In Philippi village in the Western Cape of South Africa, 24-year-old Simamkele Matinise works at an HIV-prevention mobile clinic alongside over a dozen young people in the community.
“It’s more friendly for the youth,” Matinise tells Fortune on-site in Philippi. “It provides a safe environment for us.”
A row of brightly painted trucks with a slogan written across them—“Don’t delay. Get protected today!”—comprises the clinic. The trucks are stationed in the main entrance of the village, adjacent to the side of a building covered in a mural of a woman peacefully holding her young boy in a colorful garden. Above the trucks, the mural is illuminated by the hot South African sun.
The youth-led mobile clinics are part of a project with the Desmond Tutu Health Foundation to fight HIV/AIDS in the community. The Foundation received funding from the Gates Foundation, starting with an initial planning grant to brainstorm how best to provide HIV education and prevention in hard-to-reach communities plagued by high disease rates. Over 7.5 million children and adults are living with HIV in South Africa, the largest concentration of people living with the disease globally. Many youth on the ground say the high transmission rates have made access to treatment and prevention even more urgent, particularly for the young girls most susceptible to infection. And it became clear that “access shouldn’t lie with the individual in seeking the care, but with how close you can bring the services to the person,” said Elzette Rousseau, a social and behavioral scientist and co-investigator of the Desmond Tutu Health Foundation’s FastPrEP project, which uses the youth-led mobile clinics.
The mobile clinic’s four trucks offer HIV testing, education on the infection, and an opportunity to receive a prevention method. Pre-exposure prophylaxis (PrEP) is a highly effective medicine that reduces the risk of getting HIV. It is now offered in more than one way. Matinise had not heard of the three now available HIV prevention methods—oral PrEP, injectable PrEP, and the dapivirine vaginal ring for longer-acting protection—before volunteering with the clinic. She has since tried two of them. “From the information that I get here, I’m always telling the next person, whether in my community or at work, ‘Look, there’s fastPrEP. There are the trucks!’” she says, who works as a shop clerk in the community when she’s not volunteering at the clinic. “I was excited because you have to protect yourself. You can never know. Tomorrow you might be raped. It’s not safe now because we get raped even from families.” In a report released last year by South Africa’s Human Sciences Research Council, about one in three women in the region reported experiencing gender-based violence, including sexual violence.
Culturally sensitive delivery of health care services is a matter of life and death, youth and community leaders told Fortune, particularly because of the highly prevalent stigma around HIV in communities most deeply affected by the virus. Nomathemba Chandiwana, chief scientific officer at the Desmond Tutu Health Foundation, says successful delivery of health care services counters the age-old notion from the 1989 film Field of Dreams that insinuates if you build something, people will come. Many young men and women fear going to the traditional government clinic, where they have to stand in long lines behind massive “HIV” signs to get tested or ask questions about prevention. Often, they worry they will be seen and assumed to have the virus. Other times, women in particular fear their families or spouses will assume they’ve been unfaithful.
“You’ve got to go to them,” Linda-Gail Bekker, the CEO of the Desmond Tutu Foundation and a physician-scientist who has been fighting the HIV/AIDS epidemic on the African continent for decades, tells Fortune. “They don’t come to you.”
Over 60 youth meet with leaders of the project monthly to inform the approach and brainstorm ways to reach more people, including co-designing the exterior of the trucks. “These young people are the best people to help us find solutions,” Bekker says.
Bekker says the youth-led community initiatives taught her an important lesson about the complexities of global health delivery. “Don’t take a single step without going back to the community and asking them: Can we do this better? Can we do this more effectively? Can we do it in a more cost-effective way? Where did we screw up?”
Melinda French Gates, who visited the Desmond Tutu Health Foundation in 2012 as then co-chair of the Gates Foundation, saw the power of community-driven solutions first-hand.
“This is the importance of listening,” she told Fortune in a February interview, reflecting on over two decades in global health. “We can’t devise things from Seattle or New York and expect that they’re just going to sail out into the community.”
For 22-year-old Solatho Manjati, working at the clinic has provided a newfound sense of purpose. He loves seeing people have “an element of choice.” “If it didn’t exist, it would mean that there would be a barrier for people accessing healthcare services,” Manjati tells Fortune. “It would mean that instead of reducing the spread of the virus, [you’re] throwing petrol into the fire.”
The same week Fortune traveled to Philippi, President Trump signed an executive order to begin dismantling USAID, cutting funding for programs that help curb HIV infections and deaths.
While the Desmond Tutu Health Foundation’s funding from the Gates Foundation may not be threatened for this particular project, they depend on other modes of funding, too. Rousseau recently shared that a handful of the foundation’s grants were funded through the National Institutes of Health (NIH) in the U.S., and some projects have begun termination discussions. More broadly, HIV aid budgets have been slashed or reduced from the world’s wealthiest donor countries, which puts pressure on the entire global health ecosystem and threatens a reversal of progress. HIV infections have been reduced by 60% since the mid-90s, but 40 million people still have HIV as of 2023, and 600,000 are dying each year.
Despite the Gates’ Foundation’s recent announcement that it will spend $200 billion by the end of 2045 to significantly reduce the world’s deadliest diseases, nothing can get done without government buy-in and collaborative partnerships across the public and private sectors. It’s unclear what will become of the bipartisan-supported President’s Emergency Plan for AIDS Relief (PEPFAR), established under President George W. Bush in 2003, for example, which has invested over $110 billion in the fight against HIV/AIDS globally. Over 6 million people could die in the next four years if President Trump cuts U.S. aid for HIV/AIDS.
Bekker hopes that funding is restored, because she has seen the power of community-led interventions throughout Africa. “This money has been put to such good use around the world and on such a scale. I just see a small part of it because of my focus,” she said. “I have great hope for my continent … we’ll prevail. We’ve got to keep pressing forward, believing that eventually good things happen to people who stay the course and do the right thing.”
Back in Philippi, steps away from the parked trucks, you can see the word “Ubuntu” a Zulu word meaning I am because we are—etched next to another mural covering an abandoned basketball court. It feels strikingly relevant to the youth’s work below, many of whom have become friends, as they join forces to bring other people alongside their mission to destigmatize HIV and save their neighbors and friends from illness.
As for Manjati, he dreams of becoming a minister of health one day, so that this youth-led HIV prevention program and others like it live on. He recites the well-known expression that you can take the horse to the river, but you can’t force it to drink.
“But the horse, knowing where the river is, in its own time, can go and drink the water,” he says of working on health programs that educate people on ways to protect themselves.
“It’s a privilege,” Manjati says of his work.
