines has been one of the most fulfilling parts of my career. It showed that local Ugandan research could drive global-level change.

Q: Building on that work, you have also led major HIV prevention research. Could you briefly describe the PURPOSE 1 trial?

A: PURPOSE 1 is a game changer in HIV prevention. The trial evaluated a new long-acting injectable form of pre-exposure prophylaxis (PrEP)* called Lenacapavir, which is administered just twice a year.

While existing oral PrEP is highly effective, consistent adherence can be challenging for many young women due to stigma and the burden of taking pills daily. Lenacapavir offers a simpler, more discreet option.

The study was a randomised, double-blind, placebo-controlled trial** conducted at 28 sites globally, including three in Uganda and 25 in South Africa. It focused on adolescent girls and young women in high-risk settings. As National Principal Investigator, my role was to ensure the research was conducted to the highest ethical and scientific standards, while also building strong partnerships with policymakers, regulators, and community stakeholders.

Q: The results have been described as groundbreaking. What do they mean in practical terms for women’s health?

A: The twice-yearly PrEP option could revolutionize HIV prevention for African women.

Uganda already has a robust prevention toolbox, but introducing a longer-acting option like Lenacapavir significantly expands choice. Beyond convenience, the less frequent dosing gives women greater control over a method that fits into their lives.

For the first time, we have clear evidence that a discreet, long-acting injectable option can place HIV prevention firmly in the hands of women without stigma, without the burden of daily pills, and without dependence on a partner’s decisions. For many young women, this is not just an effective drug, but also a tool of empowerment.

Q: Beyond these specific interventions, how do you hope your work will be viewed in years to come?

A: I hope people will look back and say that this was the moment when evidence generated in Uganda helped shape global policy.

Our goal is not just to run trials, but to provide data that empowers countries to offer a full range of prevention options; oral PrEP, vaginal rings, and injectables, thereby breaking barriers of stigma and adherence.

Beyond HIV prevention, I hope our work contributes to a more comprehensive standard of care, one that ensures that women not only survive, but also thrive.

Q: What is your advice to young Ugandans, especially young women, who aspire to careers in medical research?

A: If you have studied science, then you can investigate scientific problems. Medical research is not reserved for distant laboratories; it is for us here in Uganda.

To succeed, you need curiosity, resilience, and mentorship. Never stop asking questions. View challenges as opportunities to learn and grow, and actively seek guidance from those who will support your journey.

Above all, remember that research is about people. Wherever you are, whether in a clinic, a lab, or a community, carry compassion, humility, and a sense of service. If you do that, your work will not only build your career but also leave a lasting impact.

Q: As we end, is there anything else you would like to share with our readers?

A: As I reflect on my journey, I would like to highlight the transformative power of mentorship and collaboration. When I first started, there were very few African women in my field. I was fortunate to have mentors and collaborators, both local and international, who not only taught me science, but also gave me confidence and opportunities to step up and lead.

I remain deeply grateful to the many institutions and research communities that have supported my journey, including Makerere University, the MU-JHU Research Collaboration, and our global partners.

My heartfelt thanks go to my family, who have been my constant source of strength. The love, patience, and support of my husband and children have sustained me throughout this journey.

As I look to the future, I believe it is important to pay it forward. I am committed to mentoring and empowering the next generation of African scientists, especially young women. By building a community of practice that supports and uplifts each other, we can drive meaningful change and address the pressing needs of our communities.

Editor’s note:

*‘Prophylaxis’ means to prevent or control the spread of an infection or disease. Pre-exposure prophylaxis (PrEP) is an HIV medicine taken by people who do not have HIV that reduces the risk of getting HIV from sex and from injection drug use.

**In randomised, double-blind, placebo-controlled trial studies, participants are randomly assigned to receive either the actual treatment or a placebo, with neither the participants nor the researchers aware of who receives which. This “blinding” minimises biases and other factors that might influence results, thereby enhancing the study's validity.