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Thembi Xulu is leading South Africa’s effort to produce the anti-HIV injection lenacapavir locally. As CEO of the South African National Aids Council (Sanac), she works with drugmakers, activists, and government officials to turn the plan into reality.

A dealmaker in a funding crisis

Xulu will attend the 26th International Aids Conference in Rio de Janeiro this week to discuss the country’s plans for local production amidst a devastating donor funding crisis. The Trump administration’s decision to end the President’s Emergency Plan for Aids Relief (Pepfar) by early 2027 has created uncertainty for the country’s HIV programs. Pepfar previously covered nearly a quarter of these initiatives.

In 2020, when Xulu became Sanac’s CEO, Pepfar still funded 24% of all HIV programmes in South Africa, a far smaller proportion than in many neighbouring countries but still something of an existential risk for South Africa’s HIV response.

Two weeks ago, she was in Harare, presenting to the first-ever meeting of the Southern African Development Community (SADC) health and finance ministers. Last week, it was Geneva for a two-day Global Fund to Fight Aids, Tuberculosis and Malaria board meeting. Now Rio, where delegates will grapple with how to keep country HIV programmes on track in the face of an unprecedented funding crisis.

From dance mom to global health leader

Xulu’s career did not follow a straight path. Born in KwaMashu in 1974, she was raised by her great-grandmothers—one a seamstress, the other a nurse—while her mother, an activist, moved between South Africa and Swaziland. The experience taught her responsibility early. “I’d soak their feet in warm water, add salt, and rub them with ointment,” she recalled. “I’d tell them, ‘One day, I’ll fix these knees.’”

She stood out in school, leading her debating team before studying medicine at the University of Natal. After graduating in 1997, she joined the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital, working on tuberculosis drug trials. Dissatisfied with research limitations, she shifted to public health, eventually running a USAID-funded project that expanded HIV treatment across five provinces.

In 2010, Xulu became a Yale World Fellow, where she met the late Russian opposition leader Alexei Navalny. “The program didn’t tell us what to think, but how to think,” she said. This training prepared her for leadership, including her role at Equip, the international arm of Right to Care, which helped countries adopt the World Health Organization’s “test and treat” strategy.

When she took over as Sanac CEO in 2020, she faced skepticism. The council, formed amid tensions between government and civil society, had a history of infighting. Her approach—listening to communities and prioritizing their input—earned her the nickname “the People’s CEO.” The 2023-2027 National Strategic Plan, called “the People’s NSP,” reflected this focus.

Outside her job, she supports her daughters’ dance careers, learning routines alongside them. “I challenge you to a dance-off, anytime, anyplace,” she says, laughing, and hers is no ordinary laugh—it’s a multi-dimensional meme cackle, deeply sonorous and committed. “I’m afraid I was that dance mum, you know, the one who could kick up a performance of her own capable of eclipsing the actual dancing. At an event in Croatia, my daughters’ instructor Mario [Gomes] had to actually give us a talking to. ‘He said, ‘dance moms, [looking at Thembi], please behave yourselves—don’t criticise or express any unhappiness about results until you get back to your bedroom, because even in the bathroom there could be judges.’”

That laugh again.

Balancing science and community

Producing lenacapavir locally involves more than logistics. The drug must work for the people who need it. Early use showed practical issues: some men who have sex with men found injection-site bumps uncomfortable, making certain clothes difficult to wear. “The people who decide if this drug works aren’t in boardrooms,” Xulu said. “They’re in communities.”

A recent global health setback highlights how funding shifts can disrupt prevention efforts.