Zonwabele “Zola” Tshayana has been living with HIV for 25 years — long enough to bury loved ones lost to the disease, survive two suicide attempts, and now he swallows seven chronic pills a day to manage the conditions that have crept in with age.
Today, at 46, Tshayana from Ngcobo in the Eastern Cape is part of a growing but largely invisible group of South Africans ageing with HIV, navigating a complex web of declining immunity, treatment side-effects, mental health crises and mounting chronic illnesses.
As the country’s HIV-positive population lives longer on antiretroviral therapy, experts warn of a new and under-recognised epidemic: the steep rise in multimorbidity, people living with HIV developing multiple chronic conditions including diabetes, hypertension, kidney disease, hypothyroidism and HIV-associated neurocognitive disorders.
A study published in the National Library of Medicine, “Multimorbidity with HIV: Views of community-based people living with HIV”, notes that chronic conditions increase sharply with age.
“As more people living with HIV age, they develop additional chronic conditions caused by HIV itself, ageing and long-term medication side effects,” the study states.
Tshayana is living proof of this.
The early years
When he was diagnosed in the late 1990s, HIV was a death sentence. He had just buried a relative who died of Aids-related illness and believed, in his youth, that the virus only targeted those who feared it.
“Back then, I would say, ‘HIV doesn’t want someone who fears it, you must chase it so it runs away,’” he recalls. “That was a stupid move. I thought, ‘You only live once. Date who you want, sleep with who you want.’ When I tested positive, I wasn’t shocked. My fear was rejection.”
It got worse quickly. His doctor told him he had three months to live.
“I wanted to prove him wrong. But at the back of my mind, death lingered. I didn’t want to die without children, without achieving anything. I disclosed to my mother within two minutes of my diagnosis and to my whole family within five hours. Their support saved me,” he said.
The weight of treatment and side effects
South Africa’s “explosive” rise in HIV infections in the early 1990s coincided with gross inequities in healthcare access, a legacy of apartheid that continues to shape outcomes. For many diagnosed during that era, survival came with a cost.
For Tshayana, the most punishing side effects included severe weight gain, hypothyroidism linked to the medication Efavirenz, kidney complications, debilitating depression and suicidal ideation.
I started the foundation to help people facing the same challenges I overcame. Living with HIV for more than 25 years has made me resilient. I’ve learned to prioritise myself. And I want others to know they are not alone.
— Zonwabele Tshayana, Mind and Soul Foundation founder
“My first suicide attempt was a few months after starting treatment. I was diagnosed with depression soon after. I fought suicidal thoughts for years, which led to a second attempt in 2016,” he said.
Therapy and education about mental health marked a turning point.
Today mental health advocacy is central to his work.
Ageing with HIV, a new, harder chapter
Tshayana takes seven pills every day to manage HIV, hypothyroidism and other chronic illnesses that have developed over time.
“People living with HIV are ageing, and that brings more strain to an already weakened immune system,” he said. “We’re also seeing a rise in HIV-induced psychosis and other mental health conditions. The psychological side of HIV needs the same level of attention as viral suppression.”
He joined the reference and advisory group for the 50+ Programme, an initiative shaping policies for people aged 50 and older living with HIV in Southern Africa.
“We must understand people living with HIV from their lived experiences, not theories. Many of us have been traumatised. We nursed friends and family as they died. We saw them lose hope. We buried them. That leaves scars.”
He warned that young people born with HIV, now in their teens and twenties, remain under-supported.
“We’re already seeing the dangers of that. South Africa needs a holistic programme involving people living with HIV directly, using their experiences.”
Fatherhood, fear and hope
Despite the hardships, Tshayana is a father of three boys, a 12-year-old and nine-year-old twins.
“The toughest moments emotionally were around protecting my partner and my children from infection. Medically, it has been the fear of developing too many chronic conditions.”
He has faced hypertension, high cholesterol, risks of renal failure and lifestyle diseases associated with ageing.
Yet he insists there is life and love after HIV.
“When your viral load is undetectable, you cannot pass the virus to another person. People must stop thinking of HIV as a killer. Managed well, you can live a normal life.”
Advocacy and purpose
Also known as “Blackie”, Tshayana is a self-published author, keynote speaker, facilitator and founder of the Mind and Soul Foundation, which focuses on mental health, HIV, GBVF, men’s mental health, suicide prevention and chronic illness support. His flagship projects, pending funding, include:
- #WalkWithTheHippo (lifestyle disease and weight-loss initiative);
- #BlackieSpeaks (mental health and suicide education); and
- GBV programming.
“I started the foundation to help people facing the same challenges I overcame. Living with HIV for more than 25 years has made me resilient. I’ve learned to prioritise myself. And I want others to know they are not alone.”
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