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South Africa is the center of the global AIDS epidemic with an estimated 5.6 million people living with the disease. USAID works with the South African Government (SAG), other United States Government (USG) agencies implementing the President’s Emergency Plan for AIDS Relief (PEPFAR), public and private sectors, nongovernmental organizations (NGOs), and faith-based partners to train and support facility based and community based workers serving those with HIV/AIDS. Working through this network, USAID has enabled the placement of over 1.4 million people on antiretroviral treatment and ensured that more than 2 million HIV-infected people received care and support services. The spread of HIV/AIDS has fueled a concurrent tuberculosis (TB) epidemic and a growing incidence of multi and extensively drug resistant TB. With support from USAID’s health monies as well as PEPFAR funding, the South African National TB Program has built diagnostic and treatment capacity to help curb this public health threat.
A five-year Partnership Framework (PF) agreement was signed between the SAG and the USG in 2010, providing a path for the transition of the PEPFAR program from emergency assistance to sustainable activities. The focus areas under the PF are: to increase the SAG’s leadership and coordination of PEPFAR operations and to shift PEPFAR’s programmatic focus from direct service delivery to capacity development to sustain health outcomes. The latter focus will be achieved through the transfer of clinical care and treatment services to the SAG, alignment of PEPFAR’s prevention and community-based care and treatment with SAG policies and directives and integration of these activities into provincial plans, and capacity building.
PEPFAR is shifting from its initial emergency focus to a heightened emphasis on sustainability, with a core emphasis on HIV prevention over the next five years. This next phase of PEPFAR presents the opportunity to support countries in reassessing prevention portfolios in order to ensure that they are targeted for maximum impact by strengthening health systems as a way to reduce illness and death, particularly maternal mortality and childhood infectious diseases.
PEPFAR is expanding investments into high-impact prevention interventions, such as prevention of mother-to-child transmission (PMTCT) and medical male circumcision (MMC).The program is working to identify, implement, and evaluate promising and innovative prevention methods, to expand PEPFAR's existing toolkit of interventions, and to advance the science around HIV prevention. USAID also builds management and technical capacity to address the epidemic, working with the public and private sectors, nongovernmental organizations, and faith-based partners to train and support facility-based and community-based workers who are helping people with HIV/AIDS.
With support from USAID, the South African Government has provided tuberculosis treatment to more than 100,000 people co-infected with HIV to date. USAID also works with South Africa’s Department of Social Development and nongovernmental organizations to provide care for 486,355 orphans and vulnerable children.