News & Features
11th May 2026 | Biénne Huisman
Along dusty roads in northern KwaZulu-Natal, Spotlight speaks to youth leaders, community mentors and leading scientists who are collaborating to bring a groundbreaking HIV prevention jab to this area where HIV infection rates remain stubbornly high.
Next to Mtuba Primary School, vendors have laid out their wares on sheets across the parched dirt – apples, lollies, and sweets. A chicken is pecking at foil packets of chips. It’s a few minutes before 14:00 and the school’s final bell is about to ring.
Parked alongside the vendors are two converted Toyota Hilux mobile clinics, a shading tent pitched in between them. Underneath it, we sit on green plastic chairs, discussing the “peer-led” HIV prevention initiative monitored by scientists in the area.
Reflecting on the project, Azande Myeni says: “At first, it was challenging talking to friends and relatives about HIV. They were suspicious, like I might be scamming them. They were scared. So it was about building trust initially. They tell me it is difficult for them to talk to older people about these issues as they feel older people might judge them.”
Peer education around lenacapavir
Myeni is one of 30 peer navigators at the heart of the Africa Health Research Institute’s ACCEL (accelerating lenacapavir) study. It is a major implementation trial focused on how to best deliver lenacapavir, a groundbreaking twice-yearly HIV prevention injection, around these rural parts. In 2024, the institute also served as a clinical site for the PURPOSE 1 trial, which, together with another clinical trial called PURPOSE 2, showed lenacapavir to provide close to 100% protection against HIV infection.
Myeni relays that she is the second of six siblings born into the iMfekayi community. This is a main hub within the Mtubatuba local municipality, with its population of 215 000 people amidst sugar cane farms, timber forests and game parks in northern KwaZulu-Natal. Up the road along the R618 is Nongoma, official seat of the Zulu kingdom.
Speaking of her roots, the 26-year-old says: “We’re very close siblings. We respect Ubuntu, humanity. Not judging people and understanding their perspectives”. She matriculated at Dlilanga Technical High School and studied at the Performing Arts College in Durban, 236 kilometres away. She shrugs, saying she realised that being an actress was not for her. Now she is studying Human Settlements Management through the University of South Africa.
Myeni is wearing a T-shirt that reads: “Peer navigator – young people solving health problems.” She explains how this came about. “Six years ago, the Izinduna (local chiefs), they called a meeting in our community for people aged between 18 and 30 years old. They said they were looking for young people who can talk to other young people about how we understand HIV. I gave them my CV. Two weeks later, I heard back from them that I was accepted.”
Myeni completed training over three months at the Africa Health Research Institute’s Somkhele campus, 20 kilometres inland from Mfekayi. At the time, she enrolled for its Thetha Nami (“talk to me”) intervention, seeing her speak out about critical health issues amongst her contemporaries, a delicate matter as the science sometimes contradicts long-held traditional views.
Peer navigators work 20 hours a week and are paid as community caregivers. They are trained to refer young people considered at risk to youth-friendly mobile clinics such as the two parked next to us. There are also 11 primary care clinics and one secondary hospital – Hlabisa Hospital – in the study area.
Understanding local values
Myeni says she schedules health-related meetings with contemporaries in safe public spaces such as at supermarkets or sports fields, with about 70% of these meetings being with women. She stresses the importance of adhering to the values of the region.
“In our culture, it’s important to ask permission before speaking to a young person. You respect the adults by asking if you may speak to their children, even if the child is older than an 18.”
Regarding the uptake of lenacapavir, she says: “I think so many will take it. Maybe they are scared of every day PrEP, that they will forget. Or they don’t want to be seen picking up the tablets at the clinic.” Oral PrEP (pre-exposure prophylaxis) refers to antiretroviral tablets taken daily to prevent HIV infection. Such oral PrEP is already available at most public sector clinics.
SCIENCE AND STRATEGY STAR | Professor Willem Hanekom tells Spotlight about taking a ventilated young patient to the Sea Point promenade, living with HIV, the need for an African research agenda, and the recurring joy that has defined his career.
www.spotlightnsp.co.za/2026/05/07/t…
— Spotlight (@spotlightnsp.bsky.social) May 7, 2026 at 9:21 AM
Reflecting on local social and health issues, Myeni says: “Problems young women are facing include sexual abuse, being treated badly by family members, falling pregnant often from sexual assault or rape. In this case, I connect them with social workers, as they are going through the most. There is a social worker at [the Africa Health Research Institute] that we can connect with.”
Poverty remains an underlying crisis. Nursing manager Nonhlanhla Okesola says: “As much as we do the biomedical interventions [medical tools to prevent disease, like medicine], we found there are a lot of social needs that lead to the behaviour of young people. When you don’t have food on the table the last thing you will think about is going to the clinic. The first thing you will think of is getting a social grant; you will do anything to try and survive before even thinking of HIV.”
Okesola says women do approach them when they are pregnant because of antenatal clinic services. But it is more challenging to engage men.
“I can’t take a pill to prevent to not take a pill”
Seated next to her, peer navigator Sakhile Khumalo raises his hand to join the conversation. “I want to talk about men,” he says.
“Men and boys don’t like to go to the clinic. They don’t like to take the pills, the PrEP. They are afraid. They don’t understand why they should take a pill if they’re not sick.”
Peer navigator supervisor Mtobisi Zikhali agrees. “There is a saying which is repeated a lot: ‘I can’t take a pill to prevent to not take a pill.’”
Professional nurse Cabangeni Shange nods: “People say this, they get confused between PrEP and ART (ARVs to treat HIV infection).” Commenting on stigma, she adds: “Young people are very concerned about being discreet. Rattling tablets means that you are on ARV’s, so they put a tissue in the container to keep it quiet. Some will put their ARVs in a panado container to hide them.”
Zikhali adds that men’s “most important concern is being seen in the queue at the clinic. They associate [the Africa Health Research Institute] with having HIV. Also, there’s a perception that if you’re seen at the clinic, they’re not a real man. Real men go to the local chiefs.”
Mtuba Primary School’s bell has now rung and pupils are pouring from the gates, some pausing beside the vendors for snacks. One by one, they clamber into the backs of bakkies, to be transported to homes amongst the hills. The two mobile clinics will be staffed by two nurses and two clinical assistants until 16:30 later that day. The two clinics rotate between 24 sites in the area, providing HIV prevention and other sexual health services for a week at a time in one place, every three months.
In the driver’s seat: Professor Maryam Shahmanesh
Over the past twenty years, scientists at Somkhele have monitored around 156 000 people in the uMkhanyakude District, describing the impact of the HIV and TB epidemics and monitoring interventions. Just under 30% of people in the district aged 15 to 49 are estimated to be living with HIV.
Professor Maryam Shahmanesh heads the ACCEL study. The exact starting date of their lenacapavir roll-out is not clear at present, she says, adding that they want to avoid setting expectations with a defined date, as there is so much anticipation around the drug. However, they hope to start distributing roughly by September or October.
Inside a boardroom at the Africa Health Research Institute’s Somkhele campus, Shahmanesh tells Spotlight that ACCEL will aim to provide lenacapavir to about 65 000 people in the area over two years. Funded through the global health initiative Unitaid, this supply comes in addition to that procured by the National Department of Health, of which the initial batch of 37 920 doses arrived in April. The department’s nationwide roll-out is set to start in June.
“Unitaid wants to fund additional drugs to try and look at accelerating, particularly to populations that might find it difficult to access drugs through clinics for various reasons,” says Shahmanesh.
She adds that while there is excitement for the arrival of lenacapavir, there are doubts amongst their participants too, for example questions like, “how will six months’ worth of PrEP fit into one syringe?” She reckons that science alone does not shift epidemics and that prevention tools like lenacapavir can only reach their full potential through education and trust.
“This is where we have the peer navigators, mobilising and referring people and giving them the choice of options, trying to encourage people to participate,” Shahmanesh says. Apart from mobile clinics and primary healthcare facilities, she says the programme’s referral options will include the Mtuba Pharmacy, an easily accessible, low stigma setting for sexual health services.
Shahmanesh says that the ACCEL study will measure the impact of peer-led mobilisation on the increased uptake and retention of lenacapavir at a population level, particularly amongst adolescents and young adults. Additional emphasis will be placed on priority populations, such as adolescent girls and young women, and key populations, such as gay and bisexual men who have sex with men, sex workers and transgender women. The researchers will also calculate the cost and cost effectiveness of delivering lenacapavir in this setting.
She explains: “These innovative models to increase effective PrEP – and lenacapavir – coverage are likely to be more costly than delivering through fixed primary healthcare clinics. Twice-yearly lenacapavir can optimise the efficiency and expand the reach of decentralised models, reduce HIV incidence and thus be cost-effective. However, in the context of reduced funding for HIV and completing priorities for the public health budget, we need to show this impact on HIV incidence and the cost-effectiveness of peer-led and decentralised models of lenacapavir delivery to justify this approach to the Department of Health for scaling up lenacapavir for key and priority populations, nationally.”
Understanding local context
Shahmanesh illustrates their model by relaying a story that might be typical of the region. “A young girl is living in a rural community,” she says. “Her mother is working in Johannesburg, her father has died, and so she’s living with her grandparents. Her paternal uncle starts drinking and becomes violent.”
The girl leaves home, continues Shahmanesh, thinking she will find work in one of the little roadside towns. “But in practice, we have 95% youth unemployment, so she’s not going to find work. She doesn’t have friends and she doesn’t have a social structure. Then she meets a sort of nice taxi driver; he’s 23, 24 years old. He has some money, he’s nice to her, he gives her presents. And so she will end up feeling kind of obliged to have sex with him. There’s some transaction to it, but there’s also comfort.”
This is where the peer navigators step in. “Our peers will have a conversation with her. The girl has a low self-esteem, she’s isolated. She’s left school, she doesn’t have friends. So the peer helps her with multiple things: getting her ID; because if she gets an ID, she can get grants. She can get registered back into school – we do a lot of that. The peer will introduce her to safe spaces with some other girls in similar positions, take her to a clinic or mobile clinic; have a chat about contraception and PrEP.”
Traditional medicine Imbiza, made of traditional herbs
At the Africa Health Research Institute’s campus, Spotlight also meets with Celiwe Myeni, the institute’s community advisory board deputy chair. Asked about sentiment around lenacapavir in the community, she says: “They are very happy for this prevention from the HIV virus. It’s not like when I was diagnosed with HIV [in 2006]. Nobody knew what HIV was then, what was going on. There used to be this saying that HIV is for white people, that it doesn’t affect us. These were the rumours.”
She highlights clashes between science and traditional beliefs. “It is not easy. The AmaZulu do not believe Western medication. They believe in traditional medicine; Imbiza, made of traditional herbs. It is very sour, very bitter. So I went to the clinic and got tested and I started my treatment in 2006. Some other people took Imbiza, they have died. Now I help people – if you’re sick, go to the clinic, get tested. We go to the clinic with them, we bring ARVs and deliver it to them at home.”
Whizz logistics
At the institute’s Somkhele pharmacy where medicine supplies are stored, clinical research pharmacist Lucky Mtolo shows Spotlight the empty shelves where their lenacapavir will be kept once it arrives. “So we dispense to nurses, nurses dispense to participants, and so on,” he explains.
On a desktop monitor, Mtolo points at a map on the screen, discussing their response to medicine shortages. “It’s unlike in urban areas where there’s the name of the street, an address. Here they just send a pinpoint [coordinate], and I’m aware that they’re running out of whatever medication, then we plan in terms of the supply chain to go there.”
State-of-the-art surveillance samples
Later, at the Africa Health Research Institute’s Durban campus, virology and molecular team leader Thabile Zondi and diagnostic laboratory manager Xolile Buthelezi, shows Spotlight the refrigerated storeroom where blood samples for large-scale HIV and TB surveillance are kept.
Buthelezi explains: “They [nurses] do a finger prick, and then the blood is spotted on a card. So they let it dry for a few hours before they put it in an envelope and then they send it to us in Durban. We don’t use patients’ names. We use unique identifiers, so we won’t know if it was your blood. This is used to test at a population level over time, for example how lenacapavir changes the HIV infection rate or variances in HIV viral load.”
Commenting on the sample cards, Shahmanesh says: “Yes, we aim to measure the impact of the lenacapavir roll out in both uMkhanyakude and eThekwini [Durban] on HIV incidence and recent HIV infections. We anticipate seeing a drop in incidence if lenacapavir reaches the key and priority populations we are trying to reach, alongside the national roll out.”
Speaking to Spotlight inside his office at the Durban campus, the institute’s executive director Willem Hanekom describes lenacapavir as “a massive jump” in science, with significant anticipation and demand. (You can read Spotlight’s full interview with Hanekom here.)
