At 16, he mediated a hijacking. Now he's negotiating for the survival of HIV programmes

News24

5 hours ago

Ndiviwe Mphothulo grew up in Jabavu, Soweto, with activism in his bloodline. At 12, he started in student politics. By 16, he managed to calmly talk a student who hijacked a bakery truck – 'We were hungry,' the student explained – into returning it.
Mphothulo ended up in medical school, realising he could practice medicine and build communities, and then at Taung Hospital, where he helped transform multidrug-resistant TB cure rates by addressing social barriers like transport and unemployment rather than just focusing on medical treatment.
Now he's president of the Southern African HIV Clinicians Society and fighting to keep South Africa's HIV programmes intact in the face of the Trump administration's devastating funding cuts.
The first black president of the Southern African HIV Clinicians Society is not okay with the current phenomenon of lambasting the country's preeminent struggle heroes.
'You see it more and more, this thing of South Africans labelling Mandela a sellout, calling Mamphela Ramphele a sellout. People need to start telling us about themselves first, like 'I am Thabo from Taung, I helped this many marginalised black people in my village and township, and that is why I hold this view'. Activism is hard,' Ndiviwe Mphothulo says, his spectacles reflecting the spacious living room of his Glenvista home.
We gaze out through picture windows at the faint outline of Suikerbosrand and, to the west, the Klipriviersberg. Beyond those hills is the low-level city known as South Western Townships – Soweto – and Jabavu, dubbed 'the Wild West' in the 1980s on account of its high crime rate. Mphothulo grew up there.
'Some of the boys I knew would slip into nearby white suburbs like this one at night to do housebreaking. It was like a badge of pride,' he says.
Supplied/Bhekisisa
The list of things that kept Mphothulo from this path reads like a poem:
'Kung fu films at Eyethu cinema, in neighbouring Mofolo.'
'Swimming in the Jabavu pool, which everyone called Jakes.'
'Games of five-a-side in the yard of the Lutheran church on our street.'
'Big fights in the early hours: Mike Tyson, George Foreman and Roberto Duran.'
'Prayers that ended with 'Ha le lakatsa ho tseba' (If you want to know about the gospel), our neighbours' favourite hymn.'
More than these things, though, it was the influence of family that kept Mphothulo on track.
'I was born into a culture of activism, just as my parents were born into it,' he says.
From Tsomo to Soweto
Mphothulo's paternal grandfather, Molose Mpotulo, was a self-taught water harvester from Tsomo in the Eastern Cape.
Mphothulo's father, Bongo Mphothulo, travelled from Tsomo to Johannesburg after completing his schooling and became influential in both the All African Convention and the Non-European Unity Movement, which led to his arrest and banishment to Pimville in 1969.
Left alone in their Orlando West house after only a few years of marriage, Mphothulo's mother, Elizabeth Tembela Mphothulo, became increasingly involved in resistance activities herself.
'Her parents founded the church and school in Qunu in the Eastern Cape, the very same school that Nelson Mandela attended,' says Mphothulo, who spent some years living in the famous village with relatives.
'My grandmother, Tandiwe Zidlele, was already bedridden by that time, but she commanded so much respect; people from all over would come to her for help. She didn't have much, but she would feed people.'
If Mphothulo learnt selflessness from his grandmother, his mother taught courage.
'She would be arrested, dragged around, and the following week, you find her picketing outside court. If young people were hurt, she would get them to doctors and get arrested again herself. She taught us to stand up for what is right, irrespective of the consequences.'
Supplied by Bhekisisa
As a pre-teen back in Jabavu, Mphothulo's reality was one of political meetings in the home, occasional police raids in search of documents, and the smell of tear gas on the streets. In 1989, he witnessed a police attack on a gathering of students at a youth centre near his home. Some of his neighbours were severely injured. That left an impression, and from the age of 12, he became involved in student organisations like the Soweto Youth Congress, the Soweto Student Congress, the ANC Youth League and the Congress of South African Students (Cosas).
'It is hard to imagine the power that students had then,' says Mphothulo, who was called in by his principal the day after being elected chairperson of his Cosas cluster at the age of 16.
'He said, 'We've got an issue at a school called Lebone [Secondary], some of the students have hijacked the bakery truck.' So I went there, and I met the guy who hijacked the truck, and I asked him why he did it and he said, 'We were hungry.' After some discussion, he agreed to return it.'
It was an object lesson in negotiation and the power of being calm when other people are losing their minds.
'It also made me realise, you know, if this is what it takes to get back a bakery truck in Mofolo, what must it have been like for Mandela and others, leading the entire revolution? That is why I always say, before you criticise those figures, first understand what it means to be an activist.'
When activism took a back seat
The extraordinary pressures of the time caused many of Mphothulo's peers to drop out of school. He says the thought never crossed his mind.
Mphothulo attended Morris Isaacson High School. Chosen for its reputation for discipline, Mphothulo arrived to find classes that were dilapidated, with political slogans scrawled on the walls. His teachers were sound, though, and his marks were excellent, presenting an array of life choices.
'Some said I should study law, due to my involvement in student politics.
My English teacher said, 'You can write, you must enrol in humanities at Fort Hare, become a professor.' But my maths, science and biology teachers said, 'No way is this one doing English',' Mphothulo recalls.
In Soweto in the 70s and 80s, doctors like Abu Baker Asvat and Nthato Motlana were the heart and soul of the resistance.
'I saw that it was possible to cure tonsillitis and cut an appendix while also building communities, and so I enrolled for a Bachelor of Science at what was then the Medical University of Southern Africa (now Sefako Makgatho Health Sciences University) and got into medicine the following year.'
For the next six years, however, Mphothulo's activism would take a back seat.
'I think it was like a deep debriefing period for me. I was telling someone that university was the first time I had not heard gunfire in a week. I have since thought that perhaps I just wanted to be a child again.'
It wasn't long before the activist in him was reawakened. In fact, it was already stirring in his internship years in Groote Schuur Hospital, where Mphothulo picked up the nickname, 'The Social Worker'.
'My registrar started to notice that I took an interest in patients' social issues. In the orthopaedic ward, you would get patients who'd fallen off trains having traumatic amputations, and there would be stress about going to work – 'I've been here so long, what will my employer say,' and I'd call the employer for a conversation,' says Mphothulo.
For his community service in 2003, Mphothulo was dispatched to Taung Hospital in North West province. He had no intention of staying a minute longer than required, but history had already overtaken his personal plans.
On the TB frontlines
In July 2002, the Treatment Action Campaign won its case against the government, compelling the rollout of the antiretroviral (ARV) drug nevirapine to pregnant women to prevent the transmission of HIV from mother to unborn child. Taung Hospital was selected as the ARV site for both North West province's vast Dr Ruth Segomotsi Mompati district and parts of neighbouring Northern Cape province. Mphothulo was asked to stay and help set up the HIV clinic.
'Within months, I found myself working in the hospital's TB ward, after it became clear that a high percentage of the patients we were working up for ARVs already had TB,' he recalls.
In 2008, in the context of a national drive to decentralise multidrug-resistant TB (MDR-TB) care, his bosses asked him to set up and run an MDR-TB ward in Taung Hospital. Again, Mphothulo agreed, a decision that would prove auspicious.
Supplied by Bhekisisa
'The cure rates for MDR-TB at this time were bad, around 50–55%, and although the drugs we had to fight with were not perfect, I saw our patients struggling more with transport, a lack of food in the home, unemployment, stigma – social issues. I thought, 'No man, let me come with some initiatives, even if it requires me to fight with management a little bit'.'
Fight he did. With patients living up to 250km away, Mphothulo pressed district management to provide transport. He also enlisted traditional leaders, local NGOs, and the Department of Social Development to provide supportive services in different areas, and the hospital's treatment success rate skyrocketed.
'It was unbelievable, people were so interested, asking: how can a rural hospital have such high treatment cure outcomes?'
For his master's thesis, Mphothulo delved into these social barriers. His doctoral thesis, which he is about to submit, builds on this, proposing ways of supporting patients with MDR-TB to overcome social challenges.
'Our message is clear'
In Taung, various threads of Mphothulo's upbringing came together – the activism, the humanitarian values, the instinct to go beyond the merely curative.
Several discretely displayed certificates and trophies on the far side of the room attest to his effectiveness. And as his work became known, Mphothulo was drawn into patient-centred organisations like the Rural Doctors Association of Southern Africa, the Southern African HIV Clinicians Society (SAHCS) and, in 2020, the ministerial advisory committee on coronavirus disease.
In February 2024, Mphothulo became the fifth president of SAHCS. It was fateful timing – he had hardly sat down to work when Donald Trump became the 47th president of the United States and quickly made good on old threats to cancel US contributions to global health and development.
Trump's infamous stop-work order on 20 January 2025 hit South Africa's HIV programmes hard, triggering, among other cuts, a R1.6 billion withdrawal in Global Fund for HIV/TB and Malaria grants to South Africa. It also opened a rift between the Department of Health and the leadership of HIV civil society.
'They (senior government figures) will say, 'Let's go to the clinic, we will show you shelves stocked with ARVs'.
'In other words, there is no crisis. But this misses the point. Ending HIV as a public health issue, which is something we were on track to do by 2030, is not just about pills on shelves. It's about interventions targeting the most at-risk populations, like young women, sex workers, men who have sex with men.
'It's about the continuation of South Africa's cutting-edge research into HIV. These are the areas of the response that have been hit by the funding cuts, and without urgent action, we risk reversing a lot of our gains in the fight against HIV,' he says.
Mphothulo's idea for a solution is that the government should strongly consider reprising its approach to the Covid-19 pandemic, appointing multi-sectoral advisory committees to work on the various facets of the crisis in HIV.
'We think they are too relaxed,' he says. Simulation modelling analysis published in the Annals of Internal Medicine suggests cuts to the US President's Emergency Plan for Aids Relief, or Pepfar, programme could cost South Africa 565 000 new HIV infections and 601 000 more deaths from the virus by 2034.
If Mphothulo could be granted one wish, he says, it would be that the government heed the warning of medical activists.
The subject of medical activism is close to his heart, to the extent that he wrote a book about it, Medicine & Activism, launched in July this year in the company of old comrades. It is a love letter to activism.
As he signs my copy, Mphothulo says, 'When I entered medicine, it satisfied my Science and Maths teachers, and when I returned to activism, I pleased those who were politically inclined. All that remained was my English teacher, so ja, now he can be pleased, too.'