Breaking the HIV bottleneck
Why sub-Saharan Africa must lead the way
Africa remains largely overlooked in HIV sequencing research, despite bearing the greatest burden.
Despite bearing the brunt of the global HIV-1 epidemic, sub-Saharan Africa remains severely underrepresented in HIV sequencing research. A recent commentary in Nature Reviews Microbiology, led by Dr Monray Williams of North-West University (NWU), South Africa, calls for urgent global rebalancing, or risk losing control of the virus.Although sub-Saharan Africa accounts for over two-thirds of global HIV-1 infections, most research still focuses on subtype B, prevalent in the West but representing just 12% of global cases. Subtype C, dominant in Africa and responsible for over half of global infections, remains vastly understudied.
“HIV-1’s diversity is staggering,” says Dr Williams. “We cannot end a global pandemic by studying just a fraction of its biology.” The virus’s rapid mutation and recombination drive different clinical behaviours across subtypes, influencing disease progression, vaccine response, and drug resistance.
The Congo Basin, likely the origin of the HIV-1 pandemic and home to the greatest viral diversity, is critically underexplored. Unstudied strains could be resistant to existing treatments or spark future outbreaks. South Africa, despite being one of the countries hardest hit, ranks only third globally in HIV research output, with most studies still focused on subtype B.
The commentary warns that ignoring subtypes A, D, and various recombinant forms risks grave consequences if new, more transmissible or drug-resistant strains emerge.
The HARNESS Strategy
Dr Williams and co-authors propose a bold solution: HARNESS - a framework to redress the imbalance and position Africa as a leader in HIV research.
Central to HARNESS is African self-reliance: investment in local labs, biobanks, genomic surveillance, and training the next generation of African scientists. Currently, African researchers contribute just 2% of global biobank authorship.
The authors also urge increased South-South collaboration, encouraging African countries to share data, tools, and expertise. Funding must better reflect the true disease burden, not the preferences of foreign donors. Often, donor-driven agendas prioritise Northern interests, leaving African voices sidelined.
They stress the need for structural reform. African-led research must be community-driven, culturally sensitive, and ethically grounded. It must also work to reduce stigma and promote equitable access to care, objectives as critical as scientific discovery.
Recent global health funding cuts, including to PEPFAR, make regional autonomy more urgent. Yet, Williams sees a turning point: “This is the moment for Africa to reclaim agency over its health future.”
This is not merely academic; it is a rallying cry. The end of HIV-1 will not be dictated solely by the North. It will come from African laboratories, clinics, and communities if the world has the foresight to invest where it matters most.