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HIV Epidemic Control in South Africa pivots on the success of providing appropriate services for key populations, including sex workers (SWs), their clients, and transgender (TG) people. Wits Reproductive Health and HIV Institute (Wits RHI) is a national leader in developing a model of provision of accessible clinical interventions for SWs. Our existing highly successful PEPFAR-supported 5-year sex worker program is currently implemented in five provinces of the country, and we plan to expand an adapted model to provide similar comprehensive services for TG populations.

In the face of remarkably high HIV risk within both communities, we have interventions to address risk-taking behaviors, and demonstrated innovative service delivery models for HIV care, treatment, and prevention that are led by each community and effective in both clinic and community settings.

South Africa's uniquely enabling environment for SW and TG health interventions supports our efforts to bring these successes to scale and includes:

- The South African National SW HIV Plan 2016-2019, led by the South African National AIDS Council (SANAC) and supported by PEPFAR, that clearly delineates health service expectations within the national health services; and direct mention of the importance of addressing SW and TG HIV vulnerability in both the current (2017-2022) and prior versions of the National Strategic Plan for HIV, TB, and STIs (NSP).
- South Africa's Bill of Rights (Chapter 2, Section 9.3) enshrines the human rights of LGBTI people. In 2014, the Government of South Africa (GOSA) launched the National Intervention Strategy for Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTQI) sector (2014-2017), advocating for an intersectional approach to prevent discrimination and violence against LGBTI persons. In 2017, SANAC released the National LGBTI HIV Plan (2017-2022). Both documents have the objective of closing the gap between policy and practice in order to realize the rights of LGBTI people and underpin our technical approach to TG programming.
- Sustained funding from external donors for SW and TG health interventions, including from PEPFAR, the Global Fund, the Bill and Melinda Gates Foundation, and AIDSFONDS.
- Prioritizing SWs and TG people for HIV prevention interventions within the Department of Health (DOH), including one of the world's largest pre-exposure prophylaxis (PrEP) programs, and for removal of CD4 thresholds for antiretroviral therapy (ART) initiation.
- Free access to all clinical primary care requirements for SWs and TG people, including HIV testing, ART, PrEP, male and female condoms, sexually transmitted infection (STI) treatment and contraception, and laboratory services.
- Continued growth of an active, sophisticated civil-society SW movement that has increasing reach within large SW communities, as well as TG issues featuring more prominently within many organizations, and several bespoke TG-led community organizations emerging.
- Political engagement at the highest level, including the Deputy President, the Department of Social Development (DSD), the South African Police Services (SAPS), and the government.

However, significant challenges still hinder the expansion of interventions that would further support effective HIV prevention and care:

- Continued, extremely high levels of HIV and STIs among SWs and TG people, especially among the young demographic, and within surrounding communities.
- Risk-taking behaviors such as inconsistent condom use and substance abuse.
- Limited implementation of the SW Plan and NSP recommendations at a grassroots level, with inadequate coverage, undermining epidemic control.
- Poor linkage to care, treatment, and prevention interventions.
- Continued stigma, discrimination, police abuse, and gender-based violence (GBV).
- A growing and complex community of male and TG SWs.
- Poor access to dedicated TG health services for the community.

Wits Health Consortium (Pty)

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98.001 - USAID Foreign Assistance for Programs Overseas

U.S. Mission to South Africa [USAID - OM]

South Africa

Foreign

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Termination This cooperative agreement was reported as terminated by the Department of Government Efficiency (DOGE) in July 2025. See All
Amendment Since initial award the End Date has been extended from 09/06/23 to 12/30/25 and the total obligations have increased 2001% from $1,793,133 to $37,673,957.