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Prof Frank Tanser unpacks HIV battle in South Africa
Author: Corporate Communication and Marketing/Korporatiewe Kommunikasie en Bemarking
Published: 24/04/2024

​​Prof Frank Tanser, Director of Population Health Innovation in the Centre for Epidemic Response and Innovation (CERI) in the School for Data Science and Computational Thinking at Stellenbosch University, delivered his inaugural lecture on Tuesday 23 April 2024. The title of his lecture was “The rise (and fall?) of South Africa's HIV epidemic: a personal perspective".

Tanser spoke to the Corporate Communication and Marketing Division about how his research aims to evaluate and design intervention strategies that can drive back the HIV epidemic and its negative consequences in communities hardest hit by the epidemic.

Tell us more about your research and why you became interested in this specific field.

I am an epidemiologist specialising in the space-time evolution of infectious disease epidemics. My research focuses on the epidemiology of important public health problems such as HIV in rural African communities. In particular, it aims to evaluate and design intervention strategies to drive back the HIV epidemic and its negative consequences in communities hardest hit by the epidemic.

I became interested in this field when I started my first full-time job at the Malaria Programme of the Medical Research Council in Durban in 1997. I had previously used technologies such as remote sensing and geographical information systems to measure patterns of degradation for the purposes of improving land management. It seemed like a natural progression to apply these same technologies in the domain of public health to the understanding of disease spread.

How would you describe the relevance of your work, especially for sub-Saharan Africa?

The level of new HIV infections is still unnecessarily high in many African countries, but we possess the knowledge and tools to make a significant impact. My work over the past 25 years in a South African rural community decimated by HIV has provided substantial insights into the evolving and dynamic nature of the HIV epidemic and its key drivers, informing HIV prevention and treatment policy in sub-Saharan Africa. My research into the population-level impacts of the antiretroviral therapy (ART) roll-out has led to wide-reaching and rapid changes to government policy on how ART programmes in Africa are designed and implemented. A seminal study we published in the journal Science was the first to show that nurse-led, decentralised HIV programmes in rural areas could successfully reduce HIV transmission at the population level.

New national data show that South Africa is making headway in its fight against HIV. What must we do to sustain this momentum?

One of the most important things we can do is continue to increase the coverage of antiretroviral therapy to those who are HIV infected. Last year, our Health Minister, Dr Joe Phaahla, said that if we all pull in the same direction, we can achieve our goal of 95-95-95 (95% of the people who are living with HIV knowing their HIV status, 95% of the people who know that they are living with HIV being on lifesaving antiretroviral treatment, and 95% of people who are on treatment being virally suppressed) to drive the epidemic to low levels of endemicity.

Based on your previous research, what future prevention strategies are needed to reduce HIV infections in sub-Saharan Africa?

The HIV epidemic is rapidly changing and existing intervention strategies will need to evolve to keep up with the changing dynamics of the epidemic. We have recently received two grants of R40 million each from the National Institutes of Health (NIH) in the USA that will help us in this regard. The first NIH grant seeks to design future HIV prevention strategies for severely affected rural communities in sub-Saharan Africa which seek to maximise the reduction in new HIV infections. The research will be used to inform the future implementation of HIV prevention programmes. It will utilise the rural HIV surveillance site in KwaZulu-Natal to quantify trends in the rate of new HIV infection by space, time and demography and then model and design new HIV prevention strategies aimed at harnessing the changes in the epidemic to maximise reductions in the rate of new HIV infections.

The second NIH grant seeks to address one of the greatest challenges in driving the epidemic towards elimination which is the low uptake of HIV prevention among men. The grant will fund a ground-breaking trial in Eastern Zimbabwe aimed at increasing the uptake of prevention. At the heart of this trial lies the promotion of Pre-Exposure Prophylaxis (PrEP) as a highly effective method for preventing HIV infection. PrEP involves the use of antiretroviral medication by individuals who are at high risk of acquiring the virus. The trial seeks to engage hard-to-reach men through their peer networks and enable them to self-test for HIV.  The trial will recruit over 3 500 men living in 44 communities. It utilises innovative community support structures to decrease barriers to the uptake of PrEP by reducing the need for engagement with clinics.

As a leading scientist in HIV research, do you think the world is on track to end the HIV/Aids epidemic as a public health threat by 2030?

Unfortunately, I don't think it will happen by 2030 but nevertheless amazing progress has been made. Ending HIV as a public health threat will require sustained financial investment and commitment from many sectors. In July 2023, UNAIDS (the Joint United Nations Programme on HIV/Aids) released a report which shows that Aids could be ended as a public health threat by 2030. Titled “The Path that Ends Aids", the report makes it clear that ending AIDS is a political and financial choice, and that those countries and leaders who are walking the talk are achieving extraordinary results. We are already seeing positive results in countries such as Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe, to name a few.

You have spent many years in the challenging environment of higher education. What keeps you motivated when things get tough?

At times it was undoubtedly tough! But I believe that anything worth doing is not going to be easy. It was extremely motivating for a disease like HIV to be able to have an impact on policy and to be able to quantify the significant progress that has been made (after the initial years of 'doom and gloom').

What aspects of your work do you enjoy the most?

I enjoy travelling to rural sites in South Africa and beyond and meeting interesting people; working with amazing teams and learning from colleagues; and producing scientific results that change policy.

Tell us something exciting about yourself that people would not expect.                                                                                                                                                                                                                                                                         

I've nearly been killed by three of the “big five" game animals in Africa. In one of these encounters in 2016 whilst on a walking safari with my family in the Hluhluwe-Umfolozi reserve, my father was gored by a black rhino (he survived!). This near-death experience was featured on the local wildlife TV show 50|50.

How do you spend your free time?

I enjoy running, golf and tennis – last year I ran the Knysna marathon with my two sons. I also enjoy watching international rugby, visiting many of the magnificent wildlife parks in Southern Africa and walking in the mountains and other beautiful settings with my family. 

  • Photo by Ignus Dreyer (The Stellenbosch Centre for Photographic Services).