It’s true that HIV is easy to treat, but it’s only so today because it took about two decades of activism, education and fine-tuning to optimise treatment, bring down prices and get the right support to more people. 

Professor Francois Venter, clinician, activist and director of the Ezintsha Research Centre at the University of the Witwatersrand, has walked the journey of HIV in this country every step of the way, having researched the treatment of patients with HIV since the early 1990s. It’s a field though that has plunged him into the depths of human despair in the years before 2004 when the epidemic felled hundreds of thousands of lives prematurely. 

But he also got to witness a medical miracle when antiretrovirals (ARVs) were finally made accessible to the general public and people with HIV stopped dying. Now, those decades-long lessons have allowed him to shift his research in a new direction: understanding the looming obesity epidemic framed against insights that have come from treating HIV. 

Read more in Daily Maverick: The cruel treatment of obese people echoes dark days of HIV, fuelled by the diet-and-exercise fallacy

Venter delivered his inaugural lecture, titled “HIV and Obesity: South Africa’s unexpectedly similar epidemics”, at Wits University in early October. He began with a backward glance at how his academic career started when he arrived in Johannesburg in the late 1980s, fresh out of school from the mining town of Phalaborwa, a keen tennis player and a confirmed The Offspring fan.

People were dying on hospital floors – 10 or 20 people a night in the Joburg Hospital. And government just didn’t care.

Student politics at the height of the apartheid struggle would shake him up. It would make activism and advocacy central to the career he would build. It has made Venter an outspoken advocate for patients’ rights – throughout the HIV epidemic to pushing for Covid-19 vaccine equity and transparency. He pushes for appropriate Afrocentric research and trials that are not the default of research on low-risk groups.

He also used his inaugural lecture to call out professional health councils and organised labour unions that have “been silent and put the interests of the profession ahead of patients”. Venter has a public profile today as he chooses engagement to debunk myths, deepen public understanding and ensure that expert science is accessible.

‘A fight at every turn’

Venter, in his lecture, paused at the cost of bad politics and Aids denialism under the Thabo Mbeki era. 

“I don’t know how we got through those years and I don’t think we have reflected enough on what it did to people’s psyches,” he told Maverick Citizen.

It took a tragic toll in lives lost and dragged out the struggle to achieve public access to ARV treatment. In around 1996 and 1997, there were up to 1,000 deaths a day, he said.

“There were some very brave activists and clinicians, but the wave of human deaths was catastrophic. People were dying on hospital floors – 10 or 20 people a night in the Joburg Hospital. And government just didn’t care, they didn’t believe there was a problem and there was no plan forward,” Venter said.

The struggle continued until 2004 when the drugs finally became available. But then came other challenges. The early drugs were highly toxic, he said. Testing was tedious and treatment regimes were complicated. There were also challenges of stigma.

“We were writing guidelines to keep addressing issues of toxicity, adherence and drug resistance. And it was a fight at every turn,” he said. 

The work and the activism continued though until they reached the critical turning point of drug optimisation and large-scale clinical trials that led to a shift from a triple-drug cocktail to a single drug that was cheaper, less toxic and easier to take. That tablet was dolutegravir – a game-changer for treatment.  

Into the future we could see the control of obesity come down to a combination of light surgery and drugs.

But that’s also when researchers started picking up on what seemed like a side-effect linked to the new drug regime: patients were gaining a huge amount of weight – up to 10kg and 15kg. 

Venter and his fellow researchers at the University of Cape Town started looking into the treatment. What they found wasn’t linked to dolutegravir at all, but pointed to how the drugs that were previously used in HIV triple-combination treatment were able to slow down weight gain. 

It’s these drugs, Venter said, that hold the promise of being able to curb the rising epidemic of obesity. Venter pointed out that treating obesity-related illnesses in South Africa already cost about R2,500 per person a year and is a growing global public health crisis, also one, he added, that no single country in the world has successfully been able to reverse to date. 

‘The drugs are messy and expensive’

Treating obesity is complex – optimising a drug is a start, but food supply systems need to change, social determinants (the non-medical factors that influence health outcomes) need to factored in, new models for healthy measurement of weight are needed and likewise push-back on vested interests by multibillion-dollar weight-loss and fitness industries, he pointed out. 

“It’s been shown that only a very low percentage of people are able to lose weight and to keep weight off just by lifestyle modification or the use of things like diet pills, shakes or exercise. This is not a case of willpower and discipline. There is a war going on in the weight-loss and gym industry and we know processed foods are designed to be cheap and delicious and to hit the pleasure centres of the brain while fresh fruit and veg are becoming more expensive,” he said.

Read more in Daily Maverick: Studies flagging raised risk of heart attack from ultra-processed foods prompts warning of ‘tidal wave of ill health’

He added that obesity has a disproportionate impact on black women, which calls for more targeted research of this population group. 

It’s the very early days of using drugs to short-circuit these systems. Venter’s next goal is to design new drug studies and to add to the civil society pressure for the government to use regulations, including labelling, taxes and exemptions, more effectively.  

“Treating obesity is a lot like HIV in the early days: the drugs are messy and very expensive. We don’t know the side-effects or what the treatment regimes will look like at this stage either. But what we do know is that the drugs work like a bomb and not just for food cravings but also for the likes of nail biting, gambling and smoking. 

“Into the future we could see the control of obesity come down to a combination of light surgery and drugs,” he said.

Tackling obesity, like tackling HIV, is the promise of better health for more people. It makes research in obesity an obvious follow-on for Venter. Ultimately for more than 30 years now, he said in his conclusion, public health is his social justice fight; it’s still the research that makes a difference, and it’s still the struggles that remind him that practising kindness is half the battle won. DM