“HIV research also led me to other areas, including sexually transmitted infections, TB and, eventually, COVID-19. During an epidemic, you are like a firefighter. You don’t run from the fire; you run into it.”

From shaping HIV prevention for young women in South Africa to guiding international responses to epidemics from TB to COVID-19, Quarraisha Abdool Karim’s work is not just driven by science, but by a deep sense of responsibility and passion for the region she was born in.  

As she puts it, she wears many hats. She is co-founder and scientific director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), which is also a certified center of excellence for the Global Virus Network. She is a professor at Columbia University in New York, Pro-Vice Chancellor for African Health at South Africa’s University of KwaZulu-Natal, president of The World Academy of Sciences, a member of the PEPFAR Scientific Advisory Board… and the list goes on. She has authored books, peer-reviewed papers, and received many awards. Throughout everything, she insists that science must not only advance knowledge, but serve humanity.

In this conversation, she reflects on the personal journey that brought her into research, the challenges of building science in the Global South, and the principles that continue to guide her.

What inspired your interest in science?

I’m a third-generation Indian born in South Africa. My great-grandparents came from India to South Africa in 1860. They were brought out by the British as indentured laborers to work on the sugarcane plantations of KwaZulu-Natal. After a set number of years of serving the white farmers, indentured workers could eventually gain their freedom. 

I grew up in a small town called Tongaat. Despite the poverty and the hardships of apartheid South Africa, the laborers valued education and put aside part of their wages to build schools. My parents both went to school, but they couldn’t go beyond high school. Even so, they continued the tradition of investing in education.

From when I was very young, I was insatiably curious. I remember sticking my finger into a plug socket to discover electricity. It was exhilarating and felt like discovery itself. After that, I would potter around the house fixing fuses and things. I tried to share my wonderful “discovery” with my younger sister, but she didn’t find it so wonderful and got quite a shock. After that, my family decided the safest thing was to send me to school early.

I was the youngest to start school and it was very exciting. I devoured everything, including my older siblings’ textbook. I was particularly fascinated by science. Ultimately, I decided that I wanted to do something more than just inherit the world as it was. I wanted to do something meaningful.

After high school, I did a BSc majoring in biochemistry and microbiology. Around this time (the 1970s), South Africa got television for the first time. It was only available for a few hours each day, but it was transformative. I went from listening to the radio and reading newspapers to actually seeing the news on TV, including global news which really shaped my political awareness and activism.

I also developed a strong interest in immunology. After my degree, I spent a year in Johannesburg – with one of only three immunologists in the whole country. In 1988, I had the opportunity to go to Columbia University in New York to learn molecular biology techniques. To gain access to the lab, I had to register at the Mailman School of Public Health, which was how I discovered epidemiology and public health.

How did HIV become such an important focus for you?

In 1988, HIV was everywhere. The topic frequently arose in lectures and at conferences, and it was all around us in the city – playing out differently depending on the community. In Harlem and the Bronx, HIV mostly came from injection drug use and mother-to-child transmission; in the East and Greenwich Village, it was among gay men. Young people were sick and dying everywhere.

My husband, Salim Abdool Karim, and I were on a fellowship at Columbia University together. When we returned to South Africa, he chose to specialize in community health and I joined the Medical Research Council. But we were both interested in why we didn’t know more about HIV in South Africa. 

This led us to conduct a population-based survey, where we described age–sex differences in HIV infection in sub-Saharan Africa. Women were becoming infected between the ages 15 and 24, while men tended to be infected only after age 25. We called it the dynamic of age-sex disparate relationships. 

At that time, the world’s attention was almost entirely on gay men and injecting drug users. Nobody was really thinking about women. Our data was met with skepticism by some, but we were confident in what we had. We repeated the surveys and we kept confirming our patterns. Notwithstanding the growing burden of HIV infection in young women, there was a gap in women-initiated prevention technologies which we would spend the next 18 years to try and address.

HIV research also led me to other areas, including sexually transmitted infections, TB and, eventually, COVID-19. With epidemics, you don’t run away. Like a firefighter, you don’t run from the fire; you run into it. 

What is the story behind CAPRISA?

The Center for the AIDS Programme of Research in South Africa (CAPRISA) was set up over 20 years ago with funding from the US NIH – with the initial focus, that still remains,  being on preventing HIV in young women and preventing deaths in HIV-TB co-infected patients.  At this time, the Global South had no access to antiretroviral treatments and life expectancy was lower than the global average. PEPFAR – the President’s Emergency Plan for AIDS Relief – was created around the same time.

We wanted to ask questions that mattered locally. The NIH support we received came through a program grant that allowed scientists outside the US to define their own research priorities. There were two areas we wanted to focus on.

The first area was HIV. One immediate outcome of the population-based survey  was the recognition of a huge gap in prevention technologies for women. In addition, we wanted to focus on HIV subtype C. This is the dominant subtype in South Africa, but almost everything known about HIV pathogenesis at the time came from studies of subtype B.

The second area was TB. At the time, TB was the most common opportunistic infection among people with advanced HIV. After the 13th International AIDS Conference in 2000, which was held for the first time in a developing country – in my home city of Durban – there was a surge of global solidarity. That conference really helped catalyze the creation of the Global Fund to Fight AIDS, TB, and Malaria. In South Africa alone, however, around eight million people needed HIV treatment. We couldn’t treat everyone overnight, so the key question became: who should get treatment first? We recognized that TB patients would benefit enormously from antiretrovirals, but no one could answer the question of when to initiate treatment. We ran a large study, the results of which have shaped global guidelines ever since.

The science we were doing was African-led, based on African priorities, but with global relevance. The NIH program grant allowed us to do this in depth. The grant was supposed to last a decade, but NIH closed the program a few years in. This forced us to diversify our funding base – and was an important lesson about institutional resilience. You cannot depend on a single funder.

Since then, CAPRISA has done research that has not only been locally important, but globally relevant in terms of shaping policies and practices around the world. In 2010, CAPRISA demonstrated proof of concept for pre-exposure prophylaxis (PrEP). 

Today, of course, we have multiple options for HIV, including lenacapavir but access, implementation, uptake and persistent use among those most at risk remain barriers. CAPRISA continues to conduct research into HIV prevention in young women as they continue to bear a high burden of HIV intertwined with other sexual reproductive health challenges.

You’re also the president of the World Academy of Sciences…

That’s right. The academy was established 40 years ago by Nobel Laureate Abdus Salam and 36 other founding members from the Global South. Their vision involved science being a global force for good. Knowledge should benefit all of humanity, not just certain segments. At the time, there were very few scientists in the Global South, and the prevailing narrative was that the South simply absorbed knowledge generated elsewhere, rather than generating it.

Today, we have over 1,400 members, representing the best scientists from the Global South, along with some from the North. We recognize scientific excellence with awards, and invest in building a critical mass of scientists in developing countries. Already, we can see the difference this is making at the country and regional level.

I’m the first woman president of the academy. I say that deliberately, because gender matters. Given the complex challenges we face, diversity in leadership is not a luxury; it’s essential.

How did you get involved with the Global Virus Network?

Through my various roles and work, I’ve gained access to very wide networks across different subject areas. Given that CAPRISA was already working in HIV and TB, it wasn’t surprising that our paths crossed with Bob Gallo. He had set up the Institute of Human Virology at the University of Maryland before his move last year to University of South Florida (USF). As more and more outbreaks, epidemics, and pandemics emerged and re-emerged, he had the foresight to see that we needed a broader, global response.

I don’t know anyone who has discovered as many viruses as Bob. The debate around HIV was long ago settled and did not alter the facts of his contributions, particularly in his pioneering contributions, both in retroviruses more broadly, and in HIV itself, particularly diagnostics.  He’s also always building bridges, creating partnerships, engaging people around science – and always with the idea that science should serve humanity.

He is the one who launched the Global Virus Network (GVN). As the name suggests, it’s a network of people with different scientific backgrounds all coming together with the same aim: to bring our collective minds to whatever the challenge of the day happens to be. GVN's international headquarters are now hosted at USF.

GVN has regular meetings and has a network of affiliated centers (of which CAPRISA is one). Each center has to go through an accreditation process before becoming officially affiliated. It has been remarkable to watch the network grow and continue to expand. It now has centers of excellence all over the world and expertise that spans multiple disciplines.

The goal is to be more responsive and better prepared for the future. We also need to ensure that what we produce feeds into decision makers, policymakers, and investors. And beyond that, we must connect with the people we are ultimately trying to serve. That engagement cannot wait until you have a finished product. It has to be ongoing – building awareness, creating science literacy, and ensuring that communities understand what is happening and why.

How would you like to see scientific communication evolve?

COVID-19 taught us some difficult lessons about science communication. The rise of artificial intelligence and social media platforms has completely changed how knowledge is shared. Social media races ahead of us and fuels an “infodemic” of misinformation and disinformation. For many people, it has become their primary source of information. That dynamic has to change. Scientists have to find better ways to generate and share knowledge in a world where information – both accurate and false – moves faster than ever.

Science perhaps needs to draw on influencers. Right now, many influencers are driving division, hate, and self-promotion. We need to shift that narrative from “me” to “us”.

In Africa, we have a saying about Ubuntu. It’s the idea that yes, we are individuals, but we are only individuals because of the people around us. At its core, it is the recognition that we are part of a community. But we are more than that – we are part of a global community. As such, scientific knowledge has to be treated as a global common good.