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

TimesLIVE

13 hours ago

The first black president of the Southern African HIV Clinicians Society is not OK 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 sell-out, calling Mamphela Ramphele a sell-out, and others. 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, most have no idea,' Ndiviwe Mphothulo says, the afternoon sun turning his spectacles into mirrors that reflect the spacious but austere 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 deep within that sprawling expanse is Jabavu, dubbed 'the wild west' in the 1980s on account of its high crime rate. Mphothulo grew up there, in dwelling 620C.
'Some of the boys I knew would slip into nearby white suburbs like this one at night to do housebreaking. They called it hausa hausa, it was like a badge of pride,' he says, tricking out the distance between his past and present circumstances.
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, in a low, soft voice.
From Tsomo to Soweto
Mphothulo's paternal grandfather, Molose Mpotulo, was a self-taught water harvester from Tsomo in the Eastern Cape, known in the area as 'Jika umlambo' — the one who diverts rivers. 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.
'It was second nature, I think. 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, open the house to people. She instilled that spirit in us children.'
If Mphothulo learnt selflessness from his grandmother, his mother taught courage.
'She was such a brave woman. 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.'
SON OF SOWETO Mphothulo in Jabavu, Soweto, in 1989 when he was involved in student politics.
Image: Supplied
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 teargas on the streets.
He says the spirit of the June 16 Soweto Uprising was still very much alive, and running battles between youths and the police were commonplace. 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.'
SON OF SOWETO From the age of 12, Mphothulo lived with different relatives in the township during the eighties, including his grandmother's sister, Nomabhungu Finca, in Klipspruit and is pictured here with Finca and his baby cousin.
Image: Supplied
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.
'It was the Eastern Cape influence, I think — for my family there education was paramount.'
Mphothulo attended Morris Isaacson High School, famously the school of June 16 student leader Tsietsi Mashinini. Chosen for its reputation for discipline, Mphothulo arrived to find classrooms 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. Mphothulo knew of their work from his mother.
'I saw that it was possible to cure tonsillitis and cut an appendix while also building communities. I realised that I would not be lost to activism if I chose to become a clinician, 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 was so quiet, to the extent that people would say, 'What happened, bru, you were so involved, and now look at you.' I don't know, I think it was like a deep debriefing period for me, because from the age of 12 I had experienced a lot of things. I was telling someone that university was the first time I had not heard gunfire in a week. I could not explain it then, but I have since thought that perhaps I just wanted to be a child again, you know, because I hadn't really had that experience of normal living.'
On the TB frontlines
In July 2002, the Treatment Action Campaign won its case against the government, compelling the roll out 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.
'I agreed, and within months 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.
The ward, which had previously functioned as a step-down facility — 'a place where people just sit before going home' — now became busy.
'It was a crash course. I learnt a lot, and I enjoyed the work,' says Mphothulo, whose interest and aptitude did not escape notice. 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.
TB IN TAUNG Mphothulo celebrated a milestone of 100 cured multidrug-resistant TB patients with the team at Taung Hospital in 2016.
Image: Supplied
'The cure rates for MDR-TB at this time were bad, around 50-55%, and though 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, in other words. I thought, 'No, 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 inspanned 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. It is a plan that embodies the spirit of his late aunt Vuyelwa Msiwa, a former matron at Mount Ayliff Hospital in the Eastern Cape.
'Something she said has stayed with me,' says Mphothulo, his voice thickening slightly.
'She used to say a combination of poverty and illiteracy is an impairment, so be patient, it's an impairment. A lot of MDR-TB patients are impaired in this way. They are sick, they are poor, they have illiteracy problems. It isn't enough to say, 'Go to your nearest Sassa office, apply for a disability grant.' No, for someone like this, Sassa is an almost impossible mountain to climb.
'What this country needs is a support programme that basically says, we will hold your hand once you are diagnosed with TB. If you qualify for food parcels, we will get you food parcels. If you qualify for a disability grant, we will get you your disability grant. That is what I have tried to design.'
'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, succeeding Yunus Moosa. It was fateful timing — he had hardly sat down to work when Donald Trump became the 47th president of the US, and quickly made good on old threats to cancel US contributions to global health and development.
Trump's infamous stop-work order on January 20 2025 hit South Africa's HIV programmes hard, triggering, among other cuts, a R1.6bn withdrawal in Global Fund for HIV/TB and Malaria grants to South Africa. It also opened up a rift between the department of health and the leadership of HIV civil society.
BOOKISH
Image: Sean Christie
'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 — an idea communicated in writing to Deputy President Paul Mashatile, the chairperson of the South African National Aids Council — is that 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.
'Our message is clear: We think they are too relaxed — their response to date has been inadequate,' he says, calmly but without equivocation. The stakes were high when he was negotiating the return of hijacked trucks in the mid-90s, but failure to address the current crisis in HIV funding equals catastrophe. 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 government heed the warning of medical activists.
'If you look at the history of activism in the HIV space in the country, it started with lone voices in the mid-80s, who were written off as lunatics. In the early 90s more voices joined the chorus — even politicians like Chris Hani were saying there is a problem here — but the government kept its ears closed, and it was the same in the early 2000s, even in the face of so many deaths. Now we see history repeating itself. HIV activists have raised the alarm, saying there is a problem, and the government is once again in a state of denial.'
If Mphothulo's phrasing seems especially eloquent it's because 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 at the June 16 Memorial in Jabavu, in the company of old comrades. It is a love letter to activism, and an important act of remembering.
As he signs my copy, shaking his hand free of his grey jacket, I sense his pride in this achievement.
Without looking up 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.'
Mphothulo chuckles after saying this, a little self-conscious perhaps. He betrays no sign of shame, though, and in any case 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, so in each block I did they would say, 'This one has got these social issues, Ndiviwe will deal with her. He's our social worker.' 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 that sort of thing — 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, on the banks of the Harts River. He had no intention of staying a minute longer than required but history had already overtaken his personal plans.