By: Khanyisa Dunjwa, SANAC Women Sector Chairperson
South Africa’s National Strategic Plan (NSP) for HIV, TB and STIs, 2023 – 2028 is not just another technical document collecting dust – it’s our country’s collective strategic framework to end AIDS as a public health threat by 2030. It outlines the strategic direction the entire HIV response must follow: multisectoral collaboration, people-centred programming, and an honest reckoning with the social drivers of disease. But are we following that plan, or just nodding at it in meetings?
With the launch of the Global Fund’s Grant Cycle 7 (GC7) for adolescents and young people (AYP) on the horizon, we are watching funding decisions move ahead – and they seem to be following a different compass altogether.
The SHIPP Tool: Efficient, But At What Cost?
The Sustained HIV Incidence Projection and Prioritization (SHIPP) model – developed by UNAIDS – was used to select priority districts for GC7. It draws from district level HIV data to estimate incidence and burden and aims to guide investment to where the impact could be maximised. On paper, this makes sense. In reality, it leaves too much out. What about high positivity rates that signal ongoing transmission in certain districts? What about places where the treatment cascade is weak and people are falling through the cracks? What about social drivers like stigma, gender inequality, and poverty that intensify vulnerability? In some provinces – particularly the Eastern Cape – Nelson Mandela Bay Metro stands out as a district with a high positivity rate and previous Global Fund investment under GC6, yet it has been excluded from GC7 prioritisation. While a comprehensive review across all provinces hasn’t been done, Nelson Mandela Bay serves as a critical example of how the SHIPP model’s data selection risks overlooking districts facing persistent challenges.
Are We Making the Decisions?
It’s important to remember tools like the SHIPP model are just that – tools. They are not mandates. They are recommendations provided by global technical agencies to support planning. But countries are expected to make their own decisions, rooted in their strategic plans, community realities, and governance priorities.
So, we must ask: Are we making those decisions? Or are we defaulting to technical models and external guidance without applying our own lens?
If we are simply accepting outputs from a model – without robust national debate, without centering the NSP, without applying contextual knowledge – then we are not exercising strategic leadership. We are surrendering it.
South Africa has the technical capacity, the community intelligence, and the institutional structures to lead its own HIV response. But that leadership must be active, interrogative, and unapologetically sovereign.
Data is Not Neutral
Data reflects what we value, what we measure, and whose voices we prioritise. In GC6, South Africa invested in community-led monitoring. Civil society organisations collected detailed, on-the-ground insights about access, stigma, stockouts, and service delivery failures. If that was a serious investment, where is that data now? Why is it not shaping the next phase of programming?District Health Information System (DHIS) data captures clinical service indicators. But it does not reflect the lived realities of adolescent girls facing sexual violence, or key populations navigating criminalisation and stigma. And yet, it is this narrow data set that dominates district prioritisation.
Civil Society’s Role and Continued Advocacy
Through the SANAC Technical Support Unit (TSU), the Civil Society Adolescents and Young People (AYP) Technical Advisor submitted a detailed position paper on behalf of civil society in June 2025. The paper highlighted concerns about the limitations of the SHIPP model and its potential to overlook critical social realities. Despite these efforts, we have seen little change in how funding decisions are being made. Our commitment remains firm: to engage constructively, advocate persistently, and ensure that community voices and lived experiences shape the strategic direction going forward.
When Consultation is Not Enough
Yes, provinces were “consulted.” But when they were handed pre-set lists with little space to contest assumptions, how much say did they really have? And are key provincial stakeholders truly equipped or resourced to interrogate complex epidemiological models – especially when social realities don’t show up in the spreadsheets?
We are dangerously close to a culture where consultation is symbolic, and where provinces must simply align with national-level decisions, regardless of whether they reflect what’s happening on the ground.
The Stakes for U=U and Prevention
Consider the implications for U=U (Undetectable = Untransmittable) – a globally endorsed concept that affirms that when a person living with HIV maintains an undetectable viral load, they cannot transmit the virus. This is not just a scientific breakthrough; it is a powerful prevention tool.
But if we deprioritise districts with poor treatment coverage and low viral suppression – because they don’t score high on a model – we risk missing this preventive benefit. That would be a major setback for the NSP’s prevention goals.
The Contradiction Within UNAIDS
The contradiction is striking both the SHIPP model and the global “End AIDS by 2030” goal are endorsed by UNAIDS. How do we reconcile a tool that sidesteps social realities with a vision that demands holistic, rights-based, inclusive responses? We can’t. It reveals a fragmentation in global guidance – and countries like South Africa bear the brunt of trying to make fragmented tools deliver unified results.
We Need Strategic Coherence, Not Fragmentation
If the NSP is our roadmap, then our funding models, data systems, and monitoring tools must be aligned to that vision. This includes building mechanisms to ensure that civil society voices, district-level feedback, and community data influence decision-making not after the fact, but at the design stage.
Provincial Voices Must Be Empowered
Let’s be clear: provinces are not weak links in this process. They are often on the frontlines, managing trade-offs with minimal resources. But they are rarely empowered to contest or negotiate funding decisions made at national or international levels.
If we continue with this symbolic decentralisation – where provincial inputs are sought only to rubber-stamp pre-made decisions – we erode the principle of participatory governance.
Community Systems Strengthening: The Missing Link in Holistic Planning
If provinces and communities are to have real influence over funding decisions and program design, we cannot ignore the backbone that makes this possible: Community Systems Strengthening (CSS). CSS supports community-led monitoring, capacity building, advocacy, and addresses social enablers like stigma and discrimination – all crucial for generating the kind of rich, contextual data that standard epidemiological models often miss.
Yet, troublingly, the Global Fund’s Grant Cycle 7 has seen a reduction in CSS funding allocations. This is a step backwards. Cutting resources for community systems risks silencing the very voices and data sources that reveal on-the-ground realities beyond numbers. Without robust CSS investment, the programs will continue to rely on limited clinical data that fails to capture social drivers and barriers critical to success.
Investing in CSS is not just about fairness or participation; it’s about better results. Community-led interventions improve service uptake, retention, and adherence -directly contributing to the NSP’s goals. They enable local health workers and activists to hold systems accountable and ensure interventions are tailored to real needs.
Reducing CSS funding undermines these gains and threatens to deepen the disconnect between national strategies and district realities. If we want to truly sail in the direction of the NSP, strengthening community systems must be a non-negotiable priority – not an afterthought
Ambition Requires Unity
The strategic challenge facing South Africa is not whether we can afford to be ambitious. It’s whether we can afford to be disjointed. Resources are shrinking, but the stakes are growing. Every misaligned investment is not just a missed opportunity – it’s a delay in ending preventable illness and death.
No More Models Without Moral Clarity
We don’t need more models. We need moral clarity. We need to trust communities when they tell us where the crisis is. And we need to hold every partner – including donors – accountable to the country’s priorities, not just their own metrics of success
We Can Still Get Back on Course
South Africa has the vision, the plans, and the evidence. What we need now is the political will and strategic coordination to stay the course. Let’s steer the ship in the right direction.
