Spotlight meets South Africa's recently appointed Deputy Director-General for HIV, AIDS, TB and sexually transmitted infections, discussing the latest HIV prevention medicines, her career turning points, and bedtime reading.
South Africa's first consignment of a groundbreaking HIV prevention injection that will be available to the public has arrived at O.R. Tambo International Airport. The medicine is now being stored in a warehouse in Johannesburg while samples are sent to Ireland for safety testing.
The roll out of lenacapavir, a twice-yearly HIV prevention jab, in a select group of public sector clinics is earmarked to start at the end of May, says Dr Nonhlanhla Ndlovu. This is when the test results are likely to be released.
Ndlovu is South Africa's recently appointed Deputy Director-General for HIV, AIDS, TB and sexually transmitted infections. Several sources consulted by Spotlight were positive about her appointment.
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She says South Africa has laid the groundwork to ensure lenacapavir is freely available across 360 medical centres. "We've done the preparations", says Ndlovu, "from making sure it gets registered very quickly by the South African Health Products Regulatory Authority, which was done in October (2025), to us training staff at the facilities."
Game changer jab
The twice-yearly injection is considered a game changer in HIV prevention as it removes the burden of taking daily pills. Lenacapavir was tested in South Africa as part of the landmark PURPOSE 1 and PURPOSE 2 trials, with findings showing it had near 100% efficacy in preventing HIV infection.
For now, lenacapavir is only manufactured by the pharmaceutical company Gilead Sciences in California in the United States. Six generic manufacturers, none of which are South African, have been licensed to produce versions of the jab, but those products are only expected to hit the market in 2027 or 2028. Deals are in place that should secure generics at prices that the South African government can afford.
In March, the South African government, in partnership with the South African National AIDS Council and global health agency Unitaid, launched a bid to have the medicines produced locally. Local production would require both a license from Gilead and a local company that is willing and capable of producing the jabs.
"What I tell everyone is that we are meeting with Gilead weekly, making sure that everything is moving," says Ndlovu.
Speaking to Spotlight, she is wearing rose-tinted spectacles, literally. She answers with enthusiasm and quiet authority, pausing to allow for follow-up questions. Recurring themes in her responses are "multisectoralism" - having experts join hands across departments or healthcare beats - and healthcare for women. Maybe the fact that she has a daughter in Grade 7 sharpens her appreciation for the types of issues faced by girls and young women.
Lenacapavir for young women
Given that adolescent girls and young women aged between 15 and 24 are the most at risk of contracting HIV in South Africa, Spotlight asked Ndlovu how lenacapavir would be targeted to this vulnerable group.
She responds that the country's approach is built around multiple layers and role players.
"We will have youth friendly services and youth zones that are inside clinics," Ndlovu says.
She says that the department's partnerships with higher education will be crucial. For instance, Higher Health, the national agency responsible for providing health services to students at universities and TVET colleges, will bring lenacapavir directly to students on campus via mobile clinics.
Ndlovu highlights the role played by communities, including traditional leaders and healers, but adds that home values and parenting are even more important. "The influence of parents. The mother influences whether the child can easily go get contraception, the same with lenacapavir," she says. To this end, the health department will use SMS messaging to educate communities, plus peer educators and youth ambassadors to link girls and young women to services.
In schools, Ndlovu says that information about lenacapavir will be included in the curriculum. "The policy in education is very specific. They don't allow medication, so at schools it will be information through their curriculum," she says.
Career turning points
After graduating with a medical degree from the University of KwaZulu-Natal in 1996, Ndlovu treated patients with TB and sexually transmitted infections at the Prince Cyril Zulu Communicable Disease Centre, and later worked as a private sector general practitioner in Durban. In 2003, she joined the Mother-to-Child Transmission Plus Initiative. This pioneering HIV project is led by Columbia University in the United States and is partnered locally with the University of KwaZulu-Natal.
"We rolled out antiretroviral treatment, even before government did in KwaZulu-Natal," she recalls. "Remember, at that stage there was still an argument saying antiretroviral treatment requires a hospital specialist, we were already doing it in clinics."
These were tough years fighting the early HIV and AIDS epidemic. "I just needed a break," she says, "so I stepped out of public health completely and went to Novo Nordisk [a pharmaceutical company] in Johannesburg for a job in marketing [in 2005]." She says it is at that time that she realized her "heart was truly for public health", so she didn't stay long.
In 2006, she returned to Durban and joined the Office of the Premier as chief director of priority programmes. Here she led the province's response to HIV, TB and sexually transmitted infections, becoming a key figure behind Operation Sukuma Sakhe, launched to address the triple challenges of poverty, inequality, and unemployment, focusing specifically on HIV and TB.
Lenacapavir is not a silver bullet
Known to friends and colleagues as Fikile, Spotlight is meeting with Ndlovu at the Southern Sun Waterfront Hotel in Cape Town, where she is staying to attend events around World TB Day on March 24. We're at a table in a courtyard next to a swimming pool, where children are splashing and yelping. The festive mood does not derail Ndlovu's concentration as she warns about complacency and a false sense of safety, given access to lenacapavir.
Presently, only 60% of young people in South Africa are using condoms, she says, adding that the incidence of sexually transmitted infections at the moment is "high" and that it might well get higher.
"Lenacapavir is not going to protect you from other sexually transmitted diseases," she cautions. "It's not going to protect you from human papilloma virus (HPV), for example. We need to highlight this. We can't talk about lenacapavir as a stand-alone. We will not win so the conversation is about combination prevention."
Combination prevention typically refers to the idea that there is no silver bullet for HIV prevention and that condom provision, medical male circumcision, HIV prevention medicines, and behavioural and structural interventions all have a role to play (you can see the WHO's definition of the term here).
HPV and cervical cancer
The vast majority of cervical cancer cases are caused by HPV infection, an infection that can largely be prevented with a vaccine. The issue has been a rallying cry for Ndlovu, who spearheaded the government's annual nationwide HPV vaccination campaign earlier this year. This campaign, which started in 2014, reached more than 3.6 million girls mostly in public schools, with over 7.2 million doses administered, according to a statement from the health department. It added that the vaccination programme, which offers protection against HPV types 16 and 18, has now been expanded to reach all girls in Grade 5 aged 9 years in both public and private schools, including special independent schools.
Evaluating the impact of government's two-dose HPV vaccination programme, recent research published in The Lancet Global Health found a substantial decline in HPV prevalence of around 80% among adolescent girls with and without HIV. The study led by Professor Sinead Delany-Moretlwe of Wits RHI, at the University of the Witwatersrand, noted though: "As South Africa transitions to a single-dose schedule, continued surveillance - especially among women with HIV - will be crucial to monitor long-term effectiveness and any emerging disparities."
Early warning signs of cervical cancer can be detected with a pap smear screening. If cells in the cervix are found to be abnormal, they should be checked and possibly removed before it becomes cancerous. The current screening strategy in the public sector for HIV-negative women is three pap smears in their lifetime - every 10 years, from the age of 30. People living with HIV can get more regular screenings.
Ndlovu's voice grows soft as she divulges information near to her heart. In large part, she says she took the job as Deputy Director-General in September 2025 on the back of two people close to her passing away from cervical cancer.
"It's always personal," she says.
"I lost two people. A close relative who had been within the health system for over 10 years, yet the screening had not been done, the pap smear. We talk openly at home, I'm that person who educates - and so there was guilt on my side. How did I miss it? I missed it because I was assuming the clinic is doing its job properly."
The other woman had scheduled screenings, yet healthcare staff did not pick up that her pap smears were abnormal. For Ndlovu, the takeaway broadly was that there are weaknesses within the health system relating to performance management and without proper oversight, overall efficiency and outcomes are undermined.
United States aid cuts
Her views on preventable failure within the healthcare sector came into sharper focus when aid funding from the United States to South Africa and other countries was cut off in early 2025, following executive orders from the Trump administration.
"When Trump withdrew his money," she says, "that meant from a systems point of view, there will be major, major gaps. And I thought, maybe I can contribute within a system that is having so many shocks."
Ndlovu says the R753 million in emergency funds, made available by National Treasury in August 2025, is currently being deployed. Within South Africa's health budget, she highlights a general shift towards sustainability from as early as 2013, when the government transitioned to self-financing the majority of its antiretroviral drugs.
"I guess even the country anticipated [the United States aid cuts]," she says. "When you look at the South African journey, we were on the journey to sustainability. It's just that this [the aid cuts] was too abrupt. They should have phased it out, over say, five years. Allowing countries to plan. It was much harder in other African countries because they were more reliant."
Retraining for vulnerable groups
Discussing gaps following these changes, Ndlovu acknowledges that services to marginal groups, such as men who have sex with men, sex workers and foreign nationals, have been affected. Specialised services to some of these groups largely relied on foreign funding.
"When the PEPFAR funding came, it created the clinics on the side which were for these key populations: sex workers, our truck drivers; the transmission areas that needed that special attention, that were vulnerable. These clinics ran parallel to the public health system, they were not integrated. So now we have to go back; find the patients, ask can we get the files, and more," she says.
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Apart from paperwork, Ndlovu says staff at public clinics are being retrained. "As you would understand, part of this programme includes training not just our health workers, everybody, including the person at the gate, security, needs to be trained on how to be vulnerable, key population friendly."
Childhood dreams and losing a parent
Ndlovu was born in Hammarsdale, 40 kilometres east of Pietermaritzburg, and matriculated at the German Catholic Inkamana High School in 1990. The school's notable alumni include former deputy president Dr Phumzile Mlambo-Ngcuka. "That Catholic ethos of being the best at what you do, that's the environment I grew up in," says Ndlovu.
Since she can remember, she wanted to be a doctor. "It was my dream. From the age of four actually, when other kids were playing with dolls, I was playing being a doctor," she says.
Do you want to know what is happening with HIV in South Africa? Have a look at our new HIV dashboard and graph generator based on outputs from the Thembisa model: www.spotlightnsp.co.za/hiv-dashboard/
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-- Spotlight (@spotlightnsp.bsky.social) November 18, 2025 at 11:48 AM
Ndlovu says her dad passing away from lung cancer was her inaugurating brush with health systems. "That was my first encounter with health, its failure and its impact. Interestingly, for me it was the private health system." She says her father was a member of a medical scheme and had been going to private doctors. "He had been seeing a doctor for six months and was not diagnosed. Once he was diagnosed, they transferred him into public health to manage that cancer, and he died a year later."
This formative experience at Victoria Mxenge Hospital, formerly King Edward VIII Hospital, in Durban left a lasting impression. "I had a public health system [experience] where my own dad was treated so well. It was a terminal disease but how that multidisciplinary team managed him, including us the family, the palliative care, it was a dignified exit for my father. And I think it still has an impact on how I want health systems to be."
Bedtime reading
Today Ndlovu lives in Pretoria, in Faerie Glen, with her daughter. Asked what book she recently enjoyed, she laughs, saying that at present, reading books are a rare luxury. Even in her spare time, she reads World Health Organization strategy documents.
"And I used to love reading books by the way, but once I put my heart into something, I really want to get it right," she says. "I cut everything else out and just do the work."
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