Key Populations

A Hidden Epidemic: Using respondent-driven sampling to engage people who inject drugs in South Africa into the HIV continuum

The current and substantial efforts to combat the HIV epidemic in South Africa do not adequately address injection drug use. Research is needed to understand how to access this hidden epidemic, understand the HIV prevention and treatment needs of this population and how to better engage them into care.  The study aimed to:

  1. Pilot the use of respondent driven sampling (RDS) to access PWID in KwaZulu-Natal to assess the feasibility and acceptability of this sampling approach; and gather demographic and socio-behavioral data to gain a preliminary understanding of this population and its risk for HIV acquisition, morbidity, and transmission
  2. Using qualitative methods, to assess access to and acceptability of HIV prevention and treatment services among PWID in KwaZulu-Natal.
  3. Using mixed methods, to evaluate impact of the criminalization of substance use on PWID and evaluate how their interactions with the legal system affect health seeking. 

Ten key informants participated in an in-depth interview prior to the recruitment of people who inject drugs. 45 PWIDs were recruited via respondent driven sampling and participated in a survey, and 11 of these PWIDs also participated in an in-depth interview. Data analysis is currently underway.


Funder/Sponsor:Brian Zanoni, Emory University, USA
Principal Investigator:Dr. Brian Zanoni (Emory), Site Pl: Cecilia Milford

MRU Commercial City site and communities in central Durban

      Collaborators: Emory University

Completed Projects

An evaluation of a study driving project resources to under-served populations at risk of HIV: Migrant and disabled adolescent girls and young women
Young women are at significant and disproportionate risk compared to their male counterparts in South Africa. Many foreign migrant and disabled AGYW face heightened risk of HIV in this context. Social isolation and exclusion can amplify structural drivers and risk factors for these sub-populations. Community Media Trust (CMT) is implementing a protective asset building project directed to reach these two under-served AGYW populations. The intended outcome of the CMT project is that migrant and disabled AGYW increase their protective assets, resilience, and coping strategies so they can remain in school.

The overall goal of the evaluation study was to assess the degree to which project activities build protective assets, resilience, and coping strategies of migrant and disabled AGYW in Durban and Johannesburg. The evaluation design  employed qualitative methods. Focus group discussions and brief socio-demographic questionnaires were conducted with a sample AGYW participants and their parents.

Participants in this study include migrant and disabled adolescent girls and young women (AGYW) aged 14-19 years, participating in the Community Media Trust (CMT), DREAMS intervention and  parents of participating AGYW. The project has  been completed and is being written up for publication

Funder/Sponsor:Population Council  and the Elma Foundation
Principal Investigator:Dr Mags Beksinska MRU
Site:Durban and Johannesburg


SOAR project
This evaluation study assessed the effectiveness of a community-based HIV prevention programme in informal settlements within KwaZulu-Natal—one of four provinces where the programme is being carried out. The Community Responses intervention is a multifaceted behaviour change intervention using an adapted and scaled version of Stepping Stones. The intervention is designed to promote uptake of HIV and SGBV support services, while also promoting equitable gender norms and a positive enabling environment. The programme targets young men and women living in informal settlements. The Project SOAR evaluation  addressed a series of important research questions, such as what are the key factors within the informal settlement context that lead to HIV risk behaviours, what level of exposure to an intervention is needed to improve key outcomes, and how to best scale up group education models such as Stepping Stones. Building the global evidence base in this area is vital to improving outcomes related to HIV prevention and eliminating harmful gender norms and SGBV, especially in informal settlements.

The study used a cluster stepped-wedge evaluation design whereby 18 clusters (communities) were randomized to when they initiate the CR intervention. A cohort of approximately 1500 men (aged 18–35) and women (aged 18–24) in evaluation communities was  followed over the course of approximately 30 months. Survey interviews were completed at baseline and at three additional time points at 7-8 month intervals. In addition, qualitative interviews  were conducted with programme implementers and a selection of study participants to gain a deeper understanding of the process, experiences, challenges, and benefits of adapting and scaling up the Stepping Stones intervention. Data collection was completed in May 2019 and analysis is underway.

Project SOAR is a five-year (September 2014–September 2019) cooperative agreement funded by the President’s Emergency Plan for AIDS Relief and the U. S. Agency for International Development (Agreement No. AID-OAA-A-14-00060). Population Council leads the Project SOAR consortium in collaboration with Avenir Health, Elizabeth Glaser Pediatric AIDS Foundation, the Johns Hopkins University, Palladium, and The University of North Carolina at Chapel Hill.

Funder/Sponsor:President’s Emergency Plan for AIDS Relief, U. S. Agency for International Development
Principal Investigator:Dr. Julie Pulerwitz (Population Council), Site PI: Mags Beksinska (MRU)
Site:MRU Durban  and communities in central Durban and Ugu
Collaborators:CCI (Centre for communication impact)
Siyaphanta, Siyavimba!
ARV-Based Prevention and Treatment in High-Risk Women in Durban, South Africa

MRU and the HIV Center for Clinical and Behavioral Studies at Columbia University are conducting a study to explore female sex workers’ (FSW) knowledge, attitudes, and experiences with pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), and other prevention options. No one strategy will likely be effective in eradicating HIV among FSW; rather a combination of context-specific targeted strategies, including ARV-based prevention/treatment and condoms, will be needed to reduce HIV incidence. However, combination prevention models for FSW have not been sufficiently developed and tested. This formative, qualitative research study on ARV-based HIV prevention and treatment for FSW will identify the structural, health system, interpersonal and individual-level barriers and facilitators that influence access to, use of, and adherence to ARV-based prevention and treatment among FSWs.


Data has been collected through a combination of focus discussions  and In depth interviews with FSWs. In addition in-depth interviews have been conducted with Policy makers,  Health Care Providers, Hotel Managers and Bouncers. Data have been collected, and are currently being analysed.

Funder/Sponsor:U.S. National Institute of Mental Health (R21MH113436).
Principal Investigator:For further information about this study, please contact Professor Jennifer Smit, MatCH Research Unit at or Professor Joanne Mantell, HIV Center for Clinical and Behavioural Studies, Columbia University at
Site:MatCH Research Commercial City Site and community  in central Durban


DIFFER: Diagonal Interventions to Fast-Forward Enhanced Reproductive Health

DIFFER: Diagonal Interventions to Fast-Forward Enhanced Reproductive Health

The “Diagonal Interventions to Fast Forward Enhanced Reproductive Health” (DIFFER) research project tests the hypothesis that combining vertical Sexual and Reproductive Health (SRH) interventions, such as services targeted to Female Sex Workers (FSW), with horizontal strengthening of health systems for SRH within existing health facilities, is synergistic, feasible, and likely to be more effective and cost-effective than providing them separately. This multi-country study consists of a consortium of three African, one Indian and two European partners. The research activities are being undertaken in the African sites (Durban, South Africa; Mombasa, Kenya; and Tete, Mozambique) and in Mysore India.

The formative research phase was completed in 2012 and activities included a detailed situational and policy analysis which informed the development of site and context-specific intervention packages to strengthen SRH services. The intervention sought to build FSWs capacity to access much needed SRH and HIV services and assess the feasibility of combining and providing both targeted and horizontal interventions for FSW. The intervention phase ended in March 2016  which was followed up by a comprehensive evaluation exploring empowerment, SRH and HIV healthcare needs, service access and barriers. The study is currently being written up and disseminated.

Funder/Sponsor:The European Union
Principal Investigator:Prof J Smit (MatCH Research)
Site:MatCH Research Commercial City Site and community  in central Durban
Collaborators:University of Ghent – International Centre for Reproductive Health (UG-ICRH), Belgium, Ashodaya Samithi (Ashodaya), India, International Centre for Reproductive Health Association, Kenya (ICRH-K), International Centre for Reproductive Health Association Mozambique (ICRH-M), Lifeline, Durban


Acceptability of menstrual Cups in Female Sex Workers in Durban
This was a sub-study within the DIFFER project as part of the intervention to improve the range and quality of Sexual and Reproductive Health (SRH) information and services provided to Female Sex Workers (FSW) in the project catchment area. Menstrual cups were included in the ‘SRH packs’ along with other materials, condoms and pregnancy test kits. Some FSW participated in the mcup acceptability component and gave the project team regular feedback on use and experience with the device.

Funder/Sponsor:The European Union
Principal Investigator:Prof J Smit (MatCH Research)
Site:MatCH Research Commercial City Site and Community  in central Durban
CollaboratorsUniversity of Ghent – International Centre for Reproductive Health (UG-ICRH), Belgium, Ashodaya Samithi (Ashodaya), India, International Centre for Reproductive Health Association, Kenya (ICRH-K), International Centre for Reproductive Health Association Mozambique (ICRH-M), Lifeline, Durban, Sisonke, Durban


AYAZAZI: Investigating Patterns of Behavioural and Biomedical Risk for HIV Acquisition and Vaccine Trial Preparedness among Adolescents and Young Adults in a Priority Setting

This study developed a cohort of adolescents and young adults in Soweto and Durban aged between 16-24 (AYA) who were either known to be HIV negative or did not know their HIV status. The  study aimed to   identify, understand and link socio-behavioural, clinical, and biomedical patterns of risk for HIV acquisition and vaccine trial preparedness using a mixed method approach. The study was completed in 2017 and dissemination and write up of the results is in progress.

Click on the image below to see a video on the AYAZAZI study.

Funder/Sponsor:Canadian HIV Vaccine Initiative, Canadian Institutes for Health Research Via Simon Fraser University, Canada.
Principal Investigators: Co-Investigator-Durban site:Dr M Brockman (Simon Fraser University, Canada)Prof G Grey (Perinatal HIV Research Unit-PHRU)Prof J Smit (MatCH Research)
Site:MatCH Research Commercial City Site, Durban.