International Day of Action 

Brief Report on Activities in South Africa and Memo

24 June 2004

Today, in Johannesburg, Cape Town, Durban and East London, the Treatment Action Campaign led marches calling on the US Government to invest in health not war. Each march was attended by hundreds of people. Seminars These activities were part of  an international day of action aimed at the Bush Administration. In Johannesburg, COSATU President, Willie Madisha, addressed the marchers. In Durban and Cape Town, a delegate of the US Consulate accepted the following  memorandum from the TAC:

President George W. Bush
C/O Ambassador Cameron R. Hume
United States Embassy
877 Pretorius St, Pretoria
South Africa
24 June 2004

Delivered By Hand to US Consulates in South Africa

Dear President Bush


Today, over eighty organisations around the world concerned with health and human rights have joined together to express our concern with the current policies and actions of the US government.  In South Africa, we are marching in four cities to say that we are deeply disturbed by the actions and policies of your Administration that undermine the prevention and treatment of HIV/AIDS.  The effect of the US government's unlawful war in Iraq has been to divert international attention and resources away from global health and poverty.

Hundreds of billions of dollars are being spent on the military instead of investing resources in the biggest threats to human security today: HIV/AIDS, tuberculosis (TB), malaria, malnutrition and poverty.  In 2003, the United Nations estimated that 2.5 to 3.5 million people died of AIDS, one million of malaria and two million of TB.  Yet these diseases can be prevented and treated.  Further, an estimated 800 million people endured malnutrition, which continues to play a major role in half of the more than ten million annual child deaths in the developing world. 

In many countries women undergo back-street abortions and risk death because they are denied the right to make reproductive choices.  Inappropriate moral judgments stigmatise condom use and distribution, thereby putting millions of people at risk of HIV and other sexually transmitted infections.  The spread of HIV is further fuelled by the oppression of sexual minorities and draconian legislation that targets commercial sex workers and intravenous drug users. 

Successfully reducing HIV infections and giving more people with AIDS access to life-saving medicines requires the promotion of human rights and investment in developing world health systems.  The World Health Organization (WHO) has called for three million people with AIDS to be treated with life-saving antiretroviral medicines by 2005, but your Administration has shown little political will for promoting this objective or human rights.

We therefore say to your Administration:

Invest more money in the Global Fund to Fight AIDS, TB and Malaria!
The Global Fund to Fight AIDS, TB and Malaria (the Global Fund) is the best opportunity for responsible funding of initiatives to prevent and treat infectious diseases in poor countries.  Yet this initiative remains substantially underfunded.  In January 2003, your Administration promised $15 billion over the next five years to alleviate the HIV epidemic.  The Treatment Action Campaign (TAC) and other organisations cautiously welcomed your promise.  Yet the expenditure approved by the US Congress as part of this commitment for 2004 is only $2.4 billion, of which most funds are going to the President's Emergency Plan for AIDS Relief (PEPFAR) and not the Global Fund.

The total amount of US aid money for 2004 is $17.55 billion. Yet the military budget approved for 2004 is already $368.2 billion and your Administration has requested a further $87 billion war supplemental for Iraq.  Much of this military budget is being used to fight the so-called "War Against Terror" and to sustain the occupation of Iraq.  We acknowledge the threat of terrorism.  However, the most important and widespread threats to global security are the ones exacerbated by poverty and lack of development: the HIV/AIDS, malaria and TB epidemics, as well as malnutrition.  Alleviating these problems, together with promoting human rights and negotiating solutions to world problems through international institutions, is the best way to ensure long-term global security.

Your Administration must lead the world's countries in a drive to ensure the Global Fund receives the finance it needs and the WHO achieves its aim of treating 3 million people with antiretrovirals by the end of next year.

Stop Undermining Public Confidence in Safe, Effective Anti-AIDS Medicines!
In recent months your Administration has used pseudo-scientific arguments actively to undermine access to generic antiretroviral medicines, in particular fixed-dose combination (FDC) antiretrovirals that reduce the number of pills people with AIDS have to take on a daily basis.  Reduced pill burdens result directly in increased compliance with treatment and better health outcomes.  In addition, FDCs generally cost less than standalone antiretroviral pills, especially if generic and brand name suppliers compete with each other.

While cautiously welcoming recent announcements that indicate a revision of this approach, we nevertheless believe that insisting on FDA approval for FDCs and other generic antiretroviral medicines before they can be purchased with PEPFAR money both disregards and undermines the WHO's pre-qualification system and the independent regulatory authorities of many developing countries.  It will also further delay the purchase of these medicines with PEPFAR funds.

Your Administration must commit to allowing recipient countries to purchase medicines approved by their regulatory authorities or pre-qualified by the WHO.  At a minimum, the FDA must commit to a short maximum time-period for approval, with application fees for the approval of FDCs and other generic antiretroviral medicines for eligibility for purchase with PEPFAR funds being waived.

Stop Using Bilateral Pressure to Undermine the Doha Declaration on TRIPS and Public Health!
Since the World Trade Organization (WTO) ministerial meeting in Doha in 2001, which clarified the opportunities that developing countries have to access generic medicines, your Administration has vigorously pursued bilateral free trade agreements that seek to impose considerably higher standards of intellectual property protection that required by the WTO.  Imposing TRIPS-plus legislation on developing countries significantly reduces their ability to protect and advance public health, in particular, to take reasonable steps to mitigate the impact of HIV/AIDS.  We note with dismay that now there are signs that the WTO might actually be used to the benefit of developing countries, your Administration is threatening its viability.

We call on your Administration to recognise that countries can and should exercise their rights under the Doha Declaration on TRIPS and Public Health.

Stop Undermining Prevention Efforts by Marginalising Minorities and Subverting Access to Condoms!
Prevention interventions aimed at gay men, commercial sex workers and intravenous drug users are an essential part of reducing HIV transmission.  Yet your Administration, driven by religious fundamentalism, opposes such efforts.  For example a third of PEPFAR's prevention funds are earmarked for abstinence-until-marriage programmes.  While we support the promotion of delayed sexual activity as an important aspect of life-skills education, we do not believe that this should be framed in moral judgments concerning marriage or at the expense of condom promotion and distribution, especially to youth.

Further, your Administration refuses to acknowledge the vital importance of access to and information about condoms in the general population.  Most disturbing, it has been party to unscientific actions and statements questioning the efficacy of condoms, for example removing information on condoms from the website of the US Centers for Disease Control.  In addition, draconian legislation continues to put intravenous drug users and commercial sex workers at risk of HIV infection.  This has lead to the Lancet describing the current US policy on HIV/AIDS as "perhaps one of the best examples of ideology impeding sound public health policy."

We call on your Administration to encourage the promotion of condoms, work towards the decriminalisation of commercial sex-work and encourage needle-exchange programmes, both in the United States and globally.

Recognise the Right to Reproductive Choice!
You have reinstated the Global Gag Rule, cutting US funding (as well as donations of contraceptives) to family planning and other organisations that provide comprehensive information on reproductive choice, which includes the option of abortion.  Around the world women undergo life-threatening back-street abortions because they do not have access to reproductive choice, particularly the right to choose to terminate their pregnancies lawfully and safely.  Your ideologically driven and religious fundamentalist policy fails to take into account how this limits women's options, often threatening the completion of their education, resulting in the loss of work or forcing dependency on unwanted relationships and transactional sex.

We call on your Administration to drop the Global Gag Rule and recognise women's rights to choose.

Your administration has a poor record of alleviating HIV/AIDS, TB, malaria, malnutrition and poverty.  We ask you today to rectify your Administration's negligence and to invest in health, not war.

Yours sincerely

(Signed by different representatives in different provinces.)