TAC Electronic Newsletter

5 May 2003

TAC Supports Health-Care Workers 

Launch of Conditions of Service Campaign - 5-6 May

5 May 2003

Over 200,000 South Africans will die of HIV/AIDS this year. Health-care workers experience the brunt of this epidemic. Yet, the public health care system which is responsible for most people, is under enormous stress.  SAMA, HOSPERSA, SADNU, NEHAWU Western Cape and TAC have called for 5 and 6 May to be used to begin mobilising health-care workers on the need for (1) an HIV/AIDS treatment and prevention plan, (2) the implementation of antiretroviral therapy and (3) the improvement of conditions of service of public health-care workers.  

In this regard, TAC welcomes the announcement by the Treasury Department that additional funds will be committed to HIV/AIDS, treatment and improvement of conditions of service of health care workers in this year's budget. Clear policies are are now needed on how this money will be used to improve conditions of service and implement an HIV/AIDS treatment and prevention plan that includes antiretroviral treatment.

We encourage doctors, nurses and all people working in health care, both the public and private sectors, to express solidarity with the above three issues by wearing HIV-positive t-shirts on 5 and 6 May. We are also circulating the letter below, addressed to the Minister of Health, for people working in South African health care to sign. Electronic endorsements of this letter can be sent to petitions@tac.org.za. Simply write in the subject line:

Endorse HCW letter

In the email body, please indicate your title, name, whether you work in the public or private sector, your position/job and your health care facility.

Written copies of the signed letter can be posted to: 34 Main Road Muizenberg 7945 or faxed to 021 788 3726.

A joint press conference will be held by SAMA, HOSPERSA, SADNU, NEHAWU Western Cape and TAC on Tuesday, 6 May 2003 at COSATU, 358 Victoria Road, Cape Town.


Letter by Health-Care Workers to Minister of Health

Dear Minister

Our public health care system is faced with the tremendous strain of the HIV epidemic. Daily many of us see patients die unnecessarily of HIV/AIDS. In many cases patients die because they do not have access to antiretroviral medicines. Often  they die or suffer needlessly because our facilities are not stocked with essential life-saving treatments for opportunistic infections. And often they die or suffer because our facilities are under-staffed or because we have not been sufficiently trained to deal with the epidemic.  However, It is not only patients with HIV who are experiencing the burden of this epidemic; the management of all diseases suffers because of the burden of HIV. Patients are being excluded from the health-care system because there are often no beds for them, no doctors or nurses to see them and no support services to ensure that critical programmes work.

Health-care workers in the public health system are so often exposed to the painful effects of HIV Aids infection and death, particularly in the absence of treatment. This contributes to their fears to establish and manage their own HIV Status. It also results in undue occupational stress because Health care workers want to see their patients live, not die without treatment.

The public health care system also does not sufficiently comply with the Occupational Health & Safety Act. There is a high risk of occupational exposure to hazardous biological products of which HIV forms a risk factor. Some health care workers still cannot access post-exposure prophylaxis in time. This must be remedied. The difficult work conditions that health care workers endure threaten to deplete our health care system to the point that the skills required for the administration of all treatments and other critical health care interventions will become scarce.

We do not believe the dire state of the public health care system is inevitable. With political will and resources our health-care system can be greatly improved. Together we can ensure that our health facilities are adequately staffed, job freezes are removed, sufficient counsellors are trained and hired for every clinic, enough condoms are always available both for counsellors to distribute and patients to take from convenient places, nurses and doctors are trained to manage opportunistic infections and provide antiretroviral therapy and that pharmacies are stocked with all essential medicines for all common diseases. We can slow or even stop the exodus of health-care workers to other countries by improving our conditions of service and building a health-care system that we can be proud of: one that meets the needs of the poor. We call upon you to commit to increase the state's investment in the public health sector, to develop a comprehensive HIV/AIDS treatment and prevention plan and to commit to the rollout of antiretroviral treatment for people with AIDS. By doing this, you will demonstrate leadership. Let us work together to build a better health-care system for all.


Title & Name         Public/Private Sector         Position / Job            Health Facility            Date


Mobilise Every Community to Support TAC's Demand for a Treatment and Prevention Plan! Organise for a Public Sector Antiretroviral Programme

The rain poured down gently across the Western Cape soaking its landscape and making the shanty-townships pools of misery. Inside, a hall in Site C Khayelitsha more than 300 determined TAC branch leaders from Ashton, Atlantis, Khayamandi, Zwelenthemba, Ceres, Mitchell's Plain, Cape Town City Centre, from across, Nyanga, Langa, Gugulethu and Crossroads.  From 10h00 to 13h00, activists from across the province demonstrated democracy in action.
The decision by the TAC National Executive Committee to postpone the civil disobedience campaign was explained by Zackie Achmat. He told the TAC branch leaders that this was government's last opportunity to show its good faith. The Cabinet Report on anti-retroviral therapy, the NEDLAC Draft Agreement, the SA Human Rights Commission Report creates a legal and moral basis for government to act.  Failure to take this opportunity will open the road to intensified mass protest by TAC and our allies.
An intense debate ensued. Speaker after speaker, branch after branch expressed scepticism of government motives. As one person said "Government is trying to make us dance to its tune."

Grief, pain, anguish and anger against government neglect united every person in the room: "Every day our comrades, family and friends die.  How long must we wait? Will government drag out this process?"

There was agreement over the following statements made by various comrades:

"Government is trying to demobilise our protest."

"SANAC is toothless. It ignored TAC until our civil disobedience, now it wants to meet with us. But, it has no power."

Then we examined what we can do: "Civil disobedience is a tactic to win us medicines. TAC is not fighting government because we like fighting. We are struggling to save millions of lives." was the message made by a number of people.

Other comrades demanded: "We must use mass action and launch a court case for a treatment plan."

Several speakers put forward these proposals which received unanimous support:"We will use the suspension of civil disobedience to strengthen our forces in every branch and community. We can convince many more people that TAC's cause is just -- the many people in the union movement, those in the religious sector, NGOs and countless ordinary people who agree with treatment but are not yet ready for civil disobedience action. If government fails to act, we will win these people to our side."
After three hours discussion, consensus emerged.  Our civil disobedience is suspended until 17 May 2003. Our anger, pain and anguish cannot be suspended.

    * We will use our anger to mobilise larger numbers of people for mass protest across South Africa in support of the NEDLAC Draft Treatment and Prevention Plan.
    * TAC will ask our allies internationally to be ready for further mass international protest should government fail to deliver anti-retroviral treatment.
    * If SANAC fails us, we will mobilise a range of actions locally, provincially and internationally to ensure that government implements a treatment plan.


A Selection of Recently Published Articles  by TAC Activists

TAC Develops the Non-Racial Traditions of the Freedom Charter - South Africa Belongs to All Who Live in it!

By Zackie Achmat, TAC Chairperson (Published in the Mail & Guardian)

According to reports, the Minister of Health recently attacked Mark Heywood in public as a white man who manipulates Africans to take part in the Treatment Action Campaign actions. This is a betrayal of the tradition of non-racialism of the Freedom Charter and the Congress movement.  It is not the first time it has happened, nor will it be the last.  Through whisper campaigns, party caucuses and innuendo TAC leaders have all been denigrated as agents of whites, imperialism, US drug companies, Indian drug companies or as a part of a sinister, racially inspired plot against the government.

Ironically, this tactic has been employed before to undermine the struggle of black people for justice.  Apartheid kingpins such as John Vorster, Jimmy Kruger, Louis le Grange also used precisely this tactic.  Those of us who lived during that period will remember that every strike, school boycott, community action or social mobilisation was depicted as 'white communist' (or liberal) manipulation.  The message of the Health Minister and those who use the same ploy is an insult to all black people (African, Coloured and Indian). It suggests that black TAC members cannot think or act as equals to white members just as black members of the ANC were regarded by the apartheid government as cannon-fodder for white liberals and communists.  The Minister herself has a white advisor - Patricia Lambert.  Imagine the suggestion that the advisor was really the architect of national health policy - how would we all respond?

The end of the apartheid state and institutionalised racial oppression represents an irreversible achievement. But, racism and racial and social inequalities remain major stumbling blocks to development and freedom.  No person in South Africa is free of racial prejudice, stereotypes or fears. Racism as a manifestation of individual psychology can only be addressed through open discussion, appeals to reason, social solidarity and removing structural reinforcements to racist prejudice. Censorship, racial innuendo, labeling and crass attacks have no place in achieving equality.   

Racism remains alive not only because of discrimination or prejudice against individuals though, the impact of prejudice and discrimination on individuals, families and communities should never be under-estimated.  The social structure of racism is central to its perpetuation. Racism is unwittingly reinforced through social and economic choices made by government.  The vast majority of people who live in government built dormitory housing, use over-crowded and over-burdened public health services, cram into third-rate schools, fail to receive social grants, lose their jobs and who remain insecure in their neighbourhoods are black, mainly African. They are also poor. Of course, the class dimensions of racism and poverty reinforce each other. But dignity, freedom and equality continue to be denied to people who are mainly black and poor, particularly women - not simply because of a few die-hard racists but because social policies themselves reinforce racism.

TAC's struggle for a treatment and prevention plan (including social upliftment initiatives) and the use of anti-retrovirals in the public sector hospitals clearly illustrates this paradox.  The vast majority of people who die avoidable and predictable AIDS-related deaths are black people who use the public health services.  People who have access to medicines are predominantly (black and white) middle-class people who have access to private health care. The continued denial of anti-retroviral and other essential medicines reinforces the suggestion that black lives have no value to those in power. It suggests that the lives of the majority of people living with HIV/AIDS are expendable because they are poor and black.

The Minister of Health and those who share her advantageous social position, who all have access to private health-care at tax-payers expense, misapply the oppression of black people to disguise anti-poor and, in effect, anti-black policies.  TAC makes no apology for the fact that the overwhelming majority of our members are poor, black, African people, particularly women.  We are accused of bussing black people to demonstrations. Of course.  We can only plead guilty. The people who use buses don't have cars.  If we had money, TAC would use more buses, and more cars.  The TAC could bus hundreds of thousands of black (and white) people to our demonstrations.  This is not because black people allow white people to think for them, or, to write their speeches. It is simply because our mothers, fathers, sisters, brothers, friends, colleagues and children are dying because of a health policy that reinforces racial prejudice. We join TAC demonstrations in our thousands to counteract the racial and class hypocrisy of the government's HIV/AIDS treatment policy.

TAC has remarkable leaders.  Many are black working class, poor.  Others are middle class.  There are men and women.  Mandla Majola, Thembeka Majali, Vuyiseka Dubula, Terence Crow, Bongiwe Mkhutyukelwa, Theo Steele, Thabo Cele, Zodwa Ndlovu, Pholokgolo Ramothwala, Nonkosi Khumalo, Sharon Ekambaram, Portia Ncgaba, Sipho Mthathi, Edna Bokaba and countless others cannot take seriously the Minister of Health's imputations about the quality and nature of our leadership.

Mark Heywood, our comrade, friend and a leader of the Treatment Action Campaign is a white, middle class, Oxford educated, Nigerian-born male.  These were all elements of his identity when he became an anti-apartheid activist in the early eighties and when he committed himself to freedom in South Africa.  We welcomed him then.  He does not hide his racial or class privilege but consciously uses it to challenge racism and social inequality.  He leads the ranks of other white people - too few, alas -  such as Hermann Reuter, Sue Roberts, Orly Stern, Nathan Geffen and Jonathan Berger, who are dedicated members of TAC. We welcome all their contributions equally.

TAC makes no apology for its conscious development of the non-racial traditions of the ANC, the Congress Alliance and the United Democratic Front. South Africa needs examples of non-racial, cross-class, inter-generational and gender co-operation on the basis of equality. We are not naïve. Racism, sexism, homophobia, religious and social prejudice are a part of all our daily lives. In TAC, we struggle against it together. We do not retreat into ghettoes to reinforce inequality and prejudice.  Our non-racialism is not an expedient to retain to skills or capital. Although, we unapologetically utilise the privilege, education, skills and resources of our middle-class members, black and white to develop a strong pro-poor and working class leadership in TAC. But these skills are no more important that the organising and social skills that poor, under-educated people bring to our organisation.  Genuine non-racialism asserts the equality, dignity and freedom of all people and it is essential to ensure social justice for all.


TAC's focus on Anti-retrovirals is not "narrow"

By Mark Heywood, TAC National Secretary (Published in the Star)

On April 1st Kebareng Moeketsi was lowered into her grave in a cemetery in Midrand. It was an early Autumn morning, a Tuesday, and several hundred people had gathered to say farewell. They stood carefully around the edges of other fresh graves: a company of the living mingling with the growing company of the dead. Kebareng was not alone in her young age. Many of the other recently departed were also born in the 1960s. Here and there adult mounds are interrupted by those of children.
Kebareng had died suddenly of her HIV infection. On March 20th she had been 'well'. She had marched as a leader of 200 TAC volunteers to the Sharpeville police station, and personally handed in an affidavit placing responsibility for the HIV-related death of one of her friends at the doors of the Ministers of Health and Trade and Industry.

I had noticed her at the TAC workshop the day before, marked out by the depth of feeling in her eyes, a pretty and dignified young woman, strong in her silence. A week later, the sudden onset of pneumonia, diahorrea together with the TB she was already being treated for was enough to kill her.
Why did Kebareng die of AIDS when others live with HIV? The Alexandra clinic was only kilometres away, but it did not keep anti-retroviral medicines --  because that is government policy. It's nurses and doctors are mostly not trained to use ARVs - because that is government policy.
Across the health curtain that separates public health from private health, there were a plethora of modern clinics and pharmacies stocked with the medicines that would have kept her alive. But these clinics and medicines are for the old rich (apartheid's beneficiaries) and new rich  (the rapid risers of new South Africa) -- people who are secure that in their time of need they will get help. Kebareng might have bought herself temporary access to health, but at over R1000 a month it would not have been sustainable.

Kebareng is not a statistic. She was a new South African, a mother of an 11 year old boy, a daughter, a resident of Alexandra township, a young woman who had chosen to care for others in her situation. Kebareng chose to campaign for anti-retrovirals because it was a campaign for her own life: for her right to continue to be a mother, a breathing, feeling human being, a rights-holder in the new South Africa. It is these facts that make accusations by ANC leaders such as Cameron Dugmore that TAC has a "narrow" focus on anti-retroviral medicines so unfounded and shameful.

TAC is made up of thousands of people whose work takes them daily into the homes and wards of the sick and dying. TAC is made up of people of many hats: people who work tirelessly to prevent new HIV infections; nurses who treat the illnesses it causes, people with HIV in their own bodies or those that they love. All these people have drawn the conclusion that if medicines exist which help to restore wellness for rich human beings then they should also be available to the poor. Government's excuses and delays - its insulting attempts to deny the human toll of this epidemic - don't wash.  Time runs out literally.

To assert the right to life, to continue to breathe, is not "narrow".  Unfortunately, the AIDS epidemic is a reality, and for many people in the late stages of HIV infection access to medicines determines whether or not that right is extinguished.

120 years ago in one of his novels Charles Dickens used the death of young Joe the street sweeper to rage against the premature deaths of the poor. Today, his words should ring for Kebareng, and sound shame in the ears of those who could have saved her:
"Dead, your majesty. Dead, my lords and gentlemen. Dead, right reverends and wrong reverends of every order. Dead, men and women born with heavenly compassion in your hearts. And dying thus around us every day!"


Why I Disrupted the Minister of Health's Speech

By Nonkosi Khumalo, TAC Women's Health Co-ordinator (published in City Press)

I helped disrupt the Minister of Health's speech at the Health Systems Trust Public Health Conference. I even put my finger near her lips and shouted "Tula Manto". My mother would have been shocked. I have been brought up to be polite. I cannot remember having done something like this before. But I would do it again. Thousands are dying without access to life-saving medicines and Minister Tshabalala-Msimang's response is to brag about AIDS denialist, Roberto Girraldo. For too long she has denied, delayed, misrepresented and deceived the South African public. For too long she has ignored the Constitutional rights to life, dignity and health-care. I remember when the minister laughed grotesquely when in a meeting I attended, she was questioned about treatment.  She is clearly not a person who cares about the lives of poor people. The Treatment Action Campaign (TAC)  has been forced to go beyond polite diplomacy and court cases, though these are still needed. Peaceful civil disobedience is now also a  necessary part of our campaign.

The HIV epidemic has created a social crisis that is being felt in thousands of households. It is threatening the reconstruction and development of this country and its people. At least 600 people will die daily on average in South Africa this year. Yet there is no treatment and prevention plan plan to try and address this situation. Government has simply discontinued negotiations that took place at NEDLAC with the business, labour and community sectors. This demonstrates enormous callousness towards the millions of South Africans living with HIV/AIDS who will die over the next decade if they do not get treatment. This is why TAC is calling for civil disobedience after four years of discussions, debates, negotiations, court cases and many polite demonstrations and marches. On 14 February over 10,000 people marched to the opening of Parliament to call on government to come up with the a comprehensive prevention and treatment plan that includes antiretroviral therapy in the public sector. We are still awaiting government's response, as well as their response to numerous other memos we have given them.
During the last few months of 2002, an HIV/AIDS treatment and prevention plan was negotiated between government, business, labour and the community sectors at NEDLAC. Agreement was reached on 28 November 2002. The agreement also contained square-bracketed text to indicate points on which further discussion was needed, but all the negotiators were ready to sign the document. However, it seems that the Minister of Health and other Cabinet ministers were not in agreement with their negotiators, because government has refused to sign the agreement. Instead of using the last four months to resolve their concerns, government has engaged in a propaganda campaign to argue that no agreement was reached. During this time, they have ignored continuing negotiations at NEDLAC.

The Minister of Health has said that the government has a plan, known as the HIV/AIDS and STI's strategic plan 2000-2005. Unfortunately it says little about treatment generally and nothing about antiretroviral therapy. It also contains no targets or dates, which makes it read more like a wish-list than a plan. TAC is not calling for this plan to be scrapped, but for the NEDLAC agreement to complement and strengthen it.  The prevention and treatment plan that was negotiated at NEDLAC, gives firm targets and timeframes for all sectors to take responsibility for meeting those targets. This indicated clearly that the government would not be implementing the programme alone, but with assistance and commitment from other sectors. This was an opportunity for government and the Department of Health to create a partnership with business, labour and civil society to improve the HIV epidemic and save millions of lives. But it is clear that government does not really believe in partnership, despite their expensive Sunday newspaper advertisements claiming they do.

Some have accused TAC of being obsessed with antiretrovirals, but our track record over the last four years demonstrates that we have pushed for access to social grants, run numerous workshops on nutrition and worked to make all medicines more affordable. The reality is that the Minister of Health is obsessed with antiretroviral treatment. She obsessively believes, despite all the scientific evidence to the contrary, that antiretrovirals do not work.

The Minister's latest propaganda campaign to avoid her Constitutional duties is to deceptively argue that nutrition, not medicines, holds the solution to HIV/AIDS. Of course, nutrition is a critical part of the response to AIDS, as it is to many other diseases. But medicines are also critical; without them people will die. There should be no need for South Africa to choose between nutrition and medicines for people with HIV/AIDS. We can afford both. Indeed, the Minister of Finance has put aside a substantial sum of money for HIV/AIDS for the next 3 years, including nearly R2 billion to start antiretroviral programmes, if government changes its policy.

The demands of TAC's civil disobedience campaign are that government makes an irreversible and unequivocal commitment to a public sector antiretroviral programme and that it signs the NEDLAC agreement.  TAC has politely urged government to do this for a long time. The response has been gross intransigence, incompetence and arrogance. A journalist took one of my TAC colleagues to task this week, asking why we do not use the courts to get government to commit to antiretroviral treatment as we did in the mother-to-child transmission case. Indeed, we will use the courts, but there is no guarantee that this will change government's policy. Also, for the hundreds of thousands who will die before such a court case is over, government must have its lack of conscience exposed through civil disobedience. For those who are dying, their friends and families, being polite will not be enough.


Nutrition is a Basic Right, But so is Access to Life-Saving Medicines

By Sipho Mthathi, TAC Treatment Literacy Co-ordinator (Published in City Press)

For reasons including natural disasters, corruption and bad governance, the crisis of food security continues to plague the Southern African region. The UN estimates that almost 14.5 million people are in urgent need of food aid in the SADC region alone. The HIV/AIDS epidemic currently plaguing the Southern African region heightens the urgency with which food security must be addressed.  Health and nutrition are inextricably linked.  The World health Organisation (WHO) has repeatedly affirmed, "proper nutrition and health are fundamental human rights. Nutrition is a cornerstone that affects and defines the health of all people, rich and poor. It paves the way for us to grow, develop, work, play, resist infection and aspire to realization of our fullest potential as individuals and societies. Conversely, malnutrition makes us all more vulnerable to disease and premature death (Gro Harlem Brundtland, WHO)". However, no internationally recognised institution including the World health organisation has ever said that food alone is enough to prevent and treat diseases. If anything, UN agencies like the WHO recognise the comprehensive nature of responses needed to address ill health and have proactively promoted greater understanding of treatments, including medical treatments, for all illnesses.

On the issue of HIV/AIDS treatments, the World Health Organisation published guidelines for the treatment of HIV associated illnesses as long as 10 years ago and updated them in 1998. In 2002, the WHO published guidelines on the use of ARVs in resource-limited settings and has since included them in its Essential Drugs List (EDL).   These guidelines clearly demonstrate that not only is it possible to use ARVs even in settings worse than the South African one, it is morally, politically and economically plausible. Uganda is a country with the oldest AIDS epidemic in Africa and a $6 billion gross domestic product compared to South Africa's  $130 billion. However, the government of Uganda has recognised that continuing with a strategy that excludes treatment with antiretroviral therapy is not only ineffective and morally unjustifiable, as it denies people an equal the chance to live longer and healthier lives , but it is also not cost-effective. To this effect, Uganda is finalising its plans to put 100 000 people on antiretroviral therapy by 2005, in keeping with the WHO commitment to treat 3 million people living with HIV with ARV in the developing world. 

Many opportunities have been presented to the South African government to improve access to medicines for all who need it. Both the Medicines Act and the Patents Act contain provisions for importing or producing lower-priced medicines. The international Declaration reached in DOHA in 2001 reaffirms the right of governments to put public health interests over and above patents or any other measures that create barriers to accessing affordable medicines.  Not even Trevor Manuel can successfully convince the South African public that South Africa does not have the money to start antiretroviral therapy. According to Dr Ayanda Ntsaluba's presentation to the Portfolio Committee on Health on 18th March, SA already spends R 4 billion to treat HIV opportunistic infections and TB every year. This shows clearly that not using ARVs, as part of the treatment strategy for HIV is not necessarily cheap. Research at Somerset Hospital in SA demonstrates that with Antiretroviral therapy, TB in people living with HIV can be reduced by 80%.  This would free up resources that can be used to scale up treatment programmes to benefit more of the approximately 500 000 people who currently need antiretroviral treatment in SA.

These are the issues we should be discussing in South Africa now. How are we going to enhance our strategies by incorporating the experience gained over the past years through small private and public projects using antiretroviral therapy?  But instead, our health minister creates confusion and insecurity in those already taking antiretrovirals. In a Parliamentary Portfolio Committee on Health presentation on 18th March 2003, the health minister went on record as saying that "taking garlic, drinking lemon juice and use of virgin olive oil has more benefits than these AZTs [sic]".  She also said that she has videotapes to show how the health status of people living with HIV improved after being put on a nutrition program in Lesotho (run by a discredited charlatan who denies the link between HIV and AIDS). Thus, according to her, the department of health is going to focus on nutrition this year.

No scientist or rational person, including those who advocate for antiretroviral treatment, has tried to dispute the value of nutrition in the health status of any person, irrespective of their HIV status. It is internationally accepted that for people living with HIV, nutrition is a critical part of strategies for maintaining good health. However, even the most well fed person with HIV in the White House of the United States will not be saved by a good plate of food every day when the immune system is too broken to fight disease. That is why the European Union and the United States have clearly stated policies to use antiretrovirals as part of a comprehensive strategy to treat HIV/AIDS. 

600 people die as a result of HIV/AIDS in SA everyday. Most of them are poor, because parliamentarians and the better off middle-class can afford antiretroviral treatment. While a lot of work has and is being done by government, civil society and all other sectors to curtail new infections and mitigate the impact of HIV/AIDS on individuals, households and the society at large, our strategies are clearly not enough. In Minister Skweyiya's words uttered in 2000, "we need a Marshall plan" to address HIV. We need a co-ordinated, coherent, all-inclusive and clearly communicated plan with clear targets and time frames. This plan must incorporate a clear programme to address food security for all, including people living with HIV/AIDS. This is what the NEDLAC process had intended to do. We need this plan, not tomorrow, not in a few months but today.  We have a crisis that with government's own admission "is of enormous proportions".  The thing we lack more than answers on what antiretrovirals will cost is leadership. We have enough answers on the costs of HIV/AIDS medicines and how to reduce those costs.  We we really need is unwavering leadership steered by the person primarily charged with duties to take care of our health. Not someone who will tell us to take lemon juice to treat AIDS.


ANC's Dugmore Has Serious Questions to Answer

By Nonkosi Khumalo, TAC Women's Health Co-ordinator and Nathan Geffen, TAC National Manager (Published in the Argus)

In a report in the Argus (27 March), Western Cape ANC Spokesperson on Health, Cameron Dugmore claims that government has a comprehensive AIDS strategy. We are perplexed by this claim. Could we trouble him to answer some simple questions?

Why does the government's 5 year HIV/AIDS and STD strategic "plan" have no targets and no dates? Surely a plan without these is a wish-list not a plan.  Why does their plan not include antiretroviral therapy? If government is committed to treating all opportunistic infections as the Department of Health  so often claims, then can Dugmore explain why almost no clinics have the medicine, called acyclovir, needed to treat Herpes? Why do only one in  four clinics have the medicine, called fluconazole, needed to treat systemic thrush and cryptococcal meningitis?  (It is worth noting that the fact that any clinics have this medicine at all is almost entirely due to a TAC campaign that took place two years ago.)

In July 2001 a draft version of a Department of Health document on an appropriate response to the HIV epidemic provided for the possibility of antiretroviral therapy. Does Dugmore know why this was excised from the version that came out in September?

If government is so concerned about managing the HIV epidemic, why have so many public health-care positions been frozen? Why have so few nurses been trained to deal with HIV/AIDS?

If government is so concerned about prevention, why did it require a court case and years of pressure to get government to implement mother-to-child transmission prevention? Why is it  that some  provinces only started implementing and rolling out this programme after TAC threatened contempt of court charges?

Dugmore, like the Minister of Health has had a sudden realisation that we have a food security problem in South Africa. But does he really believe that a middle-income country like South Africa has to make the stark choice between preventing hunger and preventing access to life-saving medicines? Surely our government manages the economy well enough to be able to afford both?

Dugmore correctly points out that the ANC accepts the role of antiretrovirals. Government has also had this as its official view -- despite the frequent bizarre utterances of the Minister of Health -- since 17 April 2002. But then can  Dugmore please explain why nothing has been done to expedite the availability of treatment in the public sector since then? Also, why have all efforts to reduce medicine prices come from civil society and a few local officials, but not at all from national government which still has not promulgated the Medicines Act?

Dugmore and his colleagues have disputed that an agreement was reached by negotiators at NEDLAC.   If the Cabinet was unhappy with what was agreed at NEDLAC, surely government should have wasted no time in sorting out these problems by continuing to negotiate at NEDLAC? Why has government not returned to negotiations at NEDLAC for nearly four months?

Dugmore expresses outrage at TAC's non-violent disruption of the Minister of Health's speech at a recent conference. Can he explain why he does not express outrage that our Minister allows at least 600 people to die daily, on average, simply because they do not have access to life-saving medication? Does Dugmore believe that it is sufficient that some of his colleagues in Parliament, who are strangely silent, have access to these medicines? Does it worry Dugmore that many ANC supporters (many of whom are also TAC members) are dying because unlike his colleagues, they cannot buy life?

We hope that when Dugmore agrees to a public debate with Zackie Achmat, he will provide the answers to all our questions.


Response to ANC Youth League

By Zackie Achmat, TAC Chairperson (Published in Sowetan)

By Zackie Achmat

The descent of the ANC Youth League leaders into irrationality is a tragedy.  In the last few years, Youth League leaders have praised every wrong policy of government while ignoring the plight of youth in our country. One may be justified to regard the voice of its leaders as the undemocratic songs of cruelty and crassness inside the ANC. Malusi Gigaba's defence of Robert Mugabe in Business Day, Khulekani Ntshangase's attack on the Treatment Action Campaign (The Sowetan, 22 April 2003) and the Youth League's attacks on Judge-President of Transvaal Bernard Ngoepe and Archbishop Njongonkulu Ndungane are obvious examples of this irrationality. We can list many more. This is a departure from the 1950s when the Youth League leadership by Nelson Mandela, Anton Lembede, Walter Sisulu and others inspired the weak  ANC to take on the Apartheid regime in the Defiance Campaign.

Ntshangase's attack on TAC is so devoid of truth, that at first we thought it too laughable to respond to. However, the confusion created by the Youth League's spokesperson is dangerous and misleading.

Ntshangase claims that: "every honest person knows that the overwhelming majority of our people die from accidents and violence".  This is a lie. The Medical
Research Council has concluded that AIDS was already the single biggest cause of death in 2000. But Ntshangase probably does not trust independent research that does not emanate directly from government itself. He therefore should have consulted the report released by Statistics South Africa's last year, which demonstrates that Tuberculosis was the biggest reported cause of death in 2001 followed by HIV-disease (i.e. AIDS). It is almost certain that if we take into account HIV-related TB deaths then AIDS was by far the biggest single cause of death in 2001. Statistics South Africa also demonstrates that HIV-disease has been the biggest single cause of death among women since 1999.

Ntshangase says that TAC "is a conglomeration of drug-dealers who serve as marketing agents of toxic drugs which are not even used where they come from, America."  This is a compounded set of lies.  Antiretroviral medicines are approved by the United States Food and Drug Administration and are used by far more people in that country than in South Africa. Furthermore, the Medicines Control Council, an independent statutory body that has to make decisions solely on the safety and efficacy of medicines, has approved over 15 different antiretrovirals for use here. The Cabinet recognised that antiretrovirals are effective on 17 April 2002. This position was also restated as ANC policy in December at Stellenbosch.

Ntshangase is the not the first ANC member to allege that TAC receives funding from the pharmaceutical industry.  President Thabo Mbeki made that allegation in a secret Parliamentary caucus. It is unfortunate that The Sowetan did not check this before allowing a falsehood and defamatory allegation to be made. TAC's funders are listed in our audits which can be downloaded from our website by the public.  We do not accept money from pharmaceutical companies or the South African government. Much of our funding does, however, come from the former anti-Apartheid movement.

The Youth League spokesperson further suggests that: "Government should investigate ways of arresting people such as those who campaign for the
poisoning of our people." Perhaps the Youth League is playing a childish game of tit-for-tat: We have called for the arrests of the Ministers of Health and Trade and Industry for culpable homicide, so the Youth League calls for the arrest of TAC members. Ntshangase is in effect suggesting that we be arrested for expressing views shared by the scientific community.  However, the charges of culpable homicide against the Ministers follow from their negligent failure to do their jobs. This obstruction and negligence has resulted in thousands of deaths. As dangerous as we think Ntshangase's  AIDS denialist views are, basic respect for freedom of speech means we would never call for his arrest for expressing his views. He should extend the same courtesy to those with whom he disagrees.

The comparison Ntshangase draws between TAC, a peaceful movement campaigning for basic human rights, and PAGAD, a violent group that campaigns for vigilante justice, is ludicrous. It is also irresponsible and dangerous.  He writes, "Pagad was destroyed so will be TAC!"  This is incitement and hate speech.

Ntshangase claimed in a radio interview that the article was written in his personal capacity. However, he is the spokesperson of the Youth League and there is no indication anywhere in the article that he was writing in his personal capacity. We
therefore demand the ANC Youth League to print corrections to the factual errors. We also demand that they apologise for their false claim that TAC is funded by pharmaceutical companies and the suggestion that we engage in "the poisoning of our people." Ntashangase also falsely charges Cosatu and the labour movement with conspiracy to kill its members.  As a leader of the Youth League he displays a profound ignorance of HIV science and the suffering of our people.

Ntshangase and his friends say we attack the ANC. The ANC is a powerful party with more than 10 million voters and quite a few floor-crossers. It is also the party of government with a profound history of resistance and a record on social development that should speak for itself.  As a party of power, the ANC is one of the most pervasive institutions in our country. Ntshangase and his friends defends ANC leaders and the powerful against people living with HIV/AIDS, TAC and poor people who cannot access medicines. The ANC needs thinkers whose loyalty is based on pointing out in public the weaknesses of the organisation, especially where the right to life of the weak and vulnerable are at stake. Youth League leaders at its national offices appear to be job-seekers in the ANC bureaucracy not youth campaigners for social justice. TAC members and leaders proudly represent the non-racial and campaigning traditions of the ANC and the United Democratic Front.

It is sad that the Youth League, with its heroic history in the 1950s, cannot find the moral strength to agree to TAC's demands that Government must develop and implement a treatment and prevention plan for people with HIV/AIDS and commit to the rollout of antiretroviral treatment. It is this sort of moral cowardice that is resulting in thousands of preventable deaths.


President Mbeki Must Break His Silence

 By Mark Heywood, TAC National Secretary (Published in the Sunday Tribune)

During 2002 South Africans were given more information about the scale of the AIDS epidemic in this country than ever before. As if to spite those who claim that HIV/AIDS is an imagined disease, that has been conjured up by researchers in the pay of foreign pharmaceutical companies, all of this information was home-grown.
In May the Department of Health's annual ante-natal survey estimated that 4.7 million South Africans had HIV infection.

In October Statistics South Africa, released a report requested by the President, which showed dramatic changes in causes and patterns of death in our country. More people are dying young. More people are dying of illnesses such as TB and pnemonia. This was attributed mostly to HIV. Then at the end of the year a study commissioned by Nelson Mandela showed that almost one in ten people of all ages in South Africa tested positive for HIV.

The "news" was frequently concerned with the statistics provided by these reports. But behind the official news HIV took its toll on real people, mostly poor and mostly black. Every Friday for 52 weeks the Sowetan carried funeral notices of young people who had died, many of AIDS. Nurses watched mounting numbers of child fill paediatric wards. Pastors and priests spent their weekends conducting funerals.

At the beginning of this year a study of 771 households, conducted by the Health Systems Trust, an NGO that works closely with the Department of Health warned that in "already poor households HIV/AIDS is the tipping point from poverty into destitution" because "AIDS-affected households are spending up to a third of their incomer on private medical care."

Thus, for most people in SA what researchers say increasingly collides with everyday life. There is no doubt that HIV has established a terrible foothold in our society and is taking its toll - and in the face of this there is an expectation of leadership.

At last, leadership is emerging - amongst doctors, within churches, from trade unionists and occasionally even from self-interested business people. Slowly society seems to be rallying to the reality of HIV/AIDS. But, in the face of this awakening there is a terrible dearth where government should be. Frequently, instead of leadership there is questioning and confrontation. Of course, the Minister of Health claims that she is offering leadership. But this leadership has a gaping hole. It is incomplete - and will be for as long as the President continues to abdicate responsibility for this area of the national life.

In response to criticisms, Mbeki's office says that dealing with AIDS is 'the duty of the Deputy President'. Given the scale of the problem, and the amount of time that should be given to its management, this may be a justifiable delegation of power. But ? handing over management responsibility is one thing - declining to say anything on the crisis is another.

The 'Mbeki page' on the ANC website proves the point. It contains 51 speeches by the President made during 2002. In reality he will have made many more. Not one is devoted to the AIDS crisis. Even general speeches that set priorities for the country or the ANC show that, except for rare occasions, the President has little to say about AIDS and nothing to say about HIV. It seems that HIV is still a virus this President refuses to legitimize by direct reference.

For example, his recent speech marking the 91st Anniversary of the ANC, made on behalf of the NEC of the ANC, made only one - in passing -- reference to AIDS, as part of an injunction that "we must also raise the awareness of the people with regard to the other important maters relevant to the health of our people."
Silence is inexcusable because silence is not neutral. Silence on a matter of utmost national importance is in fact its opposite. It is a clamorous statement of denial, and disbelief about HIV/AIDS. Silence on HIV/AIDS in an address to the ANC national Congress is in fact an instruction by omission to ANC members: it says 'HIV is not a national issue. It is less pressing that poverty, transformation and delivery.' It is an injunction that there are other matters more demanding. It demobilizes. Arguably it throws a cloud of disapproval over those ANC members who might consider this issue of grave importance. It degrades the memory of those who have died. It gags ANC members who know they have HIV and would like to find support in the party.

This is a terrible and costly error. It is self-defeating of Mbeki as an individual and of his mission. Correctly, the President's main mission is to tackle poverty. But as much as poverty makes AIDS, AIDS makes poverty. The illness and death of millions of poor people will erode the benefits of house, health and service delivery. Things will fall apart. HIV/ AIDS will make us run, just to stand still in the battle for reconstruction and development.

In his New Year message to the nation Mbeki promised that in "2002 the sun will continue to shine on the South African people as we build this non-racial, non-sexist and democratic country, instilling in all a shared sense of nationhood and human solidarity." But refusing to talk about AIDS is a denial of solidarity with millions of South Africans who are frightened or sick by this virus. It is hard to appreciate the sun, if you are paralysed with diahorrea, thrush or TB. The death of a child clouds even the brightest day. It is hard to appreciate the sun when it is government policy to deny you medicines - and when your poverty makes you a victim of state discrimination between those who can buy life and those who cannot. 

I hope that the President reads this article, and that he responds. I hope his response is forthright. I hope that he accuses me of calumny and brings forward facts to prove that I am wrong. I want to be wrong. The reason I write this is because, in the face of one of the greatest challenges facing our nation his Presidency is silent. A leader who disarms his country in the face of threats to its future is making a calamitous mistake. 2003 must be the year when the President breaks his silence on HIV, and builds unity. Otherwise it will be too late.