Resolutions of the Third TAC National Congress

Women and People with HIV Leadership for a People's Health Service

Cape Town, 23 – 25 September 2005


“We ask President Mbeki to lead the struggle against the HIV epidemic.”
-- Linda Mafu, TAC National Organiser

“Many people who were at the last National congress are not [alive] today. This is not a fashionable struggle but one which is costing us lives.”
-- Reverend Molefe Tsele, General-Secretary South African Council of Churches

Congress Declaration

Between September 23-25 over 600 delegates convened in Cape Town for the third TAC National Congress. The delegates represented over 250 TAC branches and districts from six provinces. They also represented health-care workers, faith-based organisations, trade unions and civil society organisations.

Regrettably, no government representatives attended, despite extensive efforts to invite them.

The Congress met against the background of South Africa's massive and growing HIV epidemic. Officially, over 6 million South Africans live with HIV, of which over half-a-million have progressed to AIDS and need antiretroviral (ARV) treatment immediately. According to Statistics South Africa, mortality rates increased by 57% between 1997 and 2002. Life-expectancy among adults decreased from over 60 years in 1996 to well under 50 by 2005. Additionally, over 400,000 are infected each year. Without the implementation of more effective prevention programmes, the public health system and the treatment programme, in particular, will fail.

Despite the harrowing rates of infection, South Africa has made some progress since our last Congress in 2003. Of the approximately 120,000 people that have access to treatment, over 60,000 are in the public sector. The mother-to-child transmission prevention programme has rolled out to about 1,500 clinics. This has been made possible through the efforts of dedicated civil servants and health-care workers, as well as the activism of TAC and its allies. While this marks substantial progress – shown by the fact that at the last TAC Congress an operational treatment plan was not yet in existence – it is still not enough. ARV treatment is available to less than 30% of those who need it. The mother-to-child transmission prevention programme remains sub-optimal and public messaging on HIV/AIDS remains confused.

The greatest challenge yet is HIV/AIDS denialism supported by some of the most senior political leaders in South Africa. Unless and until President Mbeki publicly accepts facts about the HIV epidemic and demonstrates firm leadership over the matter, treatment and prevention will remain sub-optimal, and millions will suffer the consequences.

The TAC Congress was rich in discussion and debates. It highlighted the enormous challenges facing the struggle for HIV prevention and treatment. Our members have drawn up numerous resolutions and are committed to intensifying our current campaigns. We have agreed to use our branches to mobilise people and districts for the improvement of health-care services, speedier rollout of ARVs, better access to medicines for opportunistic infections, food security, clean water, and properly implemented basic services. Most critically, treatment literacy work must be optimized.

The TAC Congress pledged to prioritize women's health issues and women’s leadership in the context of HIV/AIDS. TAC also commits to building stronger leadership among people living openly with AIDS within the organization.

For the first time, nine awards were granted in the honor of TAC activists who have died and to recognise those who provide leadership. We salute the memories of Queenie Qiza, Christopher Moraka, Edward Mabunda, Charlene Wilson, Sibongile Mazeka, Sarah Hlahlele and the hundreds of TAC members who have died of HIV. They remind us of the urgency of our struggle.

Resolutions


Congress developed resolutions in plenary sessions and in six commissions.

Resolutions in Plenary

The following resolutions were adopted in plenary:

Prevention and treatment campaigns

  1. The Congress reinforces TAC's call for government to treat at least 200,000 people by March 2006, but substantially more than this must be treated by the next Congress. Scaling up the roll-out of ARV treatment is a priority. Treatment must increasingly be made available at the clinic level, as well as at district, regional and academic hospitals.

  2. TAC must call upon international and national allies to pressure President Mbeki to distance himself from AIDS denialism and to provide leadership, discipline and inspiration in the fight against HIV. TAC will request an urgent meeting with the President to insist on greater involvement on his part and to challenge his silence on HIV.

  3. TAC needs to collaborate with government and civil society to devise better strategies to overcome the failure of current prevention efforts – especially with condom distribution, clean needles, and drug replacement therapies. Congress was particularly concerned by the evidence that was presented on the vulnerability of girls and young women to HIV, the high rates of infection and the high levels of maternal mortality. This is an area that needs dedicated and urgent action.

  4. For nearly two years, government has been given evidence that dual therapy – AZT and nevirapine or triple therapy for pregnant women who need treatment – are a more effective means of reducing mother-to-child HIV transmission than the single-dose nevirapine regimen currently in use throughout most of the country. The fact that the Western Cape is the only province to have rolled out the better dual-therapy regimen marks a breach in government's constitutional obligation to provide a comprehensive mother-to-child transmission prevention programme for all. TAC must campaign better to demand that government improve the mother-to-child transmission prevention programme.


Building leadership

  1. TAC must do more to create leadership positions for women and people living with HIV/AIDS. We must ensure increased participation of women and people with HIV/AIDS (PLWA) systematically in all levels of our work by setting clear targets and plans.

  2. TAC must strengthen its work at the branch and district level to mobilise for better health delivery at the local level. Our campaigns must show that we address a broader range of issues to eliminate the false impression that we focus solely on ARV treatment. We campaign for better health services, sufficient health workers and quality care.

  3. Campaigns to prevent and treat HIV should involve all classes and races in South Africa. Currently, the majority of TAC activists are black and poor. However, campaigns to prevent and treat HIV should involve all classes and races in South Africa. We need to encourage white, coloured, Indian and middle-class people to join TAC.

  4. TAC must strengthen its international work and become more engaged in international campaigns.

  5. The treatment literacy practitioner bursary programme must recruit TAC's best volunteers and be at most a year long. New volunteers should then replace the previous set of practitioners.


The TAC General Secretary

Noting:

It was therefore agreed by the NEC that a post of General Secretary (GS) be created with effect from the third TAC Congress in September 2005. It was also agreed that

It will include the following responsibilities:

Internal:

External:


The NEC agreed that to be eligible for election a person must:

The NEC agreed that


In agreement with all of the above, the TAC National Congress hereby amends the TAC Constitution at paragraph 6.1.5 to replace the word secretary with the words “a full-time general secretary”


Resolutions in Commissions

Commission 1: Building a People's Health Service

It is South Africa's constitutional duty to provide quality health services for all. The current health system is characterised by gross inequality between private and public health systems. The private sector absorbs the majority of funding, yet provides for a relatively small percentage of society. Human resource shortages, underfunding of the public sector and a lack of good management and leadership have aggravated the systemic crisis in the public health system. TAC resolves to spearhead the movement for a comprehensive people’s plan for health care in the country, in which a package of essential health services is provided for all, based on a primary health care approach.

The Government has brought into effect the National Health Act, which is the framework for all health legislation. The Department of Health recently drafted a Health Care Charter which focuses on issues of access, equity, quality, and Black Economic Empowerment (BEE). However changes in ownership with the private health sector, as a result of BEE, does not necessarily translate into progressive transformation for the users of the health system. The Department of Health excluded civil society stakeholders from discussion while writing the first draft of the charter. TAC, AIDS Law Project, COSATU and the South African Medical Association called for it to be further debated through a forum such as NEDLAC.

In September 2005 the Department of Health eventually produced a plan to address the crisis in human resources. But the plan fails to clearly outline the specific steps it intends to take to respond to HR issues in the health sector, such as patient / health worker ratios or dates for implementation. Additionally, it fails to recognize the gravity of the HIV/AIDS epidemic.

In addition there are a number of other government strategies, such as the Risk Equalisation Fund and Government Employee Medical Fund (GEMS), which represent a general movement towards a social health insurance. We must campaign to ensure that it does not continue to strengthen the private sector and exclude the poor and unemployed.

Some of the issues discussed during the commission included:


Taking into account all of the above, the TAC Commission on the People’s Health Service resolved:



Commission 2: HIV Prevention

There is a crisis of new infections. Levels of HIV incidence are increasing significantly with over 400 000 new infections every year. Access to all forms of prevention must be based on the right to life, dignity, equal access to health-care including reproductive health and privacy. HIV infection limits the right to life, reduces quality of life and places enormous burdens on individuals, families, communities and health services.

TAC believes that, despite success in some areas, HIV prevention is failing in South Africa as well as in other parts of the world. Current prevention messages are prescriptive and do not adequately educate the public around areas of healthy sexuality or HIV. Society needs to create more open spaces for people to discuss sexual practices. We acknowledge the complexity of factors driving the epidemic and that there are not easy solutions. Nonetheless, many prevention interventions, despite good intentions, have resulted in disappointment.

The structural impediments to HIV prevention efforts such as the economic inequality and dependence of women on men and families, the social and economic marginalisation of young people particularly young men and the cultural subordination of women to men must be systematically addressed as part of HIV and development work.

TAC intends to incorporate prevention efforts across a broad range of its work, especially through community mobilization. All TAC members require detailed knowledge of the scientific issues. In addition to immediate action, we must research more effective prevention strategies.

The TAC Congress believes the following measures are necessary:

Scaling up prevention

  1. Prevention is far more complicated than the government’s Abstain Be faithful Condomise (ABC) strategy. We must encourage Khomanani to increase the frequency and visibility of their public education messages. Additionally, we must pressure LoveLife to collaborate better with other prevention campaigns and improve their public messaging.

  2. Both the government and civil society require thorough assessment of the efficacy of current preventive interventions.

  3. We must expand the numerous smaller-scale projects such as TAC's AIDS Action Committees in schools, TAC's public information campaign, Soul City, etc.

  4. We must create new interventions that reflect recent scientific data:

    • Emphasize that people are most infectious in the months following infection, which is when they are unsymptomatic and unaware of their status.
    • Pending the outcome of the circumcision trials (and peer-review of the Orange Farm circumcision trial), the issue of medical male circumcision should be debated and put on the agenda of all levels of government, while countering the view that after circumcision you can have unprotected sex.
  5. Address the dismissive attitude by most men to health issues though intensive work at the community level. Involve more men in programmes to end gender-based violence.

  6. The marginalization of women inhibits them from being able to negotiate safer sex. Violence against women is on the rise. Efforts around prevention must deal with these issues.

  7. Highlight the needs of sex workers, prisoners, soldiers, gay men and people with HIV by including them in media campaigns.

  8. Challenge misplaced complacency among coloured, white and Indian people by emphasizing that HIV is an epidemic across all races.

  9. Partner with faith based organizations, including South African Council of Churches, to pressure churches to accept the value of condoms and to openly promote their use.

  10. Create standardised counselling that addresses safer sex and distribution of condoms, more mobile and youth friendly clinics, in order to encourage VCT.

  11. Improve youth prevention through the development of creative, entertaining strategies. Integrate TAC's youth programmes into other TAC programmes.


Improve Access to prevention measures

  1. Create more effective strategies to decrease mother-to-child transmission prevention. This must include the use of better regimens than single-dose nevirapine.

  2. Condom distribution should be improved and access to female condoms needs to become more widespread.

  3. Scale up the syndromic management of sexually transmitted infections (STIs) because untreated STIs contribute to increased HIV incidence.

  4. Improve access to post-exposure prophylaxis for rape survivors and health-care workers and ensure that it is universally available in SA.

  5. Intensify the development of microbicides.


Address Social Issues that spread HIV

  1. Poverty, unemployment and poor housing lead to the breakdown of social structures, loss of dignity and increased HIV incidence. We endorse the call by COSATU and others for urgent action to address high unemployment, the housing crisis and general social security through the implementation of a basic income grant (BIG).

  2. Mining companies must escalate the termination of the migrant labour system and enable mineworkers and their families to live together in decent housing.

  3. Some people are forced to choose between grants and ARVs. We need to find ways to address this.

  4. Support youth recreational programmes at the community level (and not only through workshops).


Prevention Summit:

  1. Noting the failure of HIV prevention, and the fact that the state's Strategic Plan ends in 2005, TAC calls for a national HIV prevention summit with all other HIV/AIDS organisations. This summit must develop strategies for implementing better and more comprehensive prevention strategies.


Commission 3: HIV Treatment

A series of factors challenge the Operational Plan from proper implementation. These include the shortage of health care workers, confusing messages from the Department of Health, ongoing politically supported AIDS denialism, the need to implement the down-referral system and insufficient training for caregivers who provide ARV treatment to children. Instead of addressing all these problems, Congress wishes to highlight the following areas of concern:

Speeding up the provision of ARV treatment:

Action at the national/provincial level:

Action at the policy level:

Action at the local/facility level:

Addressing stigma

Mobilizing communities


Engaging the Government, the Minister of Health and senior officials in the Department of Health


Commission 4: Women, HIV and Human Rights

While appreciative of the fact that the theme of the Congress emphasizes the need for women's leadership, the Commission on Women, HIV/AIDS and Human Rights is critical of the organizers’ failure to provide child care. Several women were forced to bring along children in order to participate in the Congress, thus inhibiting them from full participation. Failure to provide childcare also means that other parents of small children were prohibited from equal engagement.

Noting:

Recognizing:

Organising Public Forums on Gender Equality and Women’s Health

  1. Forums, directed by provincial co-ordinators, must be created for discussing important gender-related issues. Possible topics for the forums could include cervical cancer, pap smears, termination of pregnancy, prevention of mother-to-child transmission of HIV and the rights of women living with HIV/AIDS.

  2. Without creating separatism, TAC should create safe gender-specific spaces to allow for issues that are generally difficult to speak about to be raised. We should also develop a language that allows women to speak about their experiences of gender and gendered oppression.

  3. Men are to lead public education efforts for other men on prevention, HIV, stigma, discrimination, sexuality, men’s health and the urgent need for men to access treatment.

  4. TAC must conceptualise and prioritise a public campaign on the theme of the Congress.

  5. Factors that underpin patriarchy, such as tradition, culture and the vulnerability of women, demand serious discussion.

  1. TAC should organize a conference on gender to explore the issue fully and develop a more comprehensive national gender equity plan by March 2006.

  1. Recognizing the crisis of prevention advocacy and the failure (especially in respect to women) of the existing “patchwork” approach to prevention, the TAC should campaign at the time of the April 2006 Microbicides Conference to highlight gender inequality and HIV prevention.

  2. The Commission also called for a transparent consultative process – to be lead by the Department of Health – to develop and implement a comprehensive prevention campaign that is linked to treatment and women's human rights.

  3. We must develop a campaign that addresses the age and frequency of access to the pap smear test in the public sector. A discussion of rape, exposure to herpes and cervical cancer exposure are also critical.

  1. We must work closely with other organizations that address socio-economic inequalities and gender.

  1. Organize a march at the opening of parliament to address women's special vulnerability to disease and other social ills.


Conclusion

  1. The Commission noted the following concerns that also need to be taken up more comprehensively:

  1. TAC at branch level must visit clinics and carry out campaigns to assist and support women at voluntary counselling and testing sites by providing information and support.

  2. TAC should take special note of the impact of poverty on women in rural areas, such as limited access to condoms.

  3. The Lorna Mlofana trial has taken over two years. During the 16 days of activism against violence against women, TAC must increase our commitment towards ending violence against women and children.


Commission 5: Children and HIV

The South African Constitution delineates the legally enforceable rights of children and has ratified the United Nations Convention on Rights of the Child. These rights include the rights to health and family care.

In South Africa, 42% of the population is under the age of 18 years old. Approximately 200 to 250 children under 15 years old become HIV positive every day. During the course of the commission, about 10 children became HIV positive. Without proper treatment for parents, it is projected that 5 million children will be orphaned by 2010. In speaking about children, we refer to people under the age of 18; thus, the quantity of children with HIV are higher than the above stated figures. Children, especially babies, are more susceptible to illness and death than adults. The health, care and development needs of children vary according to age.

Children have been found to respond well to treatment. However, many are kept from getting properly tested, and thus treated, because many adults neglect to get their children tested. Even more, many health facilities do not provide testing and treatment for children.

As members of civil society organisations, as members of TAC, as members of communities and families, we hereby resolve that:

On Access to Treatment for Children

  1. The TAC NEC should:


  1. The TAC Provincial Executive Committees should:


  1. The TAC Branches should


  1. PLWA support groups linked to TAC should:


  1. TAC must


  1. TAC Gender and Youth Programmes must


On Treatment Literacy and children

  1. Increase PEC and NEC awareness of children's treatment issues by regularly reporting to both on these issues.

  2. Target children's NGOs to educate them on testing and treatment.

  3. Ensure that every TAC member is able to refer parents and caregivers of children to a site closest to them.

  4. Improve understanding of and support to guardians and caregivers about testing and treatment.

  5. Develop clearer understanding, information and messages on children and disclosure.

  6. Work with the Department of Education to create public education programmes on Life skills. This should include treatment literacy workshops and age appropriate life skills programs at schools about sexuality and HIV/AIDS prevention for the life orientation teachers.

On Support of children affected and infected by HIV/AIDS

  1. The government’s Human Resources plan should include more social workers, employed by Government, to handle needs of families and children at a local level.

  2. TAC must continue to work with BIG and ACESS to advocate for the extension of social grants for children to the age of eighteen.

  3. Feeding and nutrition schemes should be extended to secondary level.

  1. TAC Branches should

On Prevention

  1. The NEC should


  1. The Provincial Executive Committees should

  1. TAC branches and members should

22. Support groups should


Commission 6: Organising and Engagement

This commission took resolutions with the objective of building TAC into an organisation that is vibrant, functional, strong and capable of realising its goals in a changing South Africa. The commission recognised the need to build TAC internally through political education, skills development and programmatic campaigns. It noted the achievements, strengths, weaknesses and challenges facing the TAC as a growing organisation. There is a need to consolidate basic organisational and political skills in all TAC structures. TAC is made up of people from diverse backgrounds who have joined the organisation for many different reasons. A concern that has been raised is that, at times, TAC focuses excessively on ad-hoc campaigns, while neglecting efforts to systematically build capacity to implement programmatic campaigns.

We acknowledge concerns about the existing tensions between remunerated Treatment Literacy Practitioners (TLPs) and unremunerated volunteers that can demotivate members and result in loss of members.

Therefore, the commission resolved to:



Strengthening the role of the TAC in building a broader civil society agenda

The Commission resolved that it was necessary to


Strengthening the capacity of the TAC to take advantage of opportunities within local, district and provincial government

Noting the important role of local government, the district health system and provincial governments in service delivery, it was recommended that TAC

Strengthening the capacity of TAC to work and campaign at a local health facility level, the district health system and provincial health structures

Local health facilities, the district health system and provincial health departments are critical to TAC's work. Many local, district and provincial health facilities do not provide adequate services and operate with inadequate resources. Additionally, many TAC structures are not fully aware of how the district health system and the provincial health departments and structures operate.

Therefore the following was resolved:

TAC role in gender education, taking forward women’s health issues and developing women leadership

Noting the theme of the Congress and the fact that 70% of members are women, TAC resolves to improve its programmes in gender education and women's particular needs in planning campaigns. TAC affirms the role of women as members, volunteers and leaders. Therefore we resolved to


The TAC role on issues affecting rural areas

Rural populations experience a disproportionate burden of low functional literacy and poverty. TAC recognizes that rural areas in South Africa require greater attention in terms of treatment literacy and organising skills. This is why it is necessary for the NEC to develop an extensive programme and approach to building TAC's work in rural areas; We have also noted a concerning increase in virginity testing schools in rural areas.

TAC resolves to


Further issues were raised in the Commission but not sufficiently discussed. These included (1) taking up issues affecting children and youth, (2) building PLWA leadership, (3) issues relating to TAC organisational structure, (4) issues of clarity on the Thekwini report (page 10 of the TAC organisational report).


ADOPTION OF COMMISSION AND PLENARY RESOLUTIONS

The resolutions of the Commission were presented and discussed in a plenary session of the TAC Congress on 25 September.

After discussion COSATU proposed that they be adopted at Congress.

Formal Mover for adoption: Thabo Cele, PWA sector, KwaZulu Natal.

Seconder: Phindi Madonsela, Deputy Chairperson, Gauteng.

Adopted unanimously.


[END OF RESOLUTIONS]