He was sitting in a clinic. Waiting. And waiting. And waiting for his grandparents' HIV medicine.
Sizwe Nzima was a high school student in Cape Town, South Africa, when he would pick up the medicine for his HIV-positive grandparents, who had difficulty traveling to the clinic themselves. Because of the long lines, Nzima usually waited hours and often made multiple trips to the clinic before and after school. He tried to bribe the pharmacists to get the medication sooner. But it didn't work.
So there he was, sitting on a hard wooden bench at the clinic one day about four years ago, when he had an idea: Why not start an HIV medicine delivery service?
He did some research and found that plenty of companies in Cape Town delivered medication to people's homes. But none were operating in the city's low-income townships, where unemployment levels are high and most people live in wooden or metal shacks. The companies told Nzima it wasn't that they were discriminating against poor people. They just couldn't find the houses.
"You punch [an address] into Google, Google won't find it," Nzima agrees. "It needs local knowledge."
Nzima might be onto something. The problem of wait times in sub-Saharan African is epic. In South Africa alone, one in eight people – more than six million – are HIV-positive. Across the continent, tens of millions are infected with the virus. The result is overcrowded health clinics, and patients who travel great distances to get their HIV medicine.
For poor people, long waits are more than just an annoyance. Suhair Solomon, an HIV expert with the international health organization Doctors Without Borders, says spending all day in line means lost income and lost opportunities to look for work. As a result, many poor people don't show up.
Across sub-Saharan Africa, millions fail to take their HIV medication consistently, leading to easily preventable sickness and death. Long lines are part of the reason.
South Africa has come up with some solutions. Doctors Without Borders has created HIV "adherence clubs" – basically, support groups that often meet at patients' houses. At the end of each meeting, a health worker distributes HIV medicine to the attendees. Solomon says the entire process takes 45 minutes to one hour.
There's also a new pharmacy in South Africa that utilizes electronic prescriptions and dispenses HIV medicine almost immediately.
And then there's Nzima's business, which might be the first of its kind: a bicycle-based, HIV medicine delivery service. It's called Iyeza Express.
On a recent afternoon, Nzima pedaled his bike — which is partially powered by an electric motor — along a narrow road, past rows of shacks. Motorcycles and buses whizzed by. He rounded a corner and was chased by an angry dog. Of the many dangers he faces — cars, robbers, vandals — he says dogs are the biggest hazard.
He eventually arrived at a small brick home and knocked on the door. Loyce Peko, a 63-year-old man with gray hair, answered. Nzima handed him a white plastic bag of HIV medicine and collected a delivery fee of about 90 cents. The two chatted inside Peko's house for a few minutes.
Peko said this delivery service, which brings his medicine one day each month, is wonderful. "Because my wife and me, we are elderlies, and without my medication, I'm nothing."
The two thanked each other and Nzima got back on his bike to head to the next client's house.
When Nzima started this business a few years ago, he had just two customers — his grandma and his grandpa. He slowly started to expand, but ran into a problem. His arrival at someone's doorstep – clad in a fluorescent green vest, with the Iyeza Express logo – felt like a pronouncement: The person who lives here is HIV-positive. He says this deterred many potential customers.
So Nzima diversified. He began delivering other medications, too – for chronic illnesses like diabetes and epilepsy. That's when his business really took off. He now has 930 clients and a staff of six riders, some of whom work full-time. He says no staff members are getting rich, but they're making a decent living.
Iyeza Express also gets support from a local business incubation program that provides free office space, including a telephone, computer and WiFi. Nzima says if it weren't for this support, he wouldn't be able to offer the service at such a low cost.
He may soon be branching out even further. Earlier this year, Nzima, now 23, was contacted by an international shipping company that hopes to offer package delivery to Cape Town's urban townships.
They want Nzima and his crew to be the deliverymen.
ROBERT SIEGEL, HOST:
HIV medicine is more widely available than ever before. More than 10 million people around the world now have access to the life-saving drugs. But actually getting those drugs from the local clinic isn't always easy. NPR's Anders Kelto explains why.
ANDERS KELTO, BYLINE: I recently stopped by an HIV clinic in Cape Town, South Africa, and it was a familiar scene - dozens of people sitting on wooden benches looking really, really bored.
KUMELO ENCLAZANE: (Foreign language spoken).
KELTO: Kumelo Enclazane (ph) told me he'd been at the clinic since six in the morning. It was two in the afternoon. I turns out long waits are a common problem across Africa, and for a poor person, it can be more than just an annoyance.
SUHAIR SOLOMON: You're asking a patient to come and sit in a clinic for more than four or five hours. It really can have a significant negative impact on their life.
KELTO: Suhair Solomon is an HIV expert with Doctors Without Borders in Cape Town. She says spending all day at the clinic means missing work and losing money, but here's the part that surprised me. Because of this lost income and the long waits, a lot of people just don't show up. Tens of thousands - maybe hundreds of thousands of people get sick and even die because of long lines. Doctors Without Borders has come up with one solution. They've created HIV clubs that deliver medicine much more quickly.
SOLOMON: At an adherence club, you'll sit for a maximum of 45 minutes to an hour.
KELTO: There's also a new pharmacy in South Africa with a special machine that dispenses HIV medicine almost immediately. But perhaps the best solution has come from this guy, 23-year-old Sizwe Nzima.
SIZWE NZIMA: That looks like a nice bike.
KELTO: He's really into bikes, especially mine which actually isn't that nice.
NZIMA: Wow, that's nice. Woah, woah, now that is what I'm talking about.
KELTO: I met him at his small office in a low-income part of Cape Town. He was stuffing white plastic bags into a backpack.
NZIMA: OK, these are the medication packs.
KELTO: Once his backpack was full, he hopped on his bike.
NZIMA: OK, let's rock and roll - Sizwe on the journey.
KELTO: When Nzima was a teenager, he used to pick up his grandparents HIV medicine. He said he would get so frustrated with the long waits that he actually tried to bribe the pharmacist.
NZIMA: Can you do this for me? Can you keep this medication for me until I get back at a certain time?
KELTO: Then he thought wait, instead of paying money, why not try to make money here by starting a medicine delivery service? He did some research and found lots of companies that delivered meds, but none were operating in Cape Town's urban townships where most people live in shacks without addresses. And, Nzima said, even if a place has an address, it won't help.
NZIMA: You punch that in Google, Google won't give it to you.
KELTO: So you just - you need someone that knows the area.
NZIMA: It needs local knowledge.
KELTO: So he turned his local knowledge into the first business of its kind, a bike delivery service for HIV patients. He peddled along a narrow road past rows of shacks. At one point, he almost got attacked by a dog.
Of the many dangers he faces - speeding cars, robbers - he said dogs, they're the worst.
NZIMA: That's the biggest hazard. Look, check these guys out. No, no, no, no.
KELTO: He made a few more turns and eventually arrived at a small brick house.
NZIMA: Don't worry you don't have to lock our bikes. You can just put them down.
KELTO: A man with gray hair answered the door.
NZIMA: (Foreign language spoken).
KELTO: Nzima handed him the medicine and collected a delivery fee - about 90 cents. I asked the man, named Loyce Peko, what he thought of this service.
LOYCE PEKO: Oh that's very wonderful. It is because my wife and me - we are elderly's, and without my medication, I'm nothing.
KELTO: The two thanked each other and Nzima got back on his bike. When he started this business a few years ago, Nzima had just two clients, his grandma and his grandpa. Now he's got a lot more.
NZIMA: I'm doing good, man.
KELTO: He also has a staff of six, and like any good businessman, he keeps expanding the company. Anders Kelto, NPR News. Transcript provided by NPR, Copyright NPR.