25 years of HIV/AIDS research and activism

The University of Cape Town (UCT) has made inimitable contributions to the fight against the HIV/AIDS epidemic. At the forefront of its efforts has been the Centre for Integrated Data and Epidemiological Research (CIDER). On 5 December, UCT colleagues, as well as representatives from the health services, non-profit organisations and various research groups gathered to reflect on and celebrate the centre’s achievements.

At the beginning of the HIV/AIDS epidemic in the 1980s, HIV was spreading and developing into AIDS at such a rapid rate that it was predicted to become the cause of more deaths than any other disease in history.

Over the past 25 years, however, the world has seen a steady decline in new incidences of HIV infections and deaths from AIDs-related illnesses. Between 1995 and 2023, the world saw a 61% reduction in the number of new HIV infections worldwide, while deaths decreased by 70% between 2004 and 2023.

These improvements are due to the development of both antiretrovirals (ARVs), effective treatment practices and public health policies globally – activities to which UCT and CIDER have made substantial contributions.

“The work you have all produced has been really, really impactful. It has changed guidelines, policy and practice at a global level.”

“The work you have all produced has been really, really impactful. It has changed guidelines, policy and practice at a global level.

The phrase I would use to describe the activity is ‘think global, act local’,” said Dr Nathan Ford, scientific officer within the Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes at the World Health Organization.

“The research that’s been done here in the Western Cape has primarily been about solving problems here, but these are problems that existed in many parts of the world. So doing the science, writing up your findings and sharing them makes a much bigger impact – even if the primary intent was, quite correctly, to solve healthcare problems and improve services locally.”

A team effort

Of course, the work that has come out of the centre would not have been possible without the support of and collaboration with many other organisations.

“Things have worked out and they’ve worked because of the collaboration with the health services in the province; because we had a university involved; because we had TAC [the Treatment Action Campaign], who came to the clinics and encouraged patients to come and created support groups,” said Emeritus Associate Professor David Coetzee.

One of the most prominent of all of the partnerships that CIDER has undertaken over the years has been with Medicines Sans Frontiers (MSF; also known as Doctors Without Borders).

In the mid- to late 1990s in South Africa, when HIV denialism and technical resistance were major challenges, MSF and then Infectious Disease Epidemiology Group (IDEG) teamed up to tackle the issue, using some unorthodox methods in a few instances.

“The first thing that we did was send [TAC co-founder] Zachi Ahmed to Thailand to collect Fluconazole, which could deal with the main cause of death at the time, cryptococcal meningitis. When Zachi came back, very proudly with his generic Fluconazole, he was arrested. Immediately. And the medication was seized,” recalled MSF practitioner Dr Eric Goemaere.

Despite this less-than-ideal start, awareness campaigns spread by the Western Cape’s provincial health department and the TAC – as well as a critical moment in which the late former president Nelson Mandela donned an “HIV Positive” t-shirt at a TAC event in Khayelitsha – saw a push for ARVs to be provided to patients and massive uptick in the use of treatment services.

“People were initially hesitant, but very quickly, we were completely overwhelmed with demand. People started to flock in and we were a bit overwhelmed, but trained nurses to start treating them and we were soon hosting a press conference showing that after 12 months of [ARV] treatment, many patients were still alive and better than ever,” said Dr Goemaere.

Resolute in research and responsiveness

In its current and past forms, CIDER has indubitably made enormous contributions to the field of HIV/AIDS research. With the success of its programmes in this field of epidemiology, the centre has managed to expand its research reach while still maintaining a commitment to advocacy and providing outstanding health services.

“CIDER has its origins in the political, social and healthcare responses to the HIV and TB epidemics. However, the data service and research platforms that resulted from this collaboration have demonstrated their potential far beyond the foundations of HIV and TB,” explained CIDER director, Dr Emma Kalk.

“Based on this, CIDER has expanded organically and now includes mental health and other non-communicable diseases. While we expand our focus, we maintain our engagement with robust infectious disease science and the commitment to quality service provision and health activism.”

The dean of UCT’s Faculty of Health Sciences, Associate Professor Lionel Green-Thompson, emphasised the importance of this focus in his concluding remarks. He noted specifically that engaged scholarship is the best way to achieve positive health outcomes for the people that programmes, like those developed at CIDER, are designed to serve.

“Listening today to all of the strides that CIDER has made, the centre may well be a case study for engaged scholarship. What has emerged today is that there is very much an intersection between the academy, the service provision platform and this real generative force in the community,” he said.

In line with the broader scope of work that CIDER has taken on over the years, Dr Kalk officially relaunched the organisation under the new name: Centre for Integrated Data and Epidemiological Research. This maintains the CIDER acronym, taken from its previous title of Centre for Infectious Disease Epidemiology and Research.