Prof Leickness Simbayi Executive director

What we do

The Social Aspects of HIV/AIDS and Health (SAHA) research programme specialises in research on the social determinants of health - not only with regard to HIV/AIDS, but also for public health in general. This research goes beyond medical interventions and strives to address health problems at their source, namely, at the social and population levels.

The programme is a national and regional resource for research on the following issues:

• Large-scale surveys at national, community and economic sector levels
• Applied, epidemiological, social and behavioural research
• Health services and health systems research
• Operations research (descriptive and intervention)
• Programme evaluation
• Qualitative research (ethnographic, focus-groups)
• Surveillance and analysis of epidemiological trends

SAHA incorporates the Social Aspects of HIV/AIDS Research Alliance (SAHARA), an alliance of partners established to conduct, support and use social sciences research to prevent the further spread of HIV and mitigate the impact of its devastation in sub-Saharan Africa.

  South African National HIV Prevalence, Incidence, Behaviour and Communication Survey report released 

SAHA conducts research in three main areas:

Behavioural and social aspects of HIV/AIDS

This research aims to understand social (interpersonal) and behavioural (personal) factors driving the HIV/AIDS epidemic. We use this knowledge to develop and test behavioural HIV interventions that are theory-based and directed at prevention of HIV infections in both the general public and people living with HIV/AIDS (PLWHA).

Other research focuses on reducing stigma and discrimination against PLWHA; risk behaviour among men who have sex with men; and efforts to mitigate the impact of the disease among orphaned and vulnerable children (OVC).

Epidemiology, strategic research and health policy

This area provides epidemiological support and expertise, undertakes applied policy-relevant epidemiological research, and conducts strategic research that addresses the needs of South Africa and other African partner countries. It covers four research areas:

• Infectious disease epidemiology, with a focus on HIV/AIDS survey methodology and epidemiological modelling;
• Biostatistics, data management and analysis;
• HIV/AIDS intervention research aimed at the development of synergistic prevention and care programmes; and
• Monitoring and evaluation, including assessing the impact of national programmes.

Health systems and social determinants of health

This area focuses on research on developing and evaluating interventions which promote evidence-based health-care provision. The issues dealt with include: disparities in health services; health promotion; the transformation of health systems; and operations research.

The research places a specific emphasis on strengthening equitable provision of health services and investigates how the social conditions under which people grow, live, work and age, affect health.

Within South Africa, SAHA works with national, provincial and local government departments, other statutory research councils, universities, parastatal and non-governmental organisations, as well as virology laboratories. Most importantly, SAHA has contributed both directly and indirectly, to the development and implementation of the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011.

In the rest of Africa, SAHA has worked mainly with partners based at the Université Cheikh Anta Diop in Dakar, Senegal, and the Tropical Institute of Community Health at the Great Lakes University of Kisumu in Kenya. Collaborative work includes government departments, university researchers and research organisations, NGOs and local and international donors. This network has allowed us to undertake several large multi-country and multi-site research studies. Through the SAHARA network, SAHA enjoys a special relationship with the Southern Africa Development Community's (SADC's) HIV/AIDS Unit in Gaborone, Botswana, and the Joint United Nation's Programme on AIDS' (UNAIDS) Regional Support Team for East and Southern Africa, based in Johannesburg.

SAHA also collaborates with many international research institutions and universities outside Africa and with several multilateral international organisations. Longstanding relationships exist with, among others, the National Institute of Mental Health, Centers for Disease Control and Prevention (CDC), National Development and Research Institutes (NDRI), ORC Macro International, Pennsylvania State University, and the University of Connecticut, all from the USA. There are moves to establish partnerships with international research institutions and universities in other parts of the world.

Funding

Although SAHA receives some government funding, being part of a statutory research council (HSRC), the majority of its funding comes from national and international donors.

Within South Africa, funders include: national and provincial government departments; other parastatals and non-governmental organisations. These include: the national Departments of Health, Science and Technology, and Social Development; the AIDS Foundation of South Africa; the Anglican Church of Southern Africa; Education Labour Relations Council; the Nelson Mandela Foundation; the Presidency; and the Safety and Security Sector Education and Training Authority (SASSETA).

Internationally, recent funding has been accessed mainly from the USA's President's Emergency Plan for AIDS Relief - PEPFAR (via a collaborative agreement with the Centers for Disease Control and Prevention).

Other funders over recent years include the following:

• Bill and Melinda Gates Foundation
• British Commonwealth Fund
• CDC Atlanta
• Ford Foundation
• National Institutes of Health (USA), mainly via the University of Connecticut
• SAHARA (drawing on funding from the Canadian International Development Agency, Department for International Development (DFID), UK, and the Netherlands International Aid Agency, DGIS)
• Swiss Agency for Development and Cooperation (SDC)
• Tibotec REACH Initiative
• WK Kellogg Foundation
• World AIDS Foundation
• World Health Organization (WHO).

Implementation networks

In keeping with the HSRC motto, Social Science that Makes a Difference, SAHA uses implementation networks to ensure that our research is relevant, properly understood and then implemented. As SAHA works at regional, national and local community levels, it involves key stakeholders at each of these levels. Multi-country and multi-site studies, and most large national studies, have Steering Committees and Boards drawn from relevant stakeholders to provide advice, while local studies have Community Advisory Boards which do the same.  In conjunction with the Policy Analysis Unit of the HSRC, we endeavour to convert all research findings into policy briefs for dissemination to key stakeholders.

Themes

Theme 1: Population-based HIV surveys

SAHA undertakes population-based HIV/AIDS surveys, employing the second-generation surveillance approach at national, provincial, and local community levels. These surveys provide essential information for informing policy and programmes in response to the HIV/AIDS epidemic in South Africa and neighbouring SADC countries. The surveys are the primary data source for the government's HIV & AIDS and STI Strategic Plan for South Africa 2007-2011.

Theme 2: National Monitoring & Evaluation and programme impact assessment

The HIV and AIDS and STI Strategic Plan recognises monitoring and evaluation (M&E) as an important policy and management tool. As a lead research programme in the design and implementation of national M&E frameworks, the government has requested SAHA to assist in the outcome and impact assessment of national policies and programmes.

Theme 3: Prevention of mother-to-child transmission (PMTCT)

An ambitious aim of the Strategic Plan is to reduce mother-to-child transmission rate of HIV to less than 5%.  SAHA conducts research to improve the effectiveness and coverage of PMTCT services, especially in poor, rural areas.

Theme 4: Nosocomial transmission of HIV and TB

Previous studies have shown deficiencies in infection prevention and control (IPC) in health facilities throughout South Africa. In addition, nosocomial transmission of HIV is suspected in several unexplained cases of HIV infection. Since 2005, there have also been multiple cases of extensively drug-resistant tuberculosis (XDR-TB) where evidence clearly pointed to a nosocomial transmission mode. SAHA has undertaken studies in collaboration with Stellenbosch University to improve infection control practices in public sector health-care facilities to reduce the potential for HIV and TB transmission both to patients and health-care workers.

Theme 5: Orphans and vulnerable children (OVC)

One of the main consequences of the hyperendemic nature of HIV/AIDS in the Southern African region has been the premature death of parents of young children which has produced large numbers of orphans. This has exacerbated an already hazardous situation in which the many children are vulnerable because of pervasive levels of poverty also found in the region. Consequently, SAHA has prioritised research into the mitigation of the impact of HIV/AIDS among OVC with a view to identify best practices which help improve both their own conditions as well as those of their caregivers, in line with imperatives of the South African National Strategic Plan on HIV & AIDS and STI for 2007-2011.

Theme 6: Theory-based social and behavioural risk reduction interventions

A set of theory-based behavioural risk reduction intervention programmes under the name Phaphama (meaning "wise up" or "be wise") have been developed and tested over the past few years in collaboration with the University of Connecticut in the USA. These are mainly aimed at providing evidence-based behaviour change interventions, which are being evaluated as a means to reduce new HIV infections. Apart from targeting individuals, some interventions are now beginning to target whole communities in order to try to change social norms. This is also in line with the imperatives of the HIV & AIDS and STI Strategic Plan for 2007-2011.

Theme 7: Positive prevention among people living with HIV/AIDS

As more people test for HIV and become aware of their status, one of the major challenges is to promote behavioural risk reduction among them, in order to promote both primary and secondary prevention. A new approach, known as positive prevention, aims to achieve both goals. SAHA is collaborating with the original developers of the interventions and is thus able to benefit directly from their expertise and experience while adapting the interventions for local conditions in line with the National Strategic Plan on HIV & AIDS and STI for 2007-2011.

Theme 8: Research on HIV/AIDS-related stigma and discrimination

HIV/AIDS is one of the most stigmatised medical conditions in the world. Stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalised by people living with HIV and AIDS. SAHA is undertaking research to understand HIV/AIDS-related stigma and how to reduce it in line with the imperatives of the HIV & AIDS and STI Strategic Plan for 2007-2011.

Theme 9: Health systems

The complexity and modalities of antiretroviral therapy (ART) have not been sufficiently explained in the South African context. SAHA is therefore carrying out operations research on traditional and complementary medicine in relation to ART in order to identify the most effective ART delivery models in line with imperatives of the National Strategic Plan on HIV & AIDS and STI for 2007-2011.

Theme 10: Social determinants of health

The social determinants of health include, among others, poverty, social exclusion and food insecurity. These factors interact with one another to structure lifestyle choices that become powerful predictors of individual and population health. SAHA is undertaking work to identify and address such factors as a critical step in diminishing inequalities in health.