Global March for Treatment Access, 9 July 2000

Text of the Global Call
List of Endorsements
Memorandum handed over to dignitaries at the end of the Global March

Report on Global March for Treatment Access

by Richard Pithouse

In May 1998 Ms Gugu Dlamini was stoned to death in Durban for revealing
that she was HIV positive. A few days ago 5000 people, many wearing "HIV
Positive" T-shirts gathered at the Durban city hall to demand equitable
access to HIV/AIDS treatment. The excited group of nuns, drag queens,
sangomas, doctors, communists, teenage punks on skate boards,
Pan-Africanists, gay activists, unionists, students and nurses had come
from all over Durban, South Africa and the world to join the Global March
for Access to HIV/AIDS treatment. The official posters castigated the drug
companies for making huge profits from the AIDS crisis while the homemade
posters said things like "AIDS is as real as cANCer" and "Mbeki, forget
your R3 million jet and buy us medicine."

The march was organised by the Treatment Action Campaign (TAC) - a rapidly
growing  organisation which strong support in the trade union movement. It
was lead by people of  the stature of  leading Muslim theologian Dr. Farid
Essack, Anglican Archbishop Njongonkulu Ndungane and  Catholic Archbishop
Denis Hurley. The streets of  Durban were full of singing, dancing,
laughter, warm solidarity and hope. Gugu Dlamini had been vindicated and
the demand for equitable access to HIV/AIDS treatment had been turned into
the single biggest issue confronting the 13th International AIDS
Conference. Previous conferences had focused on prevention but now
treatment, and equitable access to treatment, were topping the agenda.

But there was another major issue: Mbeki's reluctance to make AIDS drugs
available and his perceived support for the right wing  American AIDS
'dissidents'.  Before the conference  he had been 'trashed' on the
influential US news programme 60 Minutes and the leading  intellectual Dr.
Mamphele Ramphele had accused him of  "irresponsibility bordering on
criminality." Mbeki's credibility was compromised further by his
government's casual dismissal of the Durban Declaration, the international
outrage at his conference speech and the viciousness of his government's
response to criticism. Professor Thomas Croates of the University of
California went so far as to call the government's stance "genocidal".

There was a danger that Mbeki, rather than the AIDS pandemic, would be the
big news story coming out of the conference. But the extent of the crisis
was certainly made apparent. No one had to tell South Africans that they
were spending their weekends at funerals. But they learnt that there will
be 44 million African orphans by 2010, that South Africa has the highest
number of HIV infections in the world, that 5000 HIV positive babies are
born in South Africa each month, that 4.2 million South Africans are living
with HIV/AIDS and that by 2010 life expectancy in South Africa will drop to

Moreover the government's claim that AIDS drugs are ineffective and toxic
was conclusively refuted. South Africans learned that the drugs do work and
that those who can afford them can live a long and healthy life with HIV.
Scientists presented rigorous research showing that women who were given
AZT and 3TC after being raped by HIV positive men were not infected with
HIV. And although the South African government had repeatedly claimed that
Nevirapine is ineffective and toxic research showed that the worst side
effect of Nevirapine is that a few patients develop a mild rash on the day
after treatment and that Nevirapine does prevent mother to child
transmission. "The position," Jerry Coovadia insisted, " is now absolutely

The Executive Director of UNAids, Peter Pilot concluded that: "This
conference has made it irreversible - prevention and care are combined."
But, according to Time Magaine, only 20 000 of the millions of Africans
living with AIDS are receiving  treatment. The rest will probably be dead
within two to three years.  High Court Judge Edwin Cameron made the point
with headline grabbing eloquence: "My presence here embodies the injustices
of Aids in Africa. Amidst the poverty of Africa, I stand before you because
I am able to purchase health and vigour. I am here because I can afford to
pay for life itself."

Influential American economist Professor Jeffery Sachs agreed that "Talking
about prevention without treatment has been ended decisively at this
meeting" and added that "It (treatment) can be afforded." Jerry Coovadia
insisted that "it is too expensive not to intervene" and experts estimate
that the cost of non-intervention will be a 17% decline in the GDP by 2010.
The South African Department of Health estimates that it would cost $6
billion a year at current prices to provide anti-retroviral therapy to all
people living with HIV. That would be less than 3% of the national budget,
less than a fifth of the $32 billion which the government recently spent on
arms, and less than a sixth of the $40 billion which is spent on paying off
the apartheid debt each year.

But South Africans are still drinking bleach in a desperate attempt to self
medicate and wandering from hospital to hospital in a fruitless search from
help from the state.
Nevirapine, which costs R24 a dose, could prevent 5000 babies a month from
being infected with HIV but there is no treatment for the 1 in 4  15-24
year old South African women who are HIV positive. Nevirapine has been
approved for use in Uganda and Senegal but the Medicines Control Council
has still not approved the use of Nevirapine in South Africa.

The attack on the drug companies, which was begun at the march, was taken
forward by Edwin Cameron's widely reported comment that: "The drug
companies and African governments seem to have become involved in a kind of
collusive paralysis."
And with the World Health Organisation (WHO) and the highly respected Nobel
prize winning organisation Médécins sans Frontiérs (MSF) joining the attack
the drug companies were forced in to a defensive position. It was clear
that there is a critical mass of people who simply refuse to accept that
the Brazilian government can treat a thousand people with dual therapy for
the same price that the Ugandan government can treat 228 people or that 100
mg of AZT costs $200 in South Africa and $0.30 in Thailand.

In response to the pressure a group of 5 drug companies offered to cut
prices by 85% but the  MSF likened the gesture to "an elephant giving birth
to a mouse." MSF believes that the answer does not lie with donations or
price cuts from drug companies but rather with the Brazilian approach of
mass-producing quality generics. Countries which can't afford high prices
can either manufacture their own generics or import them from producing
countries. This could result in the cost of  a year's anti-retroviral
treatment being cut from the $2 250 which it would cost with the 85%
discount to a mere $200 a year. This is not a pipe dream. The polio vaccine
sold for several dollars in the US and just a few cents in the developing

Pfizer manufacture the fluconazole which is used to treat the opportunist
fungal infections suffered by people with HIV. Pfizer, who made a profit of
800 million US
Dollars last year from fluconazole alone (their total income was $3, 351
Million US Dollars), offered to provide free fluconazole to HIV patients
with cryptococcal meningitis. But only about 14% of  South Africans with
HIV develop cryptococcal meningitis. Pfizer are not making fluconazole
available to people with candida - the most common opportunistic infection
plaguing people with HIV. Candida leads to severe discomfort but one or two
fluconazole pills a day can restore quality of life, dignity and hope. So
unless they are prepared to smuggle a fluconazole generic in from Thailand
where it costs R3,72 a pill or India where it costs R7,81 a pill  South
Africans with candida will only be able to access fluconazole if  they can
pay R86 per pill - that's over R 60 00 a year.  Pfizer's offer expires at
the end of 2002, six months after their patent expires, and many people,
including an expert from the World Health Organisation, suspect that the
offer has been designed prevent the South African government from buying
generics for those 6 months.

It was no surprise to see that left leaning newspapers like England's
Guardian and Australia's Green Left Weekly came out against the drug
companies and the governments which support them. But it was highly unusual
and noteworthy to see conservative newspapers like The Washington Post and
The New York Times making similar arguments. The Washington Post said that
the fact that effective treatment is available but priced beyond the means
of the poor "constitutes an outrage against the most basic conceptions of
international justice, of human dignity, against the very idea of human
solidarity." This would have slotted in perfectly to Winnie
Madikizela-Mandela's rousing speech at the TAC march and it seems that the
enormity of the AIDS crisis has mounted a serious challenge to the orthodox
view that the market's thirst for profit must be put before the needs of
people. It has been widely recognised, even in conservative circles, that
there is simply no way that the AIDS pandemic can be countered until
governments insist that people's need be put before the profits of the

The demand to make the market serve the needs of people has passionate and
growing global support. What's more the TAC is prepared to take the South
African government and the drug companies to court if there is no immediate
progress and they'll have the support of people around the world -
including many those for whom the autonomy of the market was previously
non-negotiable. But what about Mbeki? Will he continue to equivocate in the
face of the avalanche of  international condemnation which has even united
Winnie and Nelson Mandela and the DP and the PAC in their criticism of the

Coovadia has acknowledged that "There is strong disapproval of the
government" and expressed his concern that the gap between the government
and its critics is widening." This raises important questions of strategy
for the AIDS activists. Should they challenge the government directly or
should they rather give Mbeki the space to back down gracefully?

The charismatic chairperson of  the TAC, Zachie Achmat, has taken a
principled decision not to take any anti-retroviral drugs until the
government makes the medication available to all people living with HIV. He
describes himself as "an ANC member in good standing - I attend all my
branch meetings!" Moreoever the bulk of the rapidly growing TAC membership
come from ANC aligned unions and are probably ANC supporters. Achmat
explains that "Our approach is to take a firm, principled stand on the
issues. But if it becomes clear that they won't compromise then we will
issue a challenge." He confirmed that if  the Minister of Health fails to
provide Nevirapine to pregnant women by Friday the TAC will launch an
urgent High Court application demanding the constitutional right to
treatment. TAC has also served notice that it will take legal action
against Pfizer to seek a compulsory license to allow South African
companies to produce cheaper copies of fluconazole. TAC have also committed
themselves to a defiance campaign.  They will import fluconazole and
distribute the drug through a number of doctors and nurses who have already
indicated their support for the project. Achmat explained that: "We are
taking this action because we've been in negotiations with government for
two years. They promised to act as soon as they got the S.A.I.N.T. report
on the Nevirapine trial. They got it two weeks before the conference but
there has been no announcement."

Mbeki's likely response to this action is still a matter of conjecture. But
it is clear that the TAC and other AIDS activists have major support in
South Africa and around the world. If Mbeki treats AIDS activists rather
than AIDS as the enemy he runs a serious risk of losing all credibility.
Indeed, it seems clear that if Mbeki fails this test a significant sector
of his own electorate will judge him to be unfit to govern.