Professor screw it, let’s do it — battle-hardened HIV researcher Francois Venter ready for another big fight

‘I hate, hate, hate talking about myself,” warns Professor Francois Venter. We are sitting in the immaculate boardroom of Ezintsha, the Wits-based medical research centre that Venter leads.

Ezintsha came to international attention in 2019 after the results of a clinical trial called ADVANCE were published in the New England Journal of Medicine, showing the effectiveness of new HIV therapies and, perhaps more importantly, demonstrating why it is important that clinical trials be conducted in the contexts in which the drugs are mainly consumed.

Venter, by this time, was already well known for his work in HIV, not only for his scientific outputs, but also for taking up cudgels on behalf of people living with HIV.

In a series of recent op-eds, for example, he has excoriated both the President and the health minister for providing scant leadership in the face of the US’s defunding of the HIV response in South Africa, comparing their inaction to the infamous Aids denialism of Thabo Mbeki and his health minister, Manto Tshabalala-Msimang.

Venter’s response to being singled out is predictable: “There are so many people in the HIV world who did much more, and more bravely.” It is the refrain of many treatment activists.

Venter is tall, powerfully built. His disposition is nervous, though, his speech often self-effacing, but mention one of his many bugbears and a quiet fury brims.

He is known for speaking without any regard to self-preservation, using what a lecturer friend calls “borderline cancel language”. Like a good journalist, he calls it as he sees it.

The comparison pleases Venter, who was editor of the campus newspaper, Wits Student, in 1991. He describes his involvement in student politics as an almost involuntary act, akin to staying afloat in a turbulent river, saying: “As far as I was concerned, there was nowhere for a white person to hide, and joining the fight [against apartheid] was the only moral choice.”

The height of the HIV epidemic

Venter did his “house job” (residency) at Hillbrow Hospital, which is where he first encountered HIV as a student.

“It was the beginning of that incredible surge in numbers that occurred between 1993 and 1997. The first cases I saw were returning political exiles,” says Venter.

By 1997, the HIV epidemic was at its zenith in South Africa, and hospitals across the country were overwhelmed. He still struggles to forgive the callousness of some senior administrators.

“And looking back, that was the first sign of the absolute arrogance of some of the health people in government. And you see it now in the way foreigners and poor people are treated in the public sector. It is one thing to have no idea how to deal with a problem, but to lack the ability to do any reflection, have any empathy and to self-­correct is so upsetting.”

Venter’s interest in HIV was sparked by his experience of looking after a haemophiliac in 1997. He was amazed at the impact of antiretroviral therapy (ART) on his patient.

Jobs followed at the Wits-based Clinical HIV Research Unit with world-­renowned HIV expert Ian Sanne and Professor Helen Rees’s Wits Reproductive Health and HIV Initiative, where Venter ran a huge US government-funded HIV-support programme for a decade in several provinces, gaining experience in expanding primary care approaches in chronic diseases.

They were heady times, in which Venter was left disappointed again and again by much of the medical community.

“Other than the rural doctors, who have always fought for their patients, and the HIV Clinicians Society, the healthcare worker organisations were nowhere to be seen,” says Venter, lamenting that little has changed.

“Through Covid-19, and now with the defunding of HIV and scientific research, it is the same people raising their voices and the same organisations sitting on their hands. Worryingly, a lot of the people we are fighting are the same ones who stood in the way of access during the Mbeki era.”

In the nearly three decades since 1997, many important clinical trials, HIV programmes, research papers and court cases have gone under the bridge, and Venter has become part of the moral conscience of South Africa.

Ezintsha, for years based in a Yeoville house, now occupies two floors of a large office block in Parktown, which also houses a new obesity clinic, where Venter sees patients with South Africa’s new pandemic.

“The new drugs for obesity are every bit as revolutionary as the HIV drugs,” he says, “but every bit as fiddly as antiretrovirals were in 2000.”

New studies, using these wonder drugs in people with both HIV and obesity, are being hatched here. Ezintsha’s health staff are looking at using HIV lessons to try to improve primary care for diabetes, hypertension and other common diseases in South Africa.

The race to the bottom

We are a long way from the early days. Donor funding, although key to the fight against HIV in South Africa, has also distanced organisations from communities and created a dependency which, after the collapse of the US government’s Aids fund, Pepfar and the US International Agency for International Development threatens catastrophe.

“What happened still feels quite unthinkable. On the one hand it feels like 2004, when Mbeki’s denial of HIV became national policy and everything felt like it was going backwards. On the other hand it is extremely frustrating that our systems have not been made sustainable, and are now on the brink of collapse as a result of Pepfar having been interwoven with the national HIV programme to such an extent that everything unravels when it is stopped.”

Venter sketches a scenario in which South Africa’s HIV response – “the one effective programme we have” – is misleadingly characterised as “too expensive” and dragged down to the lowest common denominator, “leading to the same terrible outcomes you find in crap programmes, like diabetes”.

“A race to the bottom, in other words… We have poor indicators for almost every health metric outside of HIV, TB and vaccines, and even those are now slipping, due to the Health Department dropping the ball.”

Will this grim scenario prevail, or will South African healthcare be shepherded through the labyrinth of budget cuts and misfiring systems? Venter doesn’t see why not.

“Our problems are systemic, and we have enough resources and brains to fix them. What is needed is strong leadership, which is something we currently lack,” he says.

“I’ll tell you what you do… We all declare our interests, put an end to corruption, and everyone from the President and the minister of health down in government must use the public healthcare system when using their medical aid. If they experience the system first-hand, they will have an immediate investment in assisting those fixing it.

“Stop blaming the private sector and a lack of money for the problem. Start using the innovations South Africans are world leaders in, including data systems. If we do that, I am telling you, we will fix the system in five years.”

Venter, clearly, has already rolled up his sleeves for this new fight. It will be interesting to see who joins him. DM

This story was produced by the Bhekisisa Centre for Health Journalism.

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R35.