South African scientists are leading in many areas of Aids research and many of these advances have led to significant improvements and achievements in HIV prevention and treatment programmes.
The government has demonstrated what a strong response to the HIV epidemic can achieve. Thirteen million people were tested for HIV in 2010/11.
There are signs that male condoms are becoming more acceptable; a total of 492 million condoms were distributed in 2010, up by 30 percent in 5 years. Most remarkable is the uptake of voluntary medical male circumcision: 250 000 men were circumcised last year, a 50-fold increase from 2008.
HIV infection in children may soon become a thing of the past with 92 percent of HIV mothers now receiving antiretroviral pills with the result that less than 3 percent of their babies get infected.
The South African Aids programme, now the largest in the world, has changed the lives of nearly 1.6 million sufferers. A recent report from the Medical Research Council has shown life expectancy of South Africans has increased by six years to age 60 with 20 percent fewer deaths among adults and 43 percent fewer deaths among children.
With all this success you might think Aids is under control. While there is no doubt that we are making inroads, HIV remains a crisis with about 350 000 new infections in South Africa every year.
It is widely believed that a vaccine is the only long-term solution to overcoming the scourge.
Vaccines are one of the great medical success stories. They work by pre-arming the body’s immune system to recognise and clear infectious organisms. A key component of most vaccines against viruses is the stimulation of neutralising antibodies which block the virus from infecting human cells, thereby killing or neutralising it.
This is why the recent announcement by the Caprisa team of how rare HIV-infected people develop broadly neutralising antibody responses is so important. The Caprisa consortium involves scientists from the University of KwaZulu-Natal, the National Institute for Communicable Diseases in Joburg, the University of Cape Town and the University of the Witwatersrand.
While these types of antibodies are known to be protective they unfortunately do not provide any benefit to the person who develops them. Broadly neutralising antibodies are not a cure for Aids. This is because the virus, in people already infected, gets a head start and is able to work its way around them by mutating its outer coat. However, if these types of antibodies are present in someone’s body before they are exposed to HIV, by for example vaccination, they may be able to protect against HIV.
This is why studying rare HIV-infected people who develop these antibodies is so important as it gives clues as to how to design a vaccine that might emulate this process.
Since South Africa has the world’s highest number of Aids cases it is appropriate that local researchers are among the scientists who are finding solutions to the Aids epidemic.
This ensures that research is locally relevant and tailored to our country’s needs. It also guarantees that we have some say over how new findings are advanced and commercialised. For example, the government now owns a licence for the tenofovir gel used in the Caprisa trial.
However, research is grossly underfunded in our country. The US government funding to South African Aids research in 2010 was more than 10 times the amount provided by our own government.
The National Health Research Committee has also highlighted the inadequate funding of health research by the national government.
The Department of Health invested about 0.37 percent (R416.5 million) of the 2011/2012 health budget to research, which falls short of the commitment to invest 2 percent of its budget on research.
South African scientists have the ability to find solutions to the country’s Aids crisis. This will require long-term support and commitment and an understanding of the nature of research.
Research is an exploration to find new knowledge. It relies on curiosity and innovative thinking. We cannot simply wait or rely on others to solve our problems. We have the infrastructure, wisdom and commitment to do this ourselves but we also need the financial support.