At the project’s inception, USAID/South Africa’s Health and HIV/AIDS Strategy was responding to the overwhelming challenges posed by the epidemic on individuals, families, communities and society in South Africa. There had been a dramatic rise in HIV infections during the previous decade threatening to undermine many of the advances made since efforts to transform the sector began in 1994. During the fifteen years prior to the project, HIV infection rates among pregnant women in antenatal clinics went from less than one percent (in 1990) to over 30 percent (in 2005). The South African National Department of Health estimated that about five million, or one in ten South Africans, were infected with HIV. This was more than any other country in the world, and each day, more than 1,700 additional people became infected. In 2006, the South African Government declared Tuberculosis (TB) a crisis, which became exacerbated by the emergence of extremely drug resistant TB (XDR-TB).