Meta Platforms, the parent company of Facebook and Instagram, has agreed to a record-breaking $18-billion (over R300-billion) settlement in the United States following legal action alleging that its platforms contributed to harm among children and teenagers and failed to do enough to protect young users. The settlement, which involves almost all U.S. states, mandates specific safeguards including default daily limits, nighttime lockouts, and the disabling of notifications during school hours.
While Meta has denied any wrongdoing, the settlement has intensified an already urgent global debate about children’s digital safety. Around the world, governments are taking action, from Australia’s nationwide ban on under-16s to Brazil’s parental consent requirements, the UK’s proposed restrictions, and similar measures being considered in many other countries.
However, as governments and courts grapple with how platforms should protect young users, Pretoria based, Professor Anke de Beer believes the solution must start earlier and closer to home: with education. She is the founder of the Smart Device Licence, a pioneering South African programme designed to teach children and teenagers how to use smart devices safely, responsibly and with greater awareness of the risks they may encounter online before they are given unrestricted access.
“When you give your child a smart device, you don’t just give them access to the world. You give the world access to your child,” says Prof Anke. “The Smart Device Licence is about turning that access into a valuable skill for navigating the digital world responsibly.”
Why this matters now
Children are entering the digital world at increasingly young ages, often gaining access to social media, online gaming, messaging platforms and other digital environments before they fully understand the risks involved. Concerns around cyberbullying, inappropriate content, privacy, online exploitation, excessive device use and digital addiction have made children’s online safety an increasingly important issue for families, schools and policymakers. The latest record action against Meta is one of several developments internationally placing greater scrutiny on how technology platforms operate.
But platform regulation and landmark settlements are only part of the solution. Children also need to know how to navigate the digital world before they are given a device.
A personal mission becomes a national programme
Prof Anke’s journey from housewife to academic and activist was sparked by a deeply personal family experience involving gaming addiction and its devastating consequences. The experience opened her eyes to the potential risks of unrestricted digital access and the importance of equipping children with the knowledge to make safer choices. What began as a family’s fight for survival became a broader mission to help protect South Africa’s young people.
The Smart Device Licence was developed with input from professionals working across education, psychology and child protection, with the aim of providing children with practical skills they can use in their everyday digital lives, filling the gap left by slow-moving regulation and corporate settlements.
How the Smart Device Licence works
The Smart Device Licence is an interactive e-learning programme covering:
Digital citizenship
Privacy protection
Cyberbullying recognition
Responsible social media use
Healthy device habits
Online safety
Understanding digital risks
There are two levels:
Junior Licence: Designed for primary school learners, focusing on healthy device habits, responsible digital behaviour and avoiding harmful online content.
Senior Licence: Designed for high school learners, covering privacy, adult content, sharing personal images or messages, cyberbullying, responsible online communication and the psychology of digital addiction. Learners complete modules, quizzes and practical exercises. Those who complete the programme receive an official Smart Device Licence certificate. Schools including Rabboni Christian School in Brits are already using the platform. The programme is voluntary. The licence is an educational milestone, not a legal requirement.
Expanding access
The Smart Device Licence is available to schools, parents and learners across South Africa.
“The conversation about children’s digital safety is becoming impossible to ignore,” says Prof Anke. “But we should not wait for a court case, legislation or a crisis, whether in the US or here at home, before we prepare our children. The best time to teach a child how to use a smart device responsibly is before they receive one.”
The licence fee is R115, including VAT, providing access to the programme’s modules, exercises and quizzes. Content will be updated regularly to reflect emerging technologies, digital trends and relevant developments.
A study identifies PANK1 as a previously unknown target of SGLT2 inhibitors, revealing how the medications boost energy production and improve heart function.
Top: ribbon model of PANK1 dimer. Bottom left: zoom-in of pantothenate binding to PANK1. Bottom right: super-imposed binding of AcCoA, showing extension into the PANK1 enzymatic pocket. Credit: University of Pennsylvania
Researchers have discovered that SGLT2 inhibitors, a class of drugs originally developed to treat diabetes and now widely used for heart failure, work by activating a key enzyme that helps heart cells produce and use energy more efficiently. The study, published in Science, potentially solves a longstanding gap in knowledge about these drugs and opening the door to potential new treatments for heart failure.
The study, led by researchers in the Perelman School of Medicine at the University of Pennsylvania, found that SGLT2 inhibitors directly activate an enzyme called PANK1 in heart cells. This activation boosts production of coenzyme A (CoA), a molecule essential for converting nutrients into energy. Researchers found that increasing CoA production improved the ability of human heart cells to contract and relax, two critical functions that are impaired in heart failure.
“Our findings suggest these drugs are helping the failing heart restore its energy-producing capacity,” said senior author Zoltan Arany, MD, PhD, the Samuel Bellet Professor of Cardiology and chair of Physiology at Penn Medicine. “We identified PANK1 as a direct target of these medications and found that activating this pathway makes heart cells work better. This may explain many of the remarkable benefits patients experience with these drugs.”
Figuring out why it works
For years, physicians have known that SGLT2 inhibitors significantly reduce hospitalisations and deaths among heart failure patients, but have struggled to explain exactly why, because the drugs were designed to target the SGLT2 protein which is found in the kidneys, not the heart.
Using human heart tissue from transplant recipients and donors, the researchers found that SGLT2 inhibitors increased the heart’s ability to use multiple fuel sources, including sugars, fats, amino acids, and ketones. The drugs also increased levels of CoA, which plays a central role in cellular energy production. To identify how that happened, the team traced the effect back to PANK1, an enzyme that regulates the first and most important step in CoA production. The researchers demonstrated that the drugs physically bind to PANK1 and activate it.
“The evidence was especially compelling when we found that activating PANK1 alone reproduced many of the benefits of the drugs, while blocking the pathway largely eliminated those benefits,” said Nicholas Forelli, MD, an internal medicine resident in the Arany lab and co-author of the study. “We cannot completely rule out other contributing mechanisms, but the data strongly support PANK1 as a major driver.”
The discovery may also help explain why SGLT2 inhibitors often begin benefiting heart failure patients within days of starting treatment.
Exciting possibilities ahead
Despite years of research into these medications, the role of PANK1 had gone unnoticed. “Honestly, no one thought to look,” Arany said. “Researchers knew these drugs were doing something important in the heart, but the target responsible for those effects had remained elusive.”
The findings could have important implications for future drug development. While SGLT2 inhibitors are highly effective, they can cause side effects such as urinary tract infections, dehydration, and, in rare cases, diabetic ketoacidosis. “One of the most exciting possibilities is developing drugs that directly target PANK1,” Arany said. “That could allow us to capture the heart benefits while potentially avoiding some of the side effects associated with current therapies. We’re actively working on that now.”
The first-ever European Society of Cardiology Guidelines on the management of cardiovascular disease and chronic kidney disease have been developed in collaboration with the European Renal Association. The new guidelines were published online in the European Heart Journal [1] and presented at ESC Congress 2026 on 29 August.[2]
Chronic kidney disease (CKD) is defined as the presence of abnormalities of kidney structure or function present for at least 3 months, with implications for health.[4] It has been estimated there are around 100 million people in Europe with CKD,[5] all of whom are at increased risk of a wide range of cardiovascular diseases (CVD) as a result of their kidney problem.
“The disability and lifetime lost to each disease are profound, but CKD can accelerate CVD and vice versa, resulting in cardiovascular events and the need for dialysis much earlier in life,” said Task Force Chair, Associate Professor Kevin Damman from University Medical Centre Groningen, Netherlands. “The good news is that there have been major advances over the last few years, which mean there are now several simple treatments that can substantially lower the risk of both cardiovascular and kidney complications.”
Task Force Chair, Professor William Herrington from the University of Oxford, UK, noted: “Many patients with CKD are treated by the cardiology community and the new ESC Guidelines aim to increase the use of kidney function and urine albumin testing in patients with CVD. With improved screening, more at-risk patients can be identified and the most appropriate treatments for both CKD and CVD can be prescribed.”
The Task Force developed the ‘STAMP on CKD’ acronym, which stands for: Screen, Triage, Address CKD Risk, Modify CVD management and Plan health services. The first step is screening all patients with CVD at diagnosis for CKD using blood and urine tests (estimated glomerular filtration rate from blood creatinine plus urine albumin-to-creatinine ratio). A key message on triage is the accurate assessment of risk of kidney failure and accurate assessment of CVD risk using validated scoring systems that incorporate kidney function.
Addressing risk means ensuring the early use of proven cost-effective risk-modifying therapies that have been shown to slow CKD progression and reduce the risk of cardiovascular events. “Early use of drugs called RAS inhibitors and SGLT2 inhibitors alongside statin-based therapy are particularly important and effective,” explained Associate Prof. Damman.
The guidelines highlight key areas where modifications to CVD management are needed in the context of CKD, including recommendations for medications that are permitted in patients who may not be able to clear standard treatments from their bodies due to decreased kidney function.
Finally, appropriate planning of health services ensures that services are set up to recognise high-risk patients and provide timely access to care from cardiologists and nephrologists. “Active and efficient communication between specialties is often necessary due to the complexities associated with CKD,” noted Prof. Herrington. “Engagement of patients and family/caregivers in the multidisciplinary care process also helps to ensure patients’ priorities are met, improve their experience and promote patient-centred care.” A version of the new guidelines for patients aims to give individuals the knowledge and confidence to be involved in shared decision-making with healthcare providers.[3]
The Task Force Chairs concluded, “CVD and CKD are major burdens on patients, healthcare systems and society. The key messages in these guidelines should be noted by all relevant healthcare stakeholders and policymakers, and research planned to fill several gaps in the evidence. Raising awareness will help realise the hope that the guidelines will lead to important individual and societal improvement for those with, or at risk of, CVD and CKD.”
References
[1] 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease. Eur Heart J. 2026. doi:10.1093/eurheartj/ehag098.
[3] ESC Guidelines for the management of cardiovascular disease and chronic kidney disease: What patients need to know. Available on the Patient Versions of ESC Guidelines webpage.
[4] Kidney Disease Improving Global Outcomes CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105:S117–S314.
[5] GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395:709–733.
Studies in the behavioural and brain sciences reporting a major sex-dependent effect – that a drug, treatment or other intervention is more effective in one sex than another – are supported by appropriate evidence less than 25% of the time, an analysis finds.
The Proceedings of the National Academy of Sciences (PNAS) published the analysis of 200 recent articles with a claim of a sex- or gender-dependent effect in the title. The articles included studies on human and non-human subjects and spanned six brain-related research areas: behavioural sciences, clinical neurology, neurosciences, psychiatry, psychology and substance abuse.
“We found that studies in psychology had the highest rate of appropriate evidence – 39% of the published papers included statistical evidence to support the claim of a sex difference,” says Donna Maney, corresponding author of the study and professor of psychology at Emory University. “Research in neuroscience had the lowest rate of appropriate evidence, at just 18%.”
The low rate of appropriate evidence in neuroscience is particularly troubling, Maney says. She notes that claims of sex-dependent effects are more numerous in neuroscience, where such reports are currently being published at triple the rate seen in any other field.
“The high number of reports seen in neuroscience may be due to bias – neuroscientists looking harder for sex differences than other scientists,” Maney says. “But most current evidence shows that the brain is one of the least sexually differentiated organs in the body.”
Maney’s team was particularly alarmed by the number of calls for changes in clinical approaches that were based on faulty analyses. Many of the 200 articles they reviewed, for example, called for sex-specific approaches to suicide prevention, stress-related psychiatric disorders, substance-use disorder and psychopathy – all without providing statistical comparisons of effects across sex.
First author of the PNAS paper is Madeline Olivier, who did the work as an Emory student and has since graduated with a BS in psychology.
Summary of findings
In 24% of the 200 papers, the effect compared statistically across sex and the results supported the claim of a sex-dependent effect.
In 9%, the researchers tested for a sex difference, but the results were missing.
In 9.5%, the sex difference in the effect was reported as not statistically significant, which was incompatible with the claim in the title.
In 57.5%, the sexes were not statistically compared — the researchers did not test the claim in the title at all.
A logical error
Maney is a neuroscientist who studies hormonal and genetic influences on behaviour. For more than a decade, she has also focused on investigating how sex differences are tested for and reported in biomedical research.
One issue she emphasises is that, instead of comparing the sexes directly with each other, researchers often test for the effect in each sex separately. Although it might make sense on the surface, the practice reduces the number of subjects to the point where a real effect can be missed. If the effect is detected in one sex but missed in the other, researchers are vulnerable to a logical error: that the effect differs between the sexes, when they have not been directly compared.
To show that the sexes differ, females and males must be directly compared with each other in a statistical test. Most of the articles analysed by Maney and colleagues for the current PNAS paper did not do that. Instead, the researchers relied on the individual, within-sex tests – an invalid way of comparing the sexes that produces the illusion of a difference up to 50% of the time. “It’s no better than flipping a coin,” Maney says.
It’s also easy to miss true sex differences with a subgroup approach. For example, men and women could respond differently to a treatment but when the sample is divided in half and tested separately, the effect could be missed in both.
Maney cites the classic example of a large clinical trial showing that aspirin significantly reduced mortality from heart attacks. To illustrate the problem with the subgroup error, cardiologist Peter Sleight reanalysed the data by dividing participants into subgroups according to their astrological signs. Once the trial was split into 12 zodiac groups, the benefit of aspirin was no longer statistically detectable among the Libras and Geminis.
Sleight’s “findings” demonstrated how dividing a large group into subgroups can make a real effect disappear in some of the groups, even when the treatment is clearly beneficial.
“This problem is not new,” says Maney. “I made the error myself until I learned about it. “Many researchers don’t receive training in how to test whether an effect differs between two groups.”
A simple solution
To provide evidence that an effect differs by sex, the effect must be statistically compared between males and females, Maney emphasises. Only that approach can show sufficient evidence for a sex difference.
She designed an open-source tool, housed on the web at sexdifference.org, to help guide researchers to verify sex-specific effects.
Maney’s interests extend beyond statistical sex comparisons.
“Ultimately,” she says, “I would like to see researchers not treat sex as the most important variable in a biomedical study. Variation in participants’ weights, ages or habits, for example, likely explains variation in the effect of a treatment better than which sex category they are in.”
Researchers explore brain patterns through different ages to pinpoint where memories get mixed up
Photo by Fakurian Design on Unsplash
Memory loss is usually thought of as something to address as a person ages. Slip-ups like forgetting someone’s name or recognising a familiar face but not remembering where you know them from are often viewed as issues that arise later in life.
New research by a team at Binghamton University reveals why memory shifts as we age – and that shift happens earlier in life than most people think, potentially at middle age.
“This is one of a growing list of studies highlighting that the period of middle age is really important for memory functioning and shouldn’t be ignored. For a long time, most studies have been focused on young adults versus older adults,” said Binghamton Associate Professor of Psychology Ian McDonough, co-author of a new study published in Cerebral Cortex.
McDonough and postdoctoral associate Destaw Mekbib tested a group of approximately 60 adults ages 18 to 74 by showing them faces paired with various objects and scenes. After a five-minute rest period, participants completed a memory test where they were prompted to pick the correct object or scene for each face – all while an MRI machine took readings of their hippocampal activity.
McDonough said the test mirrors how memories are formed. First, the brain records the new memory. Then, over a short period, the hippocampus replays the memory to stabilise it. Later, the brain retrieves the memory when needed.
The question the researchers had, however, was how aging affects the continuity of the information passing between those stages.
“We’re seeing a big decline in memory accuracy from the 20- to 30-year-old age group, to people in their 50s. Some of these hippocampal processes already start to decline by midlife,” McDonough said. “That suggests middle age is really a transition point.”
Image Credit: Figure 1. Overview of the experiment. Reprinted from Mekbib and McDonough (2026), Cerebral Cortex, 36(7), bhag114, https://doi.org/10.1093/cercor/bhag114, used under CC BY-NC 4.0..
In the context of this research, middle-aged participants often paired a face with the wrong object or scene. They had recalled that they had seen it before, but not which pairing was correct, almost as an “I’ve seen something like this before” phenomenon.
“It becomes hard because now all of these images on the screen during the test seem familiar,” McDonough said. “They know they’ve seen all of these before, but now what they have to remember is that specific link. And that’s where, as people age, they start to really show these errors.”
In comparing how younger and older people access memories, the researchers assumed that older adults would show weaker hippocampal activity, but this wasn’t exactly the case. What they did find was more interesting. When young adults made mistakes in the memory tests, it was because their brains were not activating the original memory patterns, which was expected.
However, when older adults made mistakes, their brains showed strong reactivation of those memory patterns.
“The more they reactivate the hippocampus that’s consistent with encoding, the more likely they are to make these memory errors,” McDonough said. “So instead of that reactivation pattern being associated with better memory, it’s associated with those errors.”
McDonough said it’s not yet known why older adults can show strong hippocampal reactivation while making memory errors. Future follow-up studies could look at memory encoding, consolidation, and retrieval at the individual level, and explore how brain stimulation after learning impacts memory.
He noted that researchers should focus more on people in middle age, following them over many years, given this new information that memory can shift earlier in life.
“We really don’t have a good scientific understanding of what is happening in middle age, because the brain is not declining uniformly across this time, with some regions declining faster than others,” McDonough said. “Finding when those tipping points are is going to be important.”
Researchers from Amsterdam UMC, in collaboration with other hospitals, have successfully completed the first-ever Phase 3 study of an in vivo CRISPR therapy. In this large-scale, double-blind Phase 3 trial, 80 patients with hereditary angioedema were randomised to receive either the CRISPR therapy or a placebo. CRISPR therapy is a medical technique that allows doctors to precisely modify errors in cellular DNA to treat specific hereditary diseases.
Danny Cohn, leader of the research, is highly enthusiastic: “The study demonstrates that the therapy is genuinely effective and safe. This confirmation is exactly what regulatory authorities need to approve the very first in vivo CRISPR gene editing treatment for the market.”
The findings were presented today at the annual congress of the European Academy of Allergy and Clinical Immunology in Istanbul, and simultaneously published in The New England Journal of Medicine.
Significant Reduction in Attacks
The study evaluates a one-time CRISPR treatment for hereditary angioedema, a rare disorder characterised by recurrent and potentially dangerous swelling. Internist Danny Cohn explains: “This is the first time CRISPR therapy has been applied in vivo within a large, double-blind, international Phase 3 trial. A total of 80 patients were randomised to receive either lonvoguran-ziclumeran or a placebo.”
The primary outcome was measured between weeks 5 and 28 following a single intravenous infusion. The results heavily favoured the active treatment, showing an 87% relative reduction in attacks. Furthermore, 62% of treated patients remained attack-free without any maintenance therapy, compared to just 11% in the placebo group. Key secondary outcomes were also strongly positive: the need for on-demand treatment fell by 89%, moderate-to-severe attacks decreased by 91%, and quality-of-life scores showed a distinctly greater improvement compared to the placebo.
Cohn notes that trial participants tended to take medication at the earliest sign of a potential swelling. “Consequently, we cannot be certain if all reported swellings were actual attacks,” Cohn says. “We anticipate that the number of completely attack-free patients will rise now that participants know they received the active treatment. This awareness will likely give them the confidence to forego on-demand therapy.”
A Single, One-Time Treatment
The implications for patients are profound, suggesting that a severe, chronic condition can potentially be managed long-term with a single intervention. Cohn: “Patients may no longer need continuous preventative medication, sparing them from the associated side effects. Furthermore, this can alleviate treatment burden, reduce drug dependency, lessen the anxiety of future attacks, and ultimately improve quality of life.”
Paving the Way for Future Genetic Therapies
In terms of safety, the treatment appears to be well-tolerated. The most frequent side effects were mild infusion-related reactions, headache, fatigue, and back pain, all of which resolved quickly. No serious adverse events were reported in the treatment group.
“This makes the results exceptionally relevant; it is not just effective, it is safe,” Cohn emphasises. He adds that data from 37 participants from the Phase 1 and 2 trials show the treatment remains just as effective and safe four years after administration. “This study opens doors to in vivo CRISPR treatments for patients with other hereditary disorders. Inserting, deleting, or repairing a gene – it is all possible with CRISPR technology.”
Lenacapavir is administered via two injections of 1.5ml each in the buttocks, thigh, abdomen or upper arm. (Photo: Nasief Manie/Spotlight)
By Biénne Huisman for Spotlight
From counselling about small nodules to overcoming people’s fears of needles, Spotlight takes the pulse of a new HIV prevention injection’s rollout in the Western Cape.
At Cape Town’s Philippi Village, beside a rainbow-emblazoned mobile clinic, Olwam Plaatjie says she switched from the two-monthly cabotegravir HIV prevention injection to the six-monthly injectable lenacapavir. Despite small nodules forming at the two jab sites on her abdomen, the 20-year-old is delighted with the new HIV prevention medicine.
Plaatjie, who is from Crossroads and who started taking cabotegravir injections three years ago, says: “I see many people who are HIV positive. Many of them are girls. Guys often don’t even want to be tested; my boyfriend didn’t want to go for HIV tests. So that’s why I started to have a fear. I was like, you know, maybe there is something he is hiding.”
Plaatjie is one of a stream of young women now taking their health in their own hands as they personally implement HIV prevention strategies, thanks to national government and research campaigns aimed at this vulnerable group.
According to Foster Mohale, spokesperson for the National Department of Health, as of 23 August, there have been 3 641 initiations of lenacapavir, or LEN for short, across the 22 government clinics in the province that are offering the injection. Nationally, the number stood at 47 934.
Due to severely constrained supply, lenacapavir is for now only being rolled out to 360 health facilities across six provinces (Free State, Limpopo, and Northern Cape are not currently included). Gauteng accounts for over a third of facilities and KwaZulu-Natal for around a quarter. The Western Cape’s 22 facilities makes up only around 6% of the total. The selection of facilities was in part informed by how well facilities had been doing in the provision of HIV prevention pills, currently available in almost all the country’s public sector health facilities.
Mohale said the three clinics with the highest administrations in the Western Cape as of August 26, were the Khayelitsha Community Health Centre, Michael Mapongwana Community Health Centre, in Khayelitsha, and Nolungile Community Health Centre, also in Khayelitsha.
Uptake in adolescent girls and young women
Asked about the high uptake in this area, Director of Service Priorities Coordination for the Western Cape Government Department of Health and Wellness, Hilary Goeiman, pointed out the community’s large population of adolescent girls and young women, who are being targeted in the medicine’s roll-out strategy.
“Nolungile Community Day Centre has demonstrated strong clinical leadership and effective implementation of the programme, successfully integrating lenacapavir into routine HIV prevention services,” she said.
On the demographics of the administrations, Goeiman said: “Most recipients are women, in line with the initial rollout focus on adolescent girls and young women, women of reproductive age, and pregnant and breastfeeding women who are at substantial risk of HIV acquisition.”
Mohale said 258 pregnant women had been initiated on lenacapavir at the 22 clinics across the Western Cape, since June.
Science in tandem with government
Meanwhile, Plaatjie was part of an initial cohort of 15- to 35-year-olds who received lenacapavir jabs in February, as part of a study spearheaded in the area by the Desmond Tutu Health Foundation. The study, called ALIGN, will evaluate implementation strategies for lenacapavir and how to encourage continued use.
The research is unfolding in collaboration with the Western Cape Department of Health and Wellness and the National Department of Health, but with a separate stock of the drug, independently sourced by the scientists. Social behavioural expert at the foundation, Elzette Rousseau, says their goal is to enrol at least 1 500 people on lenacapavir and to follow them for 18 months. She adds that at this stage, their data is still too limited to have any clear findings.
Cool, but a fear of needles
At Philippi Village, next to Plaatjie, Lutho Windvoel reflects on lenacapavir. He says that to his knowledge, men can be afraid of injections, and thus of HIV prevention through jabs. But, to him the benefit of protection over six months outweighs a fear of needles. “It’s just cool,” says Windvoel, who is wearing a black T-shirt with a pink teddy bear graphic.
At Philippi Village in Cape Town, a rainbow-emblazoned mobile clinic operated by the Desmond Tutu Health Foundation provides Lenacapavir injections. From left to right: Olwam Plaatjie, Sinovuyo Plaatjie, Lutho Windvoel, and Okuhle Trinity Potelwa. (Photo: Nasief Manie/Spotlight)
“LEN makes life easier. People are excited. Before, I took PrEP tablets daily but I worried that I would forget.”
Also in the conversation is Sive Mphambaniso, youth reference engagement facilitator at the Desmond Tutu Health Foundation. On a fear of injections, particularly among men, Mphambaniso agrees: “Most of them [men], when we talk about injections, they’re like, ‘nah.’ Many men are afraid of needles. Especially when we talked about cabotegravir when it arrived. So many of them preferred to take the oral PrEP, actually. Until the six month injection came in. Now people are saying, ‘it’s better for me to just have the guts to take the injection, rather than taking pills every day’. It’s the promise of six months that makes you just say, ‘Now let me have the guts to do this thing’.”
On some men being resistant to HIV testing or prevention, he says: “To be honest, it’s a struggle. And talking to men about HIV prevention, it’s quite a challenge, but it is happening. And I would say it is better for them to come to the mobile clinic rather than to go to a traditional clinic. Sometimes men don’t like people to think that they are sick. So they come here, it’s quite quick and it’s efficient.”
From the researchers’ side, Rousseau pointed out that one in four of their clients for lenacapavir had been men, “similar numbers to those accessing oral PrEP,” she says.
Small nodules that disappear
Speaking to Spotlight, Plaatjie and Windvoel, along with Sinovuyo Plaatjie, 22, and Okuhle Potelwa, 19, who were also in the initial cohort in the study led by the Desmond Tutu Health Foundation, agree that small nodules formed under the skin where the lenacapavir was injected. “It was like small bumps,” said Plaatjie. “It’s not even visible, but you can just feel it when you touch yourself. And it’s not sore.”
Lenacapavir is administered via two injections of 1.5ml each in the buttocks, thigh, abdomen or upper arm. Speaking to Spotlight, the four recipients say the nodules had not been painful, and that the bumps started growing smaller after about a month and eventually disappeared. They did not experience any other side effects.
Inside the “Tutu teen truck” mobile clinic parked at Philippi Village, nurse Zimasa Zwide elaborates on the nodules. “Most of the time they form immediately, especially on the slimmer people,” she says. “So what I normally do when I’m injecting people, I ask them to feel the nodules so that they won’t be surprised at home later. They get smaller with time and they disappear depending on the body of each participant. And most of them are not reporting any pains.”
However, at a workshop hosted by the Bhekisisa Centre for Health Journalism at the end of August, Spotlight heard from two lenacapavir users, who did report initial pain along with “bumps” at the injection sites – for a few weeks following administration. At some facilities, icepacks are used to numb the injection site, either before or after the injection is administered, or both.
Glass vials of pale yellow liquid
During our conversation, Zwide opens a lenacapavir dosing kit. Inside there are two syringes, two glass vials of pale yellow liquid, and a plastic container with tablets.
She says: “It’s two injections. One on each side of the abdomen, well depending on the injection site that they are choosing. And two tablets which are taken on the day of the injection, plus two tablets that I give them to take home, and which needs to be taken exactly 24 hours later. The tablets, it’s a form of speeding up the absorption process of the lenacapavir.”
If these steps are followed, she says, a recipient is fully protected against HIV three days later. The recipient needs to visit the clinic a month later for an HIV test and follow-up treatment. Zwide says the most patients she have injected with lenacapavir in her mobile clinic in a day were around six or seven people. This is her maximum capacity, she says, as the required administration takes around two hours per person.
Demand for the jab
On demand for the jab, Zwide says: “On a daily basis, there are a lot of people who are interested in lenacapavir. When we started rolling out LEN, there were a couple of participants who were coming in, even ones who were older than 35. Unfortunately, in our service, we take from 15 to 35 years, so we couldn’t give them. But luckily as it was now rolled out at the local clinics, we can refer them to Phumlani Clinic [three kilometres away].” Phumlani Clinic is one of the 22 facilities in the Western Cape offering the injection.
Contents of a Lenacapavir injection kit, including the drug vials, syringes, needles and instruction pamphlet, alongside a plastic pill container holding lenacapavir tablets. (Photo: Elri Voigt/Spotlight)
Responding to Spotlight’s questions around education on lenacapavir and demand creation in South Africa, Rousseau spoke highly of government’s rollout efforts.
“The national launch of lenacapavir in early June has created great demand and awareness of lenacapavir,” she says.
In addition, Mphambaniso points out the value of creating awareness about HIV prevention strategies and lenacapavir on channels that reach young people, specifically social media like TikTok.
Goeiman explained distribution of the medicine around the country. “Lenacapavir is procured centrally by the National Department of Health and distributed to provinces through phased deliveries. The Department continues to actively manage available stock to ensure equitable access throughout the phased rollout.” Technically, the department is procuring the medicines from the pharmaceutical company Gilead Sciences using money from the Global Fund (a large multinational donor).
For now, lenacapavir supply in South Africa remains highly constrained. That is expected to change once generic versions of the drug are registered and marketed in South Africa. Gilead have granted several companies licenses to produce generics. One of those, the Indian pharmaceutical company Hetero, has already filed a lenacapavir generic with the South African Health Products Regulatory Authority.
It seems plausible that the first lenacapavir generics will be approved in the first half of 2027 and indications are that the Department of Health will be quick to move to procuring lenacapavir generics on tender. Once that happens, the programme should expand rapidly with the aim of eventually covering all public healthcare facilities in the country.
The true impact of missing doses of blood pressure-lowering medication will be demonstrated in a presentation at ESC Congress 2026.[1]
Approximately 1.4 billion adults worldwide aged 30–79 years are estimated to have high blood pressure (hypertension),[2] one of the most significant risk factors for disease burden.[3] Despite the proven benefits of blood pressure-lowering medication in reducing cardiovascular events, around half of patients do not take them as prescribed.[4]
“We have evidence that poor adherence to antihypertensive medication is associated with worse outcomes,[5]” explained presenter, Miss Qianqian Yang from the University of Oxford, UK. “However, previous data has come from observational studies and could be confounded by other factors. We undertook an analysis of randomised trial data to assess the true impact of adherence on the benefits of antihypertensive treatment.”
A meta-analysis was conducted of patient-level data from 91 339 participants in nine trials where an antihypertensive regimen (intervention group) was compared with another treatment (comparator group: either placebo or a less-intensive regimen). Participants who took at least 80% of their assigned treatment were classified as having higher adherence, while those who took less than 80% were classified as lower adherence.
“A decline in adherence over time was apparent, even in the structured setting of trials,” noted Miss Yang. Overall, the proportion of patients classified as having higher adherence was 88% in the first year and only 79% by year five.
In patients with higher adherence, systolic blood pressure was reduced by 5.2mmHg in the intervention group vs. the comparator group. In patients with lower adherence, the reduction was only 3.0mmHg.
Next, the researchers studied the impact of adherence on major cardiovascular disease defined as stroke, myocardial infarction or ischaemic heart disease and heart failure causing death or hospitalisation.
The incidence of major cardiovascular disease was significantly reduced by 11% in the intervention group vs the comparator group in patients with higher adherence, but there appeared to be no significant reductions in patients with lower adherence.
“Notably, our results reinforce the saying that ‘drugs don’t work in patients who don’t take them.’ Patients with lower adherence derived little or no cardiovascular benefit, whereas those with higher adherence had greater reductions in blood pressure and prevention of cardiovascular events,” said Miss Yang.
According to the authors, adherence assessment and education should be more prominent in hypertension management. In addition, strategies that help improve adherence should be promoted. These include simplifying regimens, using single-pill combinations to reduce the medication burden and using longer-acting agents where the effect of an occasional missed dose is less.
Commenting on the findings, Professor Felix Mahfoud, Chair of the ESC Communication Committee, said: “For years, we have neglected non-adherence to medication as a cause for uncontrolled hypertension. Assessment of adherence should become a routine part of hypertension care so patients do not miss out on life-saving benefits. As healthcare providers, we are here to have open, non-judgemental conversations with our patients about any barriers they may have to taking medication, to help improve adherence.”
[3] GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990−2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406:1873−1922.
[4] Abegaz TM, Shebab S, Gebreyohannes EA, et al. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96:e5641.
[5] Chowdury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940−2948.
The inaugural Women’s Health Matters Conference 2026, sponsored by Discovery Health, will take place on Thursday, 3 September 2026, at GIBS Business School in Johannesburg. Supported by Spar Group, the event will bring together leaders from healthcare, business, academia and civil society to tackle some of the most pressing health issues facing women in South Africa today.
Across a full-day programme, delegates will explore women’s health at every stage of life, from reproductive health, pregnancy and childbirth to menopause, cancer prevention and mental wellbeing. Discussions will also shine a spotlight on critically important issues that continue to receive insufficient attention, including period poverty, endometriosis and the health impact of gender-based violence.
Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health and headline sponsor of the conference, will open the programme with an address on Women’s Health Through the Life Course. Her presentation will highlight the importance of data-driven insights, prevention, early intervention and equitable access to care in improving health outcomes for women across their lifespan.
“Supporting women’s health requires a life-course approach. Improved outcomes are achieved through a strong focus on health promotion, disease prevention, early intervention, and timely access to appropriate care. It also demands a coordinated response from healthcare systems, employers, and communities that reflects the changing needs and challenges women experience throughout their lives. Discovery is proud to support a platform that unites these stakeholders around meaningful, action-oriented solutions,” says Dr Nematswerani.
The conference programme will move beyond awareness and explore the practical actions required to transform healthcare systems, workplaces, communities, and public policy in support of women’s health.
Key conference discussions will include:
Women’s Health Across the Life Course Exploring prevention, early intervention and access to care across reproductive health, maternity care, cancer, mental health and midlife health.
Pregnancy and Birth in South Africa Addressing high-risk pregnancies, preventable complications, informed decision-making and respectful maternity care.
Period Poverty and Access to Dignity Examining the affordability of menstrual products, menstrual health education, stigma, and the role of schools, workplaces, government and public-private partnerships in improving access.
The Endometriosis Diagnosis Gap Exploring the impact of delayed diagnosis on chronic pain, fertility, treatment outcomes and women’s participation in the workplace.
The Menopause-Ready Workplace Focusing on manager education, employee support, healthcare benefits and practical workplace interventions to better support women during menopause.
Closing the Women’s Cancer Care Gap Covering screening, early diagnosis, treatment access, survivorship and the role of employers and healthcare funders in improving outcomes.
GBV Is a Women’s Health Crisis Examining the physical and mental health consequences of gender-based violence, and the importance of survivor-centred healthcare, support services and prevention strategies.
SPAR will place a special focus on period poverty through a session led by Mpudi Maubane, National PR, Communications and Sponsorship Manager at SPAR, titled “Period Poverty: Dignity Should Not Depend on Income.”
“Period poverty extends far beyond access to menstrual products. When girls and women are unable to manage menstruation safely and with dignity, it affects school attendance, workplace participation, confidence and future opportunities. Addressing this challenge requires solutions that combine access, education and sustained partnerships to ensure that menstruation never becomes a barrier to full participation in society,” says Maubane.
The discussion will continue in a panel session titled “From Products to Policy: What It Will Take to End Period Poverty,” which will explore how business, government, educational institutions and community organisations can collaborate to develop sustainable, long-term solutions.
The programme features contributions from leading experts and advocates in women’s health, including clinical psychologist and founder the CBT group Dr Colinda Linde, obstetrician and gynaecologist Dr Sumayya Ebrahim, menstrual health activist Candice Chirwa, reproductive medicine specialist Prof Zozo Nene, menopause researcher and practitioner Dr Nicole Jaff, Co-CEO Tiko Benoit Renard, and head of oncology risk management and care coordination, discovery health Dr Kagiso Seripe.
The Women’s Health Matters Conference is expected to bring together between 200 and 250 stakeholders, including healthcare professionals, medical schemes and insurers, corporate and HR leaders, government representatives, NGOs, academics, researchers, workplace wellbeing practitioners and women leaders.
The conference will conclude with a forward-looking session, “From Awareness to Action,” focused on identifying practical commitments and collaborative actions that healthcare providers, employers, policymakers and communities can take forward beyond the event to create meaningful and lasting change in women’s health.
Event Details
Event: Women’s Health Matters Conference 2026 Date: Thursday, 3 September 2026 Registration: 08:30 Conference: 09:00 – 17:00 Venue: GIBS Business School, Johannesburg Headline Sponsor: Discovery Health
Discovery Health’s registered wellness providers will be on-site from 08:00 to 19:00, offering a complimentary Wellness Health Screening Experience for all attending delegates and guests. This includes glucose, cholesterol, blood pressure and BMI checks. Conference delegates will have the opportunity to gain valuable insights into their health and wellness throughout the day.
There is no link between the widely used diabetes and obesity medications known as GLP-1 receptor agonists and increased suicidal thoughts, depression or other serious psychiatric harm based on an integrative review of current scientific evidence conducted by researchers at New Mexico State University and the University of Nevada, Las Vegas.
The review, published in the journal Diabetology, traced the earliest concerns raised over GLP-1 RA therapies and found that after subsequent investigations, the medications do not increase psychiatric risk.
“GLP-1 RAs have become a cornerstone treatment for Type 2 diabetes and obesity, now used by tens of millions of patients worldwide,” said Jagdish Khubchandani, a professor of public health at NMSU, who co-authored the study with Kavita Batra, executive director of medical research and scholarly activities at the UNLV Kirk Kirkorian School of Medicine.
Reports that GLP-1s might trigger suicidal ideation, depression or anxiety began appearing soon after the medications gained mainstream popularity. Those reports then prompted formal safety reviews by the U.S. Food and Drug Administration and the European Medicines Agency, beginning in 2023.
The research team analyzed five years of mechanistic, pharmacovigilance, observational and regulatory evidence to trace how early reports were investigated and how the scientific and regulatory consensus shifted over time. Earlier this year, the FDA removed its suicidality warning from GLP-1 medications.
“When reports of depression and suicidal thoughts first surfaced with GLP-1 RA use, they came from patients and doctors voluntarily reporting what they saw, and such reports can raise a question, but can’t answer it,” Batra said. “Since then, studies following millions of patients, including a pooled analysis of 91 clinical trials, have found no increase in psychiatric risk. But an answer for millions isn’t an answer for everyone. The right response is to screen and check in with each patient, not to take an effective treatment off the table.”
The review found that early warning signals were largely tied to one drug from selected patient groups, while larger controlled studies often pointed in contradictory directions – something the research team attributes to study design rather than the drugs themselves.
Khubchandani said spontaneous adverse-event reports can be skewed by media attention, by the fact that people with obesity and diabetes already have higher baseline rates of depression and suicidality, and by more frequent medical visits among treated patients that create more opportunities for symptoms to be reported. Controlled studies that account for these factors do not show exceptionally high risks, he added.
Still, the review found that some groups using GL-P1s may need closer monitoring. Patients already taking antidepressants or benzodiazepines showed a substantially amplified reporting signal for suicidal ideation, suggesting that any residual risk may be concentrated among those with pre-existing psychiatric vulnerability rather than the general patient population.
“Depression is more common in people with Type 2 diabetes than in the general population, and it works in both directions: Depression makes diabetes harder to manage, and diabetes makes depression more likely,” Batra said. “So, the mood symptoms a patient reports on any diabetes medication may have been there long before the prescription. That’s exactly why asking about mental health should be a routine part of diabetes care, not a special step reserved for when a drug is under suspicion.”
Khubchandani said the pace of research on GL-P1 medications needs to catch up with their pace of usage, particularly among groups like adolescents, those with serious mental illnesses and other groups underrepresented in clinical trials to date.
“Just like for several other medications, the decision to use GLP-1 RA should include individualized screening of patients for psychiatric history and suicidality before starting treatment, watching more closely for patients with a history of mood disorders or concurrent psychiatric medication use, and educating patients and caregivers to report mood changes promptly,” Khubchandani said.
