South Africa: Treatment Action Campaign turns 14

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December 10, 2012 -- TAC Electronic newsletter -- The Treatment Action Campaign (TAC) was launched on December 10, 1998, the 50th anniversary of the Universal Declaration of Human Rights. TAC turns 14 years old on international human rights day. This birthday comes at a time where many celebrate the good progress made with regards to expanded access to antiretrovirus medicines (ARVs), but its not yet uhuru [liberation]. This does not mean the war against HIV and AIDS is over as many of us tend to forget where we come from and much focus is still needed on the road ahead. Many global leaders have started to reverse their commitment to see this struggle through and get to the zero-infection, zero-deaths and zero-discrimination target.

TAC campaigns for the realisation of the right to health including socioeconomic rights and the right to equality for poor people. Our main focus is the right to access quality health care that includes access to life-saving HIV treatment enshrined in the South Africa constitution. Between 1998 to 2012 TAC has created a profile as an organisation that fights for the realisation of the right to health for poor people living with HIV.

Our strategies were shaped by the political environment in South Africa and internationally regarding access to HIV treatment. TAC had no choice other than to mobilise people in communities through education and ownership of scientific knowledge, law and politics to create active citizenship to challenge and overcome poor political will to change HIV policies and private power and profiteering over medicines in South Africa. Both campaigns had demonstrable success. In early 2002 the price of first line anti-retroviral medicines fell dramatically, making them affordable in South Africa. AIDS denialism ended with the appointment of Barbara Hogan as Minister of Health in October 2008 and with the current minister of health Dr Aaron Motsoaledi.

But with [the African National Congress' South African state president Thabo] Mbeki gone, and access to ARV medicine guaranteed to the extent that the health system has the capacity to provide it and the government can afford it, the next decade will contain different challenges, both for government and civil society. A balance will have to be found between sustaining campaigns for access to ARV treatment and health care services, and robust political advocacy and action against inequality.

In the late 1990s it seemed as if AIDS would follow the course of other diseases of the developing countries: treatable if you were rich and life threatening and a death sentence if you were poor. However, TAC and AIDS activists globally were able to change that course. TAC's volunteers were mostly marginalised young women and men from poor communities, many of them living with HIV and in need of treatment. They were assisted to organise and unleash their power as rights-bearing citizens of a democratic South Africa through utilising constitutionally entrenched rights to demonstrate, organise, educate and finally resort to the courts to promote and fulfil these rights. In many ways TAC developed as a model of how human rights, law and mobilisation can be combined to further the interests of poor people.

TAC's achievements are real. The course it followed in overcoming the obstacles to access to treatment was unavoidable. Guaranteeing access to life-saving medicines was, after all, its primary mission. But TAC has grown into more than just a limited campaign for ARV treatment. We now reflect aspirations to protect human rights more broadly and sustain access to treatment through transformation and improvement of the broader state health system. This therefore requires us to examine TAC in the broader context of the social and political factors. The TAC strategies largely remain the same, using the intention to defend the constitution and sustain community mobilisation in order to utilise the national state as an instrument of democracy that can deliver on poor people's needs.

Major achievements

It took sweat, struggle, confrontations and court battles to achieve every major breakthrough in the struggle for access to treatment. For example, the prevention of mother-to-child HIV transmission campaign (2002) resulted in mother-to-child HIV transmission in South Africa being reduced from 30% to 2.7%. This campaign allowed more recognition of sexual reproductive rights for women living with HIV. The right to have a healthy child, which in the early 1990s and still today in some areas was or is taken away through forced sterilisations imposed to HIV positive women.

Through a national treatment plan (2003), access to ARVs has expanded from zero people in the public sector in 1998 to 1.7 million in 2012. The cost of ARVs has dropped significantly from R4500 in 1998 to less than R200 for first-line drugs

 This came about as well through sacrifices of many TAC comrades, to name a few: Sarah Hlalele, Edward Mabunda, Kebareng Moketsi, Zoliswa Magwentshu, Vuyani Jacobs, Winston Zulu, Mandisa Magugwana, Mike Matyeni , Nomfundo Somana, Oupa Fazi, Queeni Qhiza, Christopher Moraka, Nkosinathi Magwala and many many who fought tirelesslessly calling for a national treatment plan.

However, there are still many challenges as the cost of other essential drugs are still persistently too expensive. For example multidrug resistance TB drugs, cancer medications and second- and third-line ARV drugs are not affordable to poor people.

Today, South Africa has the largest ARV program in the world but this achievement has its own challenges. Today we are faced with treatment interruptions where many people in the poor provinces are given three days to two weeks of treatment. This highlights public health sector's challenges in managing supply-chain management among other challenges.

 We fought for access to treatment for prisoners (2006), we achieved an ambitious National Strategic Plan on HIV, AIDS and sexully transmitted conditions (2007) that now aims to treat 3 million people by 2016, and we challenged and fought the battle against state-encouraged quackery since (2008). This work still continues, changes in treatment guidelines to treat earlier and the latest announcement of the introduction of a fixed-dose combination "pill a day" from April 2013 are among some of the latest strides in the access to medicines campaign.

Against this constant, the question of profiteering from medicines by multinational pharmaceutical companies was an issue taken on by TAC successfully, but only sporadically. Similarly, the critical issues of access to a quality health-care system and HIV prevention received scant attention. Two other issues can be postponed no longer: preventing new HIV infections and resuscitating South Africa's health system.

Sustainability of HIV treatment program

Unless the tap of new infections is turned off it will be impossible to meet the demand for treatment. Successful HIV prevention on a large scale cannot be undertaken without challenging the socioeconomic drivers of HIV infections. The sustainability of access to treatment for people with AIDS is dependent on both interventions.

Unless, the health system is strengthened and improved it will be impossible to supply the demand. We have to challenge the inequalities within it, and the systems for its governance, particularly its financing and quality of services it provides. These issues necessitate a new approach to AIDS by civil society as a whole and TAC in particular. In a country with the highest HIV prevalence in the world and with government commitment to fight the scourge, evident in the largest AIDS treatment program in the world, which is mostly financed by government, the way forward presents different challenges for both government and civil society.

Future challenges

For TAC in the next few years our challenge is to make sure that the ARV program produces quality HIV and TB care for all people living with HIV. This can be done by pushing for more integration of TB and HIV-care services, integration of women's reproduction health and of mental health care in HIV care. This includes mobilising others to join forces to ensure equal access to affordable medicines, diagnostics and vaccines. Also we need to make sure that everyone who is eligible for treatment has access, while retaining those on treatment in care through improving adherence support.

Affordable medicines can only be available where there is no monopoly of the market, South Africa must amend its patent laws in the interests of public health. We have seen how the ARV tender has managed to negotiate the best prices, the same needs to apply to TB medicines, cervical cancer vaccines and cancer treatments.

TAC envisages its role in national health as one that directly challenges government policies that causes and reinforces inequality. The relationship between health and development is one that cannot be ignored any longer. Globally, the campaign for resources for health is a priority. In a system where human rights are supposed to be the basis for policy decisions, resource decisions must also be subject to the constitution. When governments declare that there is no money for universal access to treatment there may be legitimate budgetary limitations, but we demand to know the methods they have used to calculate available resources.

The war against HIV has just seriously began and we are starting to see the signs and we cannot stop here -- we have to cross the finish line.

As the ANC prepares for it conference in Mangaung we ask for principled leadership that is prepared to deal decisively with the everyday health challenges faced by South Africans, the regular treatment stock-outs must end.

The ANC conference must choose a leadership prepared to end gender-based violence by scraping the Traditional Courts Bill that seeks to undermine women's rights. It must act to end corruption in the public sector and must ensure that the young people of South Africa will have job opportunities in this life time.

TAC would like to thank our former leaders, namely comardes Sipho Mthathi, Zackie Achmat, Mandla Majola, Edwin Cameroon, Morna Cornell, Fatima Hassan, Thabo Cele, Gordon Mthembu and many others who led the struggle. Thanks to the thousands of current and former TAC members and supporters who continue to dedicate their time, skills and energy to help us achieve all that we have achieved. We also want to remind all of us that the struggle continues.

Support TAC by donating, volunteering or supporting us:

Bank details: Bank: Nedbank, Cape Town, Account Holder: Treatment Action Campaign, Account Number: 100 972 6269, Branch code: 100 909

Office details to enquire about volunteering: 021 422 1700 or email: manti@tac.org.za.