In South Africa, men are less likely than women to start and stay on HIV treatment. Coach Mpilo, founded by a former football goalkeeper and funded by the Gates Foundation, pairs HIV-positive “coaches” with “players” to turn that around.
South Africa carries the world’s largest HIV burden, with roughly eight million people living with the virus, close to one in five adults. Treatment coverage reveals a stubborn gender gap: by UNAIDS figures, about 80 percent of women living with HIV are on antiretroviral therapy, compared with only 68 percent of men. Men test later, start treatment later, interrupt it more often, and die of HIV-related causes at higher rates than women.
Coach Mpilo was built to address that specific failure.
The program grew out of the work of Silver Shabalala, a former goalkeeper for Durban’s AmaZulu Football Club, who became an HIV advocate after his brother was diagnosed while imprisoned in Pretoria. When Shabalala and his colleagues asked men directly why so many avoided treatment, the answer was about trust rather than logistics. The men wanted proof that someone like them could live openly and well with HIV.
As Shabalala put it, in an interview with the Gates Foundation, men wanted proof that someone like them could live openly and well with HIV. “A man needs a friend he can speak to, a friend who has walked that journey and has accepted himself.”
That insight drives the model. Coaches are men living openly with HIV, stable on treatment, and trained over about a week in interpersonal communication, mentorship, and problem-solving. They take referrals from clinics and community testing sites, field calls prompted by posters, accompany men to appointments, and ease the disclosure conversations that many men dread.
The framing borrows from sport, with “coaches” mentoring “players.” “Mpilo” means life or health in Zulu. Coaches lean on simple teaching tools, including bottles of colored beads to show how treatment suppresses the virus, and on the U=U message, short for Undetectable = Untransmittable. This means that once treatment suppresses the virus to undetectable levels, it cannot be sexually transmitted.
In South Africa, Coach Mpilo is a community-led movement helping men living with HIV support one another as they navigate diagnosis, treatment, and stigma. Men are less likely to test for HIV, start treatment, or stay on it—even when services are available. Built on trust and shared experience, the Coach Mpilo program has helped tens of thousands of men take charge of their health and move forward without shame— strengthening families and communities along the way.
The approach is led by Population Services International with Matchboxology and partners including BroadReach Healthcare and Right to Care, with funding from the Gates Foundation. A 2020 pilot across three districts produced strong early retention, and an independent evaluation in KwaZulu-Natal, run by the University of Cape Town’s SALDRU with J-PAL Africa, is now measuring longer-term effects on viral suppression, mental health, and stigma. The Gates Foundation reports that 96 percent of the 41,000 men reached so far have started or resumed treatment.
Coaches are recruited locally, trained in about a week, and work close to home, which makes the program quick to set up and deploy. That makes the current threat to it striking. Recent cuts to public health funding have cost some coaches their paid positions, yet many keep showing up, escorting men to clinics without reimbursement.
As Shabalala sees it, the program built brotherhood. That may be the clearest measure of whether peer support can outlast the budgets that started it.
This summary is based on the following sources:
- The peer coaching program getting men back on HIV/AIDS treatment in South Africa, by the Gates Foundation
- Coach Mpalo: A Community-Based Peer-Support Intervention to Improve Men’s Linkage to and Early Retention in HIV Treatment, by MenStar Coalition
- Using Peer Coaches to Counter HIV Stigma in South Africa, by Shawn Malone, Project Director, HIV/AIDS Gates Project in South Africa, PSI Global
- Supporting men living with HIV in South Africa through a peer-led intervention, by L’équipe du FID
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