Seven years ago, the President’s Emergency Plan for AIDS Relief (PEPFAR) made its first investments in South Africa, the heart of the global HIV/AIDS pandemic. These historic investments quickly grew to become the largest single bilateral health account in the world. The resulting story of U.S. engagement in South Africa is one of strategic choice, sustained commitment, and significant human impact. In the past three years, it has also been the story of increased South African ownership and action, as its government has brought unprecedented levels of money and political will to the battle against HIV/AIDS.
Today, South Africa is home to a profoundly important transition in U.S. foreign assistance. The United States and South Africa are negotiating a complex, multiyear handoff that will shift financial and managerial responsibilities for HIV/AIDS to the South African government and move the United States away from direct service delivery and into technical assistance. This report outlines five key steps the United States, in close partnership with South Africa, can take to build on recent gains, manage the risks and tensions associated with the transition, and raise the prospects of success.