18 March 2003
Open Letter to Health Systems Trust
Mr. David Mametja (Executive Director)
Dr. Lillian Dudley (Managing Director)
Health Systems Trust
PO Box 808
17 March 2003
By Fax: 031 3040775
Dear Mr. Mametja and Dr. Dudley
OPEN LETTER: MINISTER OF HEALTH MUST MAKE WRITTEN UNEQUIVOCAL,
IRREVERSIBLE COMMITMENT TO ANTIRETROVIRAL THERAPY
Health Systems Trust (HST) has for many years conducted invaluable
research on the South African public health system. This research
demonstrates the devastating effects of HIV/AIDS on the public health
system and the widening inequities in health care access between rich
and poor in our society. Furthermore, HST's research leads to the
inescapable conclusion that South Africa needs an HIV/AIDS treatment
and prevention plan to assist in lifting an enormous burden of
morbidity and mortality from the health system. In particular, there is
an urgent need to make antiretroviral therapy available in the public
As you are aware, for over four years, the TAC has tried to convince
the Department of Health to adopt and implement a treatment and
prevention plan. For many years, doctors, nurses, religious,
trade-union and business leaders have urged our government to introduce
antiretroviral treatment into clinics and hospitals. Your former
director Ms Antoinette Ntuli witnessed the support for a treatment and
prevention plan at the Treatment Congress held at the end of June 2002
in Durban. Yet, the Minister of Health continues to obstruct every such
Among many scientific and other research work, your research also
demonstrates that the Minister of Health's failure to implement a
treatment and prevention plan renders her responsible for hundreds of
thousands of unnecessary deaths. She is willfully neglecting her duties
and responsibilities to realise, within the bounds of her Cabinet
position, the Constitutional rights to life, dignity equality and
health-care access. She is intentionally depriving people with
HIV/AIDS access to medicine and is thus making a calculated effort to
bring about their destruction. She is therefore committing a gross
violation of human rights.
Your organization also has direct first-hand knowledge and experience
of the Minister of Health's efforts to obstruct and censor the work of
doctors, scientists and researchers. We are aware that the minister has
been invited to the HST Public Health 2003 Conference at 9am on
Tuesday, 25 March at the Woodstock Holiday Inn in Cape Town. We ask you
to demand that the minister produce a written commitment, before she
speaks, to signing the NEDLAC Framework Agreement for a National
HIV/AIDS Treatment and Prevention Plan. We further ask that you demand
that she makes an unequivocal, irreversible commitment to the rollout
of antiretroviral therapy in the public health sector. If she does not
meet these demands, her invitation to speak should be withdrawn.
If she fails to do this and her invitation is not withdrawn, the TAC
will disrupt her speech. If she is replaced by another member of the
Department of Health, we will disrupt his or her speech. If we are
prevented from entering the conference, we will block entrance to and
from it until we are arrested. While thousands die, government business
cannot continue as usual. We call on all decent health care
professionals, researchers and officials who attend this meeting to
ensure that the South African Health Minister and her employees do not
receive an official welcome from the Health Systems Trust until they
sign the national treatment and prevention plan agreed at NEDLAC and
until she commits irrevocably to antiretroviral therapy in the public
We will work with government, the HST and any agency to promote an
equitable, affordable public health care system in South Africa and
globally. But, we will no longer allow any public forum to be used by
the Minister of Health to promote herself and the destructive policies
of the government in relation to HIV/AIDS and public health.
We look forward to an immediate response.
Questions and Answers on TAC Civil
Why has TAC started a civil disobedience campaign?
The HIV/AIDS epidemic is a crisis that threatens South Africa's
reconstruction and development. Up to five million people are infected
with HIV. AIDS is now killing over 600 people every day. For four
years, TAC has campaigned for government to develop a treatment and
prevention plan for HIV/AIDS and to implement antiretroviral therapy
programmes. Government has not done this and there is no indication
that the Department of Health intends to do this. Our activities have
always been peaceful and restrained. We have made numerous efforts to
work and negotiate with government. We therefore feel there is no
reasonable alternative but to increase the pressure on government
through a civil disobedience campaign.
What are TAC's demands?
Government must make an irreversible and unequivocal commitment to a
public sector antiretroviral programme. It must also commit to signing
a framework treatment and prevention plan agreement negotiated at a
forum called NEDLAC.
What sort of civil disobedience activities will take place?
All civil disobedience activities will be peaceful and dignified. No
physical violence will be committed and no property will be damaged.
TAC volunteers will commit actions which are likely to result in their
What is the NEDLAC agreement on an HIV/AIDS treatment and prevention
NEDLAC is a statutory body where agreements about how to deal with
development and labour issues are negotiated. It has four sectors:
government, labour, community and business. During the last few months
of 2002, high-level negotiators from each of these sectors reached a
draft framework agreement on an HIV/AIDS treatment and prevention plan.
Agreement was reached on 28 November. The government and business
negotiators then said they would refer the agreement back to their
principals for signing. After some minor changes to the agreement,
business has committed to signing it. However, since 28 November,
government has stopped conducting proper negotiations and it has also
tried to undermine NEDLAC through misrepresentations it has put forward
in the media. Some of these misrepresentations are described here.
The Minister of Health refers to the NEDLAC agreement as a "TAC
Discussion Document". Why is this a misrepresentation?
Senior government negotiators participated fully in the NEDLAC
negotiations until the draft agreement was reached on 28 November. This
is what the Deputy-President Jacob Zuma wrote to the Treatment Action
Campaign on 14 November 2003: "Government is also participating
actively in the NEDLAC special committee drafting a framework agreement
for treatment and prevention, which again indicates our unwavering
commitment to unity in action and partnerships against HIV/AIDS."
Neither TAC nor Cosatu "peddled lies" or "willfully misrepresented" the
nature of the agreement.
Government also made a written submission which is included in the
agreement. All sides made contributions as well as compromises in the
formulation of the latest text. It is not a TAC discussion document; it
is an agreement reached through detailed negotiations.
The Minister of Health says nothing on antiretroviral treatment has
been agreed upon in the NEDLAC agreement. Why is this a
Nearly all the text on antiretroviral therapy has been agreed.
Throughout the whole agreement of 15 pages, there are a few paragraphs
that are still under negotiation. TAC has made it clear that government
only needs to sign the part of the text that it has agreed to. If it
wants to negotiate other aspects of the agreement which its negotiators
agreed to, then it can continue using the NEDLAC process to do this.
The Minister of Health says government has an HIV/AIDS plan. Why is
TAC saying this is not enough?
South Africa has a five-year HIV/AIDS strategic plan, which was adopted
in 2000. TAC is not calling for this plan to be scrapped. We are
calling for a treatment and prevention plan to strengthen the strategic
plan, which says very little about treatment generally and nothing
about antiretroviral treatment. The NEDLAC plan gives firm targets and
timeframes for all sectors of society to take responsibility for
meeting those targets.
The Minister of Health and her supporters are saying that nutrition
is the critical issue. This has often been articulated through the
slogan "Basic Needs First". Why is TAC saying this is wrong?
Good nutrition is essential for good health in everyone, especially for
people with HIV/AIDS. However, the minister is trying to create the
impression that we must choose between nutrition or treatment. This is
false logic, because both are needed. Without antiretroviral treatment,
over 250,000 South Africans will die of HIV/AIDS this year. For someone
who has AIDS, treatment is a basic need.
Some say that TAC is obsessed with antiretrovirals and ignores other
aspects of the HIV/AIDS epidemic. What is TAC's response?
Our record demonstrates that this is false. We have campaigned
extensively for treatments for opportunistic infections and for social
grants. Our numerous treatment literacy workshops address issues such
as prevention and nutrition. It is actually people who deny the link
between HIV and AIDS, as well as the Minister of Health who are
obsessively and irrationally opposed to antiretroviral treatment. This
has resulted in this issue being controversial and receiving so much
attention in the media.
Some have accused TAC of being anti-government. Is this true?
The TAC supports the efforts of government to reconstruct and develop
SA, to eradicate poverty and create equality. It is because we support
this agenda that we demand an end to political denial about HIV. Our
demonstrations, petitions, court cases etc are all an affirmation of
the rights we won under our new Constitution. We supported the
Government's court case against the pharmaceutical industry in 2001 and
we have run a campaign which has resulted in a donation of an essential
medicine called fluconazole to the public health sector.
Is TAC saying that Government has done nothing about HIV/AIDS?
Government has made some important achievements that we acknowledge and
support. For example, the state is currently implementing
mother-to-child transmission prevention and post-exposure prophylaxis
for rape survivors. The Minister of Finance has put aside money for
HIV/AIDS for the next three years, some of which could be used to start
antiretroviral treatment programmes.
Who in Government is responsible for the failure of Government to
make treatment more accessible?
During the civil disobedience campaign, the TAC will present a large
body of evidence that shows that the Minister of Health has known about
the extent of the HIV epidemic and that she has had the resources to
alleviate the epidemic yet she has negligently and willfully failed to
act to improve the situation. The TAC will also present evidence that
the Minister of Trade and Industry has had the resources to take action
to reduce the prices of HIV/AIDS medicines but has negligently and
willfully failed to do this. The TAC holds these two cabinet ministers
responsible for Government's failure to implement an HIV/AIDS treatment
and prevention plan.