It’s a balmy afternoon in Mtubatuba, in northern KwaZulu-Natal (KZN), and the local taxi rank is abuzz with activity. Drivers are calling out their routes while others rev their engines, getting ready for departure to various destinations.
Amid the noise of hooting taxis and hawkers selling fresh fruit, mielies, and takeaways, 54-year-old driver Dumisani Ngubane wipes his windscreen and looks toward a white mobile clinic parked a few metres away, the words “AHRI” displayed in bold blue along its side.
“Having this clinic inside the rank has made our lives so much easier,” he says with a smile.
“Before this truck started coming here about a year ago, we waited for hours to see a nurse at the community clinic. Now, we get health services right here while waiting for our taxis to fill up,” he tells Health-e News during an Africa Health Research Institute (AHRI) media visit in October.
The clinic that Ngubane is referring to isn’t just any health service. It is a site for the “Mobile Men study”, an HIV prevention programme led by AHRI, the Desmond Tutu Health Foundation, and other international research partners that compares which PrEP (pre-exposure prophylaxis) option works best to keep men whose jobs keep them on the move such as taxi drivers, truck drivers and job-seekers, HIV-free. This group is also known as “mobile men”.
PrEP is medication for people who are HIV-negative that almost eliminates the chances of getting HIV infection, reducing the risk by up to 99% when taken consistently and correctly.
HIV prevention options
With sites in KZN, Eastern Cape, and Uganda, the programme is breaking new ground as the first male-only study in sub-Saharan Africa to weigh up the uptake of a daily pill and a two-month anti-HIV injectable, known as CAB-LA (cabotegravir long-acting), among 400 HIV-negative heterosexual “mobile men”.
Lead researcher Thabang Manyaapelo says, despite this group of men being at high risk for HIV infection, most HIV-prevention research in Africa has focused on other high-risk groups, such as adolescent girls, young women, and men who have sex with men (MSM).
Through the 18-month study, which started a year ago, researchers are testing how well the two PrEP options are adopted by “mobile men”, adherence to each option, and which PrEP is most preferred, and what influences men’s choice.
“One of the objectives of the study is to address the gaps facing this group, and we are looking into different aspects. For instance, will the people being offered PrEP take it as prescribed? If they are taking a pill, will they be taking it every day or not, and those that are coming for injections, will they come back for their visits?” says Manyaapelo.
Researchers hope the outcomes of the trial will provide a “real-world feel” of PrEP uptake and help guide the rollout of PrEP in this population.
Spotlight on men
Research shows that HIV infection rate among “mobile men” in Africa remains high, with a 2025 review finding the prevalence of HIV among commercial motorcyclists to be between 2% and 9.9%, and as high as 33% when combined with taxi drivers.
The high HIV infection rate was associated with high-risk behaviours such as having multiple sexual partners, unprotected sex, stigma, and limited access to HIV prevention, including condoms and safe male circumcision.
A community assessment led by Manyaapelo in preparation for the Mobile Men trial found that having multiple sexual partners and unprotected sex were widespread among these men, while many regarded PrEP as being for women. When given information on both options of PrEP, many men said that they would prefer injectable PrEP to avoid having to carry pills while travelling and to avoid forgetting about them.
Although the Mobile Men study is still ongoing and results are expected before the end of next year, Manyaapelo says early observations show poor uptake of PrEP.
“One of the biggest challenges that we have experienced is getting men to come to the clinic. Enrolling them was fine, but getting them to come back for follow-up visits has not been easy because of the nature of the work they do,” he says.
Research shows that stigma, misconceptions about PrEP, inconvenient clinic hours and conflict with work schedules are some of the barriers to HIV services and PrEP uptake among men.
A 2022 UN report on male engagement in HIV-testing and prevention notes that while harmful gender norms, such as equating illness with “weakness” and considering sexual and reproductive health as a “female issue”, have resulted in the low uptake of PrEP. To end the HIV epidemic as a public threat by 2030, the report recommends that, alongside other health system interventions such as extending clinic operating hours to accommodate these men, there needs to be accelerated action across all levels of HIV care to reach men and boys and improve their access to HIV services.
Need for male-friendly spaces
Professor Linda-Gail Bekker, who heads the Desmond Tutu Health Foundation, agrees that more effort is needed to make public healthcare spaces “male-friendly”.
“It would be nice if there were more male navigators or ambassadors who could make men feel more at home and understood. I do think also offering male-specific services around sexual dysfunction, and a friendly place to discuss sexual health in general, may help to attract men into what has traditionally been quite a women-oriented space,” she says.
Bekker is hopeful that newer and long-acting forms of PrEP, such as the twice-a-year anti-HIV jab Lenacapivar (LEN), are likely to improve the uptake and adherence to PrEP by mobile men because of long intervals between shots.
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The South African Health Products Regulatory Authority (SAHPRA) became the first African medicine regulator to approve LEN in October. South Africa is among nine countries globally selected to roll out the medicine under the Global Fund to Fight AIDS, TB, and Malaria. The injectable, considered a potential game changer for scaling HIV prevention, is expected to reach 2 million people across low-and middle-income countries over the next two years.
“Less frequently dosed, longer acting PrEP may very well be an option for people on the move, young people, pregnant and breastfeeding women. These are people who have competing priorities and may not be able to prioritise their health-seeking behaviour above job seeking or parenting. The longer the interval, the better,” says Bekker.
Irrespective of the PrEP option, Bekker believes the medication must be easily accessible and be made attractive to people who need it the most, such as men and students at colleges and universities.
“Data shows that if we offer people choice in their prevention options, then overall coverage of risky exposures increases markedly.”
Meeting men where they are
Apart from offering PrEP to study participants, the mobile clinic in Mtubatuba also offers other health services to men, including HIV testing and sexual health services, and counselling.
Ngubane agrees that having more male-friendly health spaces and not having frequent clinic visits would be more attractive. “As men, we don’t want to go to clinics where we are judged or have to queue for a long time. We are providers for our families. If I must sit at the clinic the whole day, then who must provide for my family? Our time is money,” he says. – Health-e News
