On 15 July, South Africa submitted a concept note to the Global Fund for HIV/TB funding. More than half of the funding requested is to support prevention interventions specifically targeting key populations including young women and girls, men who have sex with men and people living in disease hot spots.

The proposed slate of interventions would position the Global Fund as the single biggest investor in key populations programmeming in the country, complementing the government’s annual budget for its High Transmission Areas programmeme and the PEPFAR/USAID budget for DREAMS, inmates and other key populations.

The remainder of the funding would support improvements in quality of care through high-impact interventions that focus on gender-based violence, stigma, treatment adherence and strengthening health and community systems, supporting multi-sectoral work by the government of South Africa.

South Africa embraced good practice for an inclusive country dialogue. Health Minister Aaron Motsoaledi joined a prioritisation discussion at the CCM in March, and consultations included a wide range of constituencies. A series of smaller technical consultations was led by South African National AIDS Council (SANAC): a coordination and oversight body that deliberately does not take funding from the Global Fund. The CCM also published a Civil Society Priorities Charter, as well as a Key Populations Supplement: important guiding documents for the prioritised interventions in the concept note.

Brian Kanyemba, a civil society representative for the LGBTI communities in the country coordinating mechanism (CCM), drove the development of the Key Populations Supplement.

“Key populations are too often ignored and stigmatized, or patronized in trials and studies, rather than being truly engaged in solutions to the epidemic,” said Kanyemba.

The decision to focus on key populations and specific geographic hot spots was informed by emerging evidence supporting a more targeted approach to HIV and TB resource distribution in South Africa. Preliminary results from a first geospatial mapping show that there are clear hot spots and cold spots within provinces, and that a district-based approach that strategically saturates hyper-endemic hot spots (which could be as focused as 16 km2 sub-districts) is a more efficient method.

In addition to offering a comprehensive package of services to key populations in targeted districts, South Africa has also presented innovative activities for consideration for incentive funding, including mobile smartphone applications and sustainable finance mechanisms.

“The resulting concept note is a well-balanced proposal that supports the very ambitious treatment programme that has made South Africa a world leader in the AIDS response,” said Dr. Fareed Abdullah, CEO of SANAC. “The programme also scales up interventions for previously neglected key populations such as sex workers, men who have sex with men, transgender women and men, people who inject drugs and prison inmates, to levels that will have a national impact.”

A longer version of this article first appeared on

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