Treat 200,000 by 2006
TAC Electronic Newsletter - 10 February 2005Contents
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[This is the executive summary of the TAC NEC's resolutions adopted on 24 and 25 January. The full resolutions document will be placed on the TAC website, www.tac.org.za, in the next week.]
TAC's focus in 2005 will be to campaign for 200,000 people to be treated with antiretrovirals in the public sector by the beginning of 2006. At least 10% of these should be children. We will launch this campaign with a march to Parliament in Cape Town on 16 February. The event will start at Keizersgracht Street at 11am.
The Operational Plan published on 19 November 2003 was a significant milestone in the struggle against the HIV epidemic. The Plan estimated that half-a-million people needed treatment immediately. It envisaged treating 53,000 people by March 2004. Without explanation, it was announced that the target of 53,000 had shifted to March 2005. Yet by end of September 2004, slightly less than 20,000 people were on treatment in the public sector according to the Department of Health. The Civil Society Monitoring Forum has calculated that there are approximately an additional 45,000 people on treatment through medical schemes, NGOs, individuals paying out-of-pocket and work-based treatment programmes. The Actuarial Society of South Africa estimates that over 300,000 people died of AIDS last year and more will die in 2005. Only a significant scale-up of treatment can stop this.
Approximately, 60,000 children were infected with HIV last year. About half of HIV-infected children die by the age of two. Yet very few of those being treated are children. That is why the TAC is calling for 10% of those treated this year to be children. The government has a moral, legal, Constitutional and humanitarian duty to scale up treatment.
Progress in the Western Cape and Gauteng provinces is good; they are treating more people than the other provinces put together. The central challenge for these two provinces is to ensure a primary health care rollout. But progress in all the remaining seven provinces is too slow. Limpopo Province is the slowest. It claims to have about 100 people on treatment and, along with Kwazulu-Natal Province, has been the least co-operative in providing information and making treatment available. It is commendable that provincial departments of health, except Limpopo, have been forthcoming with information and co-operative, in general, with civil society. The lack of leadership from the National Department of Health remains the most important factor blocking a speedier rollout.
This is what must be done to achieve the 200,000 target:
A large public information campaign encouraging people to get counselled, tested, and where necessary, treated.
Antiretroviral treatment must be made available on a far wider scale, especially at primary care level. Tintswalo Hospital in Limpopo Province has the capacity and need to treat hundreds of people immediately, but no antiretrovirals have been made available to the hospital. Madwaleni is a rural area in the Eastern Cape. Doctors and nurses there want to commence treatment, but they need resources start, including a pharmacist and antiretrovirals. In Gauteng, Orange Farm residents have to travel an impractically long distance to get treatment such as to Chris Hani Baragwanath Hospital.
The procurement tender needs to be finalised. Drug shortages because of an inadequate procurement mechanisms continue to affect hospitals and clinics.
TAC's Other Key Campaigns for 2005
The backbone of TAC's work is our treatment literacy programme directed by Siphokazi Mthathi. 120 trained treatment literacy practitioners in Gauteng, Kwazulu-Natal, Eastern Cape and Western Cape provinces teach at clinics, hospitals, schools, workplaces and community institutions. These treatment literacy practitioners are provided bursaries of R1,000 a month by TAC for a year in order to learn more about treatment literacy while doing practical education in communities. Subjects covered include the science, prevention, treatment and care of HIV, nutrition for people with HIV, social grants, the health-care system and political issues relevant to our work. This year we will extend the programme to Limpopo and Mpumalanga provinces.
The TAC TP is currently treating exactly 100 people. Last year 3,475 of our members tested their CD4 counts through the TAC TP. Over 1,320 had CD4 counts below 200, indicating they need to go onto treatment immediately. This year we intend to raise the funds to put 1,000 people on treatment. For every TAC member treated, the TAC TP pays for the treatment of one person, not necessarily related to TAC, in the public sector. A number of companies, including Levis, YDE and Olympia Cafe, have run projects to raise money for the TAC TP.
Drug Supply and Price Activities
Efavirenz is an essential antiretroviral medicine. All patients initiating treatment in the public sector are put onto either efavirenz or nevirapine, depending on their individual needs. However, there have been regular delays in filling orders resulting in a concern among doctors of potential stock shortages. Therefore TAC has called on MSD, the patent-holder, to allow generic companies to supply efavirenz on the same terms that GlaxoSmithKline, Boehringer Ingelheim or Bristol-Myers Squibb have done with their patented antiretrovirals. The response from MSD till now has been inadequate and we have therefore begun to prepare litigation to compel MSD to allow generic competition. We are also preparing to demonstrate outside MSD offices. Efavirenz is also the most expensive of the first-line antiretrovirals (R214.31 per month), costing twice as much as an entire first-line regimen supplied by one generic company to government.
TAC is also concerned about supplies of the Abbot patented drug, ritonavir. Ritonavir is needed with all protease-inhibitors used in second-line antiretroviral regimens. We are concerned that Abbot has restricted the supply of ritonavir in order to compel second-line patients to use its protease-inhibitor, lopinavir, which is sold in combination with ritonavir.
Mother-to-Child Transmission Prevention
Government has indicated that it has implemented the single-dose nevirapine regimen for mother-to-child transmission prevention in over 1,500 facilities. TAC has sent a letter to the Minister of Health asking her to state clearly that single-dose nevirapine is safe and effective and requesting what plans the Department of Health has to rollout a more effective regimen (as has been done in the Western Cape).
Public Information Campaign
The TAC will run a public information campaign which will involve running adverts in newspapers and on radio conveying important information about treatment, prevention and nutrition with respect to HIV. While we do not have the funds to run campaigns the size of LoveLife and Khomanani, our intention is to set examples of public messaging for these organisations.
Youth and Prevention
TAC will be running youth camps with a focus on prevention. Following these youth camps, public actions highlighting the need for condoms and sex-education in schools will be run.
TAC's international work will consist of supporting the campaigns around the G8 for debt reduction, sustainable AIDS funding, greater market access for developing countries, and increasing our treatment literacy work in the SADC region.
Response to ANC Today Attack on TAC and Nevirapine
On 17 December, ANC Today published an article that defamed TAC and made inaccurate claims about the safety of nevirapine.
The TAC NEC has decided not to sue ANC Today because we believe that the majority of ANC members and leaders are not AIDS denialists and would not subscribe to the views expressed by the unnamed author of the article. Litigation would be a diversion from trying to unify ANC members and the country as a whole behind effective HIV prevention and treatment. Instead TAC will produce an "Open Letter to ANC members" setting out our real objectives and answering some of the inaccuracies in the article. This will be made available to ANC members at community level, and we will challenge the ANC to allow TAC a right of Reply in ANC Today on the same basis that they gave The Economist.
[END OF TAC CAMPAIGNS FOR 2005 - BACK TO CONTENTS]
Levis Rage for Revolution Concert to Raise Funds for TAC Treatment Project
The Treatment Action Campaign accepts the support of Levi Strauss through the Red for Life initiative, to place people on antiretroviral treatment and to promote condom use among youth. The first major project of Red for Life is the ‘Rage for Revolution’ concert, to be held on 12 February 2005 (from 14:30 until late), at the Castle of Good Hope, Cape Town. The event will showcase arguably some of South Africa’s finest musical talent, including Tumi and the Volume, the Springbok N-u*d-e Girls and F-o&k-ofpolisiekar, and will be MC’d by Reddy D and Mr Fat.
Levi Strauss has long been identified with a proactive stance against sweat-shop labour, and more recently, the implementation of a comprehensive AIDS policy that incorporates the provision of antiretroviral medication for HIV-Positive employees. TAC insists that all companies should develop similar policies.
The Red for Life initiative, along with YDE's Wear Rubber Campaign, is the first instance of South African corporate support for the TAC Treatment Project. Historically, TAC has been exclusively funded by international donors, and is entirely reliant on donations. The TAC welcomes the support from Levi Strauss, as it is evidence that South African companies are now becoming actively involved in the struggle to promote access to a decent public healthcare service for all South Africans.
The TAC Treatment Project is a program that aims to provide treatment to TAC activists and community members. The Rage for Revolution concert and other Red for Life projects will contribute directly to this project, and will save lives.
The theme for the whole Red for Life/TAC Treatment Project campaign is ‘Condoms Everywhere’. This slogan promotes both prevention and acknowledgement of increasing rates of infection among youth. A recent study by the Reproductive Health Research Unit at Wits University shows that while young people are well informed about the dangers of HIV/AIDS, the various risks and ways in which the virus can be contracted, they mostly did not use condoms when having penetrative sex.
[END OF LEVIS CONCERT -BACK TO CONTENTS] Law and Freedom, a new two part documentary by Zackie Achmat to be broadcast on SABC 1.
One of the most important gains of the first ten years of democracy in South Africa has been the legal revolution brought about by the Constitution. Narrated and directed by Zackie Achmat, Law and Freedom is a two part documentary exploring key decisions of the Constitutional Court. Law and Freedom intervenes at a crucial point in our national debate on the role of the judiciary in giving meaning to our constitutional state in which the sovereignty of parliament and the actions of individuals have to pass the test of the Constitution. A synopsis of both parts of the documentary is included below.
Broadcast Dates on SABC 1:
Part 1: Who was Mrs. Komani?
Monday 14 February, 10:00 pm.
Part 2: It’s a Nice Country!
Monday 21 February, 10:00 pm.
Synopsis of Law and Freedom:
Part 1: Who Was Mrs. Komani?
Part 2: It’s a Nice Country!
Duration: Two parts of 48 minutes each
Director: Zackie Achmat
Producer: Jack Lewis
DOP: Giulio Biccari
Editor: Lucilla Blankenberg
Who Was Mrs. Komani? relates the dramatic cases that led to the abolition of the death penalty and the decriminalisation of sodomy, a ruling that acknowledged the equality of gay and lesbian people. These judgments stand in contrast to the legal execution, harassment and persecution of apartheid era law. However, even under apartheid, as human rights lawyer Geoff Budlender explains, "law was a limit on power" and so spaces arose in which people could use the law to contest the abuse of power. One key example explored in the film is that of Mr and Mrs Komani whose 1980 case led was a key cause of the collapse of the hated Pass Laws. Who Was Mrs. Komani? brings to light the people who made possible these cases which have dramatically affected the lives of our people and the history of our country.
In Part 2: It’s a Nice Country! We meet courageous women and men who have used the Constitution to build democracy and a better life for all. First, we meet Irene Grootboom whose struggle for housing culminated in a landmark ruling of the Constitutional Court that is seen as crucial for the establishment of greater socio-economic rights. In the case of Ngxuza and others v the Eastern Cape Provincial Government, we meet the Meltafas, who even in the new democratic order, had to challenge abuse of power when their grants were unlawfully withdrawn. When labeled a troublemaker by officials, Mrs Meltafa responds, "You have been sleeping, I have woken you up!". It’s a Nice Country! also explores the case of the Treatment Action Campaign’s battle for the use of antiretrovirals to prevent mother-to-child transmission of HIV. In this personal reading of the "Nevirapine case," Achmat pays tribute to TAC members who, through their work of education and community mobilisation, used the Constitution to achieve access to life saving treatment.
[END OF LAW AND FREEDOM -BACK TO CONTENTS] Condoms an Essential Component of Anti-AIDS Strategy, SACC Warns
The General Secretary of the South African Council of Churches, the Rev. Dr. Molefe Tsele, expressed shock and dismay at continuing assertions that condoms "don't work" as a means of preventing the spread of HIV.
"All credible scientific studies conclude that the virus that causes AIDS cannot pass through a latex condom. When used properly, condoms are effective in halting transmission of the virus," Dr. Tsele said.
He noted that, despite the scientific evidence, there were continuing disagreements among the Council's 26 member denominations about the moral implications of condoms. The Methodist and Anglican Churches, for example, do not rule out condom use. A resolution adopted by the Council's National Conference in 2001 called on churches to "encourage the use of measures necessary to prevent infection" in addition to promoting sexual abstinence and faithfulness in marriage.
The General Secretary also attacked as "theologically wrong" the "demonisation" of condoms and the attempt to portray condom use as a "morally inferior" option for preventing HIV infection. "The use of condoms is consistent with a theological tradition that emphasises the sanctity and dignity of human life."
Dr. Tsele accused the US President's Emergency Plan for AIDS Relief (PEPFAR) of fueling the resurgent moral conservatism behind the emerging war on condoms. PEPFAR, President Bush's US$15 billion anti-AIDS plan, is legally obliged to commit at least one third of its resources to programmes that stress "abstinence-until-marriage" as the primary prescription for halting the spread of HIV.
Although the plan does not rule out condom distribution, it urges that promotion of condoms be limited to groups that engage in "risky behaviour" - mainly sex workers and couples where one partner is HIV positive and the other is not. Reports indicate that many organisations have curtailed or eliminated condom distribution schemes from their
public health programmes in order to increase their chances of attracting PEPFAR funding.
"This message creates the false impression that sex within marriage is not 'risky' unless the couple know that one partner is infected," Dr Tsele warned." In fact, women are particularly vulnerable to infection, often by husbands whom they incorrectly presume to be faithful. Fidelity alone is not an adequate defence against HIV."
The General Secretary also criticised US officials responsible for AIDS initiatives for promoting an interpretation of Uganda's experience that attributes the country's apparent success in decreasing HIV prevalence rates largely to abstinence and fidelity whilst downplaying the role of condoms.
However, condom distribution was a key aspect of the multi-faceted programme pioneered by the Ugandan government. Scientific studies of Uganda's record have shown that delaying one's first experience of sexual intercourse, reducing the number of sexual partners, and using condoms all played important roles in curbing the spread of the disease.
The General Secretary praised the South African government for its continuing commitment to condom distribution. "Abstinence and faithfulness are powerful and vital messages, especially for religious bodies to be communicating. But condoms clearly remain an essential component of any public initiative to halt HIV transmission," Dr. Tsele
said. "You can be faithful and still wear a condom."
[END OF SACC STATEMENT -BACK TO CONTENTS]
[END OF NEWSLETTER]