The Treatment Action Campaign (TAC) was founded in December 1998 to campaign for access to AIDS treatment. It is widely acknowledged as one of the most important civil society organisations active on AIDS in the developing world. One of its most significant victories was the 2002 Constitutional Court ruling in which the South African government was ordered to provide anti-retroviral drugs to prevent transmission of HIV from mothers to their babies during birth. In the years following the judgment the TAC’s campaigns were instrumental in securing a universal government-provided AIDS treatment programme, which has since become the world’s largest. In 2006 the New York Times called the TAC “the world’s most effective AIDS group,” while the founding director of UNAIDS, Dr Peter Piot, has written that “TAC was in my opinion the smartest activist group of all, worldwide.” In 2007, in large part owing to pressure from the TAC, the National Strategic Plan on HIV, STIs and Tuberculosis 2007-2011 was adopted by Parliament.
Today the TAC continues to represent users of the public healthcare system in South Africa, and to campaign and litigate on critical issues related to the quality of and access to healthcare. The organisation currently has over 8,000 members and a network of 182 branches and provincial offices in seven of South Africa’s nine provinces. Members elect the leadership of the organisation, which ensures accountability and that the TAC’s policies reflect the realities on the ground. Members receive basic training in the science of HIV, TB and related conditions, and about their rights in the healthcare system. Through its branches and members the TAC monitors thousands of clinics and hospitals. Its members are the people who need the public health system to work, so they are the first to notice when it doesn’t. In addition to the large national campaigns, the local activism of the TAC’s members is the true life-blood of the organisation. By organising locally, our members demand accountability and quality healthcare services where the services are actually delivered.
South Africa’s AIDS response is in peril
Approximately 12% of the South African population is HIV-positive – this amounts to over 6 million people. For people aged 15 to 49 the rate is 17%. South Africa has the world’s largest AIDS treatment programme with over 2 .4 million people on antiretroviral therapy as of mid-2014. At least another two million people will require treatment in the next five years. In parallel with the scale-up in the provision of AIDS treatment, life expectancy at birth has recovered from a low of 54 years in 2005 to 61 years in 2012. This is still 20 years fewer than most inhabitants of industrialised countries can expect to live, but demonstrates the importance of ensuring that the antiretroviral treatment programme continues to work and improve.
We have come a long way, but there are now worrying indications that the AIDS response is stalling – and perhaps beginning to unravel. Literally hundreds of thousands of lives are in jeopardy. In his June 2014 budget vote speech Health Minister Dr Aaron Motsoaledi stated that 37% of patients starting antiretroviral treatment are lost to follow-up three years after initiating treatment. This drop-out rate is much higher than had been thought previously. In addition, less than 40% of those who are on treatment are known to be virally suppressed. A survey published by the Stop Stockouts Project late in 2013 found that one in five healthcare facilities had experienced a stockout of key HIV or TB medicines at least once in the preceding three months. On August 25, 2014 the New York Times published an in-depth article under the headline “AIDS progress in South Africa is in peril.”
While South Africa has generally had good health policies under Health Minister Dr Motsoaledi, we are witnessing growing evidence that the implementation of these policies is now failing. In many respects the healthcare system suffers from the same mismanagement, corruption, cadre-deployment and politisation that plagues much of the public service. The problem is exacerbated by poor governance in provinces, which provide the bulk of health services. Provincial administrations suffer from poor capacity and weak management systems, while many Provincial Health Ministers (MEC) appear to be appointed on the basis of political loyalties, rather than commitment or competence.
In this context, the TAC’s work to campaign for quality healthcare for all has by necessity become intertwined with the struggle for good and accountable governance and management of the public health system. This is likely to be the most significant challenge facing South Africa in coming years. In our view, well-informed, human-rights-based, politically astute civil society organisations like the TAC has a crucial contribution to make in this struggle. Strong activism by the TAC has driven the AIDS response for 15 years, and only strong activism can sustain it.
Read more about the TAC -- "Invest in Life, Dignity, Democracy"
 NY Times, For People With AIDS, a Government With Two Faces, 30th August 2006 (http://www.nytimes.com/2006/08/30/opinion/30wed4.html?_r=0)
 Peter Piot, No Time to Lose (W.W. Norton, 2012), p. 284.
 NY Times, AIDS Progress in South Africa in Peril, 26th August 2014 http://www.nytimes.com/2014/08/26/health/aids-south-africa-success-pepfa...