Twenty years ago, at the height of HIV and AIDS denialism in South Africa, former President Nelson Mandela, through the Nelson Mandela Foundation, commissioned the first HSRC study to estimate HIV prevalence in South Africa. Published in 2002, the Nelson Mandela/HSRC Study of HIV/AIDS found that 11,4% of the participants were HIV positive. Among those who did not believe that HIV caused AIDS, the HIV prevalence was higher than among those who believed it. This highlighted the danger of HIV denialism among leaders at the time, said former HSRC CEO, Dr Olive Shisana who led this seminal study, in an interview published in the March 2019 edition of the HSRC Review. Significant controversy followed the launch of the findings, Shisana said, but HSRC researchers were steadfast, speaking truth to power and urging South Africa to follow the science during this difficult time.
Soon after the wide dissemination of the 2002 report, other Southern African countries, especially Botswana, Swaziland and Mozambique, became interested in implementing similar studies. Prof Leickness Simbayi, acting HRSC CEO who was the project leader of the first survey, wrote:
‘We provided them with technical assistance, with support from the Southern Africa Development Community (SADC), which was itself supported by a grant from the European Union. Botswana undertook its Botswana Aids Impact Survey (BAIS) II in 2004, BAIS III in 2008 and BAIS IV in 2013, followed by Swaziland in 2006–2007 and Mozambique, with its Mozambique Aids Indicator Survey in 2009. In November 2007, I had the privilege to present our model of HIV surveillance to ministers in charge of HIV/Aids in all SADC countries during the SADC Leadership Conference, at Victoria Falls, Zimbabwe. It was adopted as a gold standard for national HIV surveillance that all SADC countries should try to implement at least once to benchmark their national estimates derived from antenatal clinics.’ (HSRC Review, March 2019)
In the last two decades, South Africa has made significant strides in its fight against this epidemic and is home to world-class expertise on infectious diseases, including COVID-19. Continuing its work to track the HIV epidemic, the HSRC repeated HIV surveys in 2005, 2008, 2012 and 2017. Fieldwork for the 6th South African HIV Behavioural, Sero-status and Media survey (SABSSM VI) was launched on 8 February 2022 .
Over the years, the researchers have increased the number of biomarkers measured, expanded participation to entire households, and introduced electronic data collection systems, which allow them to access data immediately. The first survey included 9 963 participants and focused on estimating HIV infection, prevalence (cumulative HIV infection cases), incidence (new HIV cases), knowledge, attitudes and perceptions about HIV/AIDS and sexual behaviour. The 6th survey is the largest to date and has been expanded to collect data on SARS-CoV-2, the virus that causes COVID-19. Researchers plan to interview 93 000 people and to collect 65 000 blood specimens in all 9 provinces .
The SABSSM surveys have become a major source of information for measuring progress in the implementation of South Africa’s national strategic plan to curb HIV, sexually transmitted infections and tuberculosis. This type of information helps us understand what drives HIV infection and helps scientists and the government to build models and make projections while critically reflecting on the effectiveness of current HIV policy and research interventions. Through these processes, the SABSSM surveys have had a substantial impact with respect to informing policies and strategies to curb the epidemic. The surveys are also relevant to the COVID-19 pandemic, since the policy and research investments that have been made over the past 20 years, together with the research and policy capacity that has been built through the SABSSM, are helping us in our fight against COVID-19.
The SABSSM surveys also build important research partnerships. For example, SABSSM VI was funded by the President’s Emergency Plan for Aids Relief through the CDC, and the HSRC partnered with the South African Medical Research Council, the University of Cape Town, the National Institute for Communicable Diseases, the National Department of Health, the South African National Aids Council, the United Nations Children’s Fund, the US Agency for International Development, and the Joint United Nations Programme on HIV and Aids.