Africa, the cradle of the HIV pandemic, must be the cradle of the cure

Mail & Guardian

01-07-2025

There will be no HIV cure without Africa's involvement. Photo: Delwyn Verasamy
They say history is written by the victors. But in the case of HIV, the story isn't over. Not by a long shot. And if we're honest — if we're truly listening — it is Africa that holds the pen for the next chapter.
Let's call it what it is: the HIV pandemic has Africa as its epicentre. More than 25 million people on the continent live with the virus. That's more than two thirds of the world's HIV-positive population. Here's the truth, raw and unfiltered: there will be no HIV cure without Africa.
Why does cure research in Africa matter? Because science divorced from relevance is science done wrong. The virus here is different — literally. Subtype C, dominant in Southern Africa, behaves in unique ways compared to subtype B, the strain most studied in Western labs. A cure crafted without considering this risks being ineffective.
But it's not just virology. It's people. Culture. History. It's the grandmother in rural Malawi still caring for five orphaned grandchildren. It's the young man in Soweto tired of hiding his status. It's the community health worker who's seen more funerals than birthdays.
Yet, scaling research in Africa is like climbing a muddy mountain in the rain. The challenges are real and they're brutal.
First, the money. Or the lack thereof. African research institutions are starved of resources. Laboratories are too few, too outdated or too dependent on external donors whose priorities shift with the wind. Promising trials stall, not for lack of will, but for lack of wi-fi or reagents. A potential cure is held hostage by broken centrifuges and expired funding cycles.
Second, the regulatory swamp. Clinical trials understandably need approval. But in Africa, the processes can be glacial. Ethics committees, often underfunded and overworked, are left to wade through complex protocols with limited support. Meanwhile, researchers — eager, bright, burning with passion — wait. And wait. Time bleeds. Momentum fades.
Then, there's trust. Or rather, the scars left by its absence. For decades, Africa has been the testing ground for drugs, devices and diagnostics, many of which never returned in the form of benefit. People remember. So when someone says, 'We're testing a cure,' people in Africa ask, for who and at what cost? Without deep, honest community engagement, even the best science will sit in sterile labs, untouched, unused.
Oh, and don't forget the brain drain. Bright African minds are too often lured abroad. Can you blame them? Better funding. Better infrastructure. More recognition. But the loss is ours. When the very people best positioned to solve Africa's problems have to solve someone else's, that's not just sad, it's sabotage.
So, what now? Roll over and wait for Western labs to save the day?
Absolutely not.
What's needed is a fundamental shift, a re-imagining of how global science is done. One that sees Africa not as a passive recipient of cure breakthroughs but as a co-creator. A leader. A standard-setter.
We need to fund African-led research and advocacy institutions such as the African HIV Cure Consortium (AHCC), not as side projects but as central nodes of global strategy. We need regulatory harmonisation across borders so that a trial approved in Kenya isn't buried in red tape in Nigeria. We need to invest not only in labs, but in people, in narratives of ownership and pride.
And, most critically, we must demand that cure research be ethical, inclusive and future-focused. No more parachute science. No more backroom deals. No more data extraction without shared benefit. Africa must be in the driver's seat, hands on the wheel, eyes on the road ahead.
A cure isn't just a medical milestone. It's a justice issue. To end HIV without ending inequality would be to miss the point entirely. If the cure becomes another tool of global exclusion — available in Boston before Bulawayo, or Paris before Pretoria — then we haven't cured anything. We've only perpetuated the disease of disparity.
Africa deserves better, it demands and needs to do better, because the people who've borne the brunt of this pandemic have also carried the torch of resilience, courage and hope.
Dr Albert Machinda is the co-principal investigator and head of secretariat for the Africa HIV Cure Consortium funded by the Gates Foundation and AIDSFonds.