Today, the global public health community places an emphasis on creating “sustainable” intervention mechanisms that integrate with local governments and existing infrastructure for long term success. Through an in-depth evaluation of Botswana’s public-private healthcare intervention to combat HIV/AIDS, with supporting on-the-ground interviews and extensive evaluation of published data, I argue that key factors deemed essential for long-term sustainable healthcare programs have the potential to isolate and additionally harm certain segments of a population. Given the distinct marginalization of key populations, the concept of sustainability needs to be recast in a manner that achieves health for all segments of a population.