Biological sample availability creates important opportunities for researchers to advance medical science and contribute to collective good [1, 2]. However several ethical, legal and social issues co-exist . Research Ethics Committees (RECs) globally have a mandate to protect research participant interests such as confidentiality, ownership, export, storage and secondary use of samples (individual good) with specific consent, regulations and policies but implementation of these policies differs from one REC to another . Researchers (unable to predict future use of samples due to scientific advances) prefer a broad general form of consent to advance scientific research and promote the collective good [1, 5–9]. This divergence of perspectives creates tension between RECs that promote individual benefit and researchers who support collective benefit. Recently the tension has been exacerbated by participant groups instituting litigation for improper use of biospecimens - Havasupai Indian Tribe Case  and other groups requesting return of specimens - Yanamamo Tribe Case .
Consideration of best practices for use of biospecimens should begin with an exploration of participant expectations . This is an important first step in discerning the complexity of the debate. Several studies have investigated participants’ preferences around the world - Egypt , Asia  Scotland , Sweden [14, 15], Canada [2, 16], United States , United Kingdom , Uganda  and the Netherlands . In South Africa, however, such a process of public engagement has not occurred.
Debate should however be bidirectional with pathologists and researchers also actively engaged on consent for use of biological specimens. This process is important for fostering mutual understanding between researchers and participants and informing research ethics guidelines. Pathologists have an important contribution to make, as they are generally the custodians of biobanks and other stores of biological samples . Pathologists and researchers share a common goal in terms of scientific research and the advancement of scientific knowledge , but hold a variety of views relating to the use of biological specimens [5–7, 21].
There is generally strong support for broad consent as it is sometimes practically difficult to re-contact and re-consent participants [7, 22]. Some believe that it is unethical not to store samples and conduct previously unforeseen future studies, and that, since research participants donate specimens, there is no need for external control on what research is conducted on them as society will ultimately benefit . There is a school of thought that supports the use of research using biological samples donated to generate patents and profits that should not be shared with participants [23–25]. And of course, the contrary view is held as well .
Internationally RECs differ in terms of their consent requirements for use of biological samples and are criticised for their lack of consistency in policy development and enforcement . In South Africa there is significant variance in the composition and functioning of RECs . The existing 33 RECs registered with the National Health Research Ethics Council (NHREC) currently are not equally capacitated and hence differ in terms of their agendas, financing, resources and ethics capacity training.
Southern Africa is regarded as fertile ground for a wide range of research endeavours due to the enormous burden of infectious disease in the region, highly skilled medical researchers and large numbers of treatment naïve patients [28, 29]. South Africa is positioned at the epicenter of the HIV pandemic and HIV research as well as HIV biobanking is flourishing scientifically. There are currently 1390 clinical trials registered on the South African Clinical Trials Register hosted by the Department of Health. Three years ago (2010) there were 946 trials registered . This indicates a significant growth of clinical trial research over the past 3 years. South Africa (SA) is home to hundreds of research projects involving biospecimen collection, analysis, storage and future use. Exportation of samples to developed countries occurs frequently.
To date, apart from a small study conducted on 20 research participants at a single site, there has been very little empirical research published examining the ethical aspects of participant perspectives related to biospecimen use in research in SA . This timely study has employed empirical research to elucidate perspectives on biospecimen use in research in SA with a view to informing guideline development, research ethics deliberation and legislation in this controversial research area. The Human Tissues Act No 65 of 1983 has been replaced by new legislation in the National Health Act No 61 of 2003 dealing with use of human tissue samples, biobanking, import and export of samples. There are gaps in some of this legislation with respect to export of samples, informed consent from participants and material transfer agreements. The National Health Research Ethics Council (NHREC) in SA is involved with the development of guidelines for the collection, use, storage and export of biological samples. These guidelines aim to address gaps in legislation and elaborate on ethical concerns more specifically. Findings from this study will therefore impact timeously on policy development.
We are aware of two reported research studies that used quantitative methods to investigate the perspectives of African research participants regarding sample storage and re-use, in Egypt  and Uganda . The Ugandan study (n = 343) found that a large majority (95%) of participants would consent to their sample being re-used without additional consent, subject to approval by an Institutional Review Board (IRB). On the other hand, the study in Egypt (n = 600) found that just under half (44.3%) of the participants felt that consent forms should include a separate section relating to storage and future use of samples and data. To our knowledge, apart from a recent publication on biological sample use amongst 20 participants with Tuberculosis at a single study site in South Africa , a focus group study on biobanking in Nigeria amongst lay persons  and a broader study on consent for genetic and genomic research in Ghana , no other qualitative research studies have been reported in Africa. Considering the contextual complexity of these issues and the vast cultural and geographical diversity on the African continent, we believe it is of paramount importance to seek the views of South African research participants on these issues. Our study aimed to provide an exploration into these issues, specifically seeking to qualitatively explore the views of research participants on sample storage, export and future use.