Sibongile Tshabalala

It is my privilege, honour and joy to welcome you, my Comrades, to the Treatment Action Campaign’s 7^th National Congress.

Since we last gathered, the world has changed. We have come through a life-altering pandemic, one which pushed the health system we rely on to its absolute limits. But it also held up a mirror to those of us who have dedicated our lives to improving the lot of our people, especially those relying on the health system.

Congress offers an opportunity at critical self reflection. It also offers us a chance to pat each other on the back for exemplary leadership.

This congress, I applaud many comrades, who despite immense challenges have played a key role in improving access to healthcare services for our people. A few highlights we should feel proud of are:

• The Ritshidze project team, who have led the way in holding duty bearers to account. This project is world class and the Ritshidze model is now being used all over the Global South. Watch this space!
• Gauteng comrades for their protest action, sleeping outside the office of the Gauteng province Premier until they were heard.
• Comrades across the country who have advocated for TB to be declared a national health emergency.
• The treatment literacy team, which helped TAC members and broader community members better understand COVID-19 and the need for vaccination, but also the science which led to its safe development. It was a proud moment when our Comrades were among the first to report for those first J&J shots.

However, we cannot rest, this Congress is held at a critical time when the gains of the past need to be amplified in order to fulfil the Constitution’s promise of quality healthcare for all.

As Tata Madiba reminded us:

“I have walked that long road to freedom. I have tried not to falter; I have made missteps along the way. But I have discovered the secret that after climbing a great hill, one only finds that there are many more hills to climb. I have taken a moment here to rest, to steal a view of the glorious vista that surrounds me, to look back on the distance I have come. But I can only rest for a moment, for with freedom come responsibilities, and I dare not linger, for my long walk is not ended.”

TAC’s long walk has not ended.

Corruption

Comrades, I think everyone has an idea of the socio-political situation in our country. We are in the midst of many intersectional struggles.

We are in a country where corruption has become commonplace. Many of these have been in the healthcare sector. These include the Digital Vibes scandal, which saw the health minister resign and several officials disciplined, the PPE procurement scandals which saw millions and millions of Rands misappropriated, the Eastern Cape Health Department scandals and the Midvaal municipality scandal.

The reality is that those who pay the ultimate price are poor people. Poor people who died in hospital queues or clinics with no medicines or waiting for ambulances that never come. While poor people die, those who steal the money live comfortable lives.

The corruption is also taking place against the backdrop of poor healthcare services and austerity measures. So, while the crooks steal millions, there is less money for services that are literally lifesaving.

Yet we have hope. Brian Hlongwa and his cabal are finally facing criminal proceedings after over 12 years.

Importantly, community members are also taking a stand. According to a Corruption Watch report into corruption in the healthcare sector titled “X-Ray: The Critical State of the Health Sector in SA”, over 700 whistleblowers approached them to report corruption.

But we cannot mention whistleblowers without paying tribute to Babita Deokaran who paid the ultimate price for trying to stop the disgusting theft of money meant for a hospital where patients were dying lonely and hungry. Her death cannot be in vain!

Xenophobia and Key Population discrimination

We need to unite against xenophobia in all its forms. Those who harbour hate are becoming louder and more outspoken. TAC has a key role to play in calling out xenophobia whether it be in communities or in the healthcare sector.

TAC needs to make sure that as NHI is implemented that it is indeed UNIVERSAL healthcare coverage and not Healthcare coverage for some.

The Ritshidze Key Populations report highlights continued and worrying discrimination against people who use drugs (PWUDs), sex workers, trans people and gay men, bisexual men and other men who have sex with men (GBMSM).

The discrimination they face, like that of many others is broad and also in terms of access to health. It is worrying, sad and outrageous that 20% of KPs interviewed said they were not accessing healthcare services anywhere.

That is one in 5 people.

Poor staff attitudes, lack of safety and lack of privacy were the main complaints at public health facilities.

My hope is that we improve our understanding about the plight of marginalised and/or vulnerable populations in general and advocate for their rights without ‘othering’ them.

Inde lendlela, but we will overcome.

Gender-Based Violence

Gender Based Violence and Femicide has been rightly described as a pandemic by the country’s President. 

As I’m talking to you, womxn and children are still suffering in their communities and in their homes, in their workplaces and their schools.

According to official statistics, a shocking 10, 818 rapes were reported in the first three months of 2022. Even worse, 4, 653 of these occurred in the home of the survivor.

Gender-based violence also negatively affects us as people living with HIV.

As TAC and Ritshidze, we monitor over 200 indicators quarterly. One of these involves index testing. In Quarter 4 (July – September 2022), of 7, 606 people living with HIV, 13,6% said that they were not told that they could refuse to participate in index testing.

We maintain that this is 13,6% more than we find acceptable given the violent society we live in.

This could be the difference between life and death.

It is telling that 44% of facilities proceeded to contact all partners for testing, regardless of a propensity towards violence or not.

The question that we need to ask ourselves, have we done enough? It is my hope that the representatives appointed in sectors prioritise this and engage in data driven advocacy, leading the organisation in this radical step towards fostering a healthcare revolution in the country.

PLHIV Sector

TAC has always prided itself on being centred in the struggles of people living with HIV. In our broader struggles for quality healthcare services for all, it is important not to lose this identity.

While we are resolute in our conviction to protect the status of those who do not want to disclose, I plead with those leaders who will be newly elected to disclose their status should they be PLHIV in order to destigmatize the pandemic and be a shining example of living positively through U=U.

It is generally accepted that the focus on COVID-19 negatively affected the response to the HIV and TB pandemics. The Lancet reported a 48% decrease in HIV testing within the first month of COVID in South Africa. ART initiation also dropped drastically, with a 46% drop experienced during the first week of lockdown.

We therefore call on members of TAC to help reprioritise HIV through calling for increased testing and holding duty bearers accountantable in initiating and keeping PLHIV on treatment in order to achieve the 95-95-95 targets.  

Importantly, we are proud that our efforts to unify the PLHIV sector have borne fruit. Through them we have seen the birth of the award winning Ritshidze project. This project, which is the largest in the world, currently monitors over 400 facilities. 35 additional TAC pilot sites have been started, which ought to swell to 216.

As such, we hope to have at least 620 sites by the end of the year.

Ritshidze continues to show that data driven advocacy and our insider-outsider approach is revolutionary and effective.

Allow me to take this opportunity to congratulate all who have been part of Ritshidze for its many successes.

We look forward to other revolutionary community-led monitoring projects with other PLHIV sector organisations in the near future.

Important sites of struggle in healthcare

TAC has devoted more time speaking about its involvement in SANAC than it ought to. This is because SANAC has at various times been populated by some individuals more interested in self advancement instead of the broader fight against HIV, AIDS and TB.

The response on the ground simply does not show commitment.

AIDS Councils from the local level to the provincial level are not fully functional and there’s less political will from the Mayors, Premiers and other duty bearers. Surprisingly, when there are international conferences they are all interested to attend and the question is why?

It seems that they want to shine internationally but fail to shine at home where they are placed in power and given more opportunities to do so.

The upcoming SANAC elections offer us a chance to have a clean slate. We are calling upon all TAC members at all levels to engage other sectors and ensure that we swell the ranks at district, provincial and national level.

Building local activism

I worry about the declining state of activism in the country broadly and the organisation specifically. There has been an exodus of leaders at all levels, as comrades continue moving on to greener financial pastures. This has had a negative effect on the organisation.

It is worrying that 51 TAC branches were not accredited for this congress. Furthermore, 35 branches received partial accreditation, meaning only 66% of the branches will be able to fully participate in all the democratic processes.

We commit to building a radical, mass-based movement in every community across the country. We commit to having at least 50 members per branch as part of this.

Critically, COVID has made us think about how we engage as activists to reach our desired ends.

What is clear is that traditional forms of protest action are no longer viable and there is a need for re-radicalisation and a more creative approach. As it is, in some instances, duty bearers join us in these actions, knowing that they need to weather the storm for a few hours before everything goes back to normal.

The passive resistance campaigns TAC has been involved in in the Eastern Cape and Gauteng, which included sleeping outside Premier David Makhura’s office for two days in direct contravention of the Lockdown regulations affords us a blueprint of how to ensure we get the desired outcomes.

We pay special tribute to comrades in India led by Delhi Network of Positive People (DNP) who are over 30 days into their passive resistance sit-in campaign at the National AIDS Control Office protesting stockouts and their governments callous response advising patients to change their treatment regimen. In other states, adults have been given paediatric doses, while others give children adult break up doses.

Comrades are only asking for one month’s medicine supply, instead of the three to six months we call for. While South Africa has a long way to go, at USAID supported clinics globally (excluding South Africa), more than 70% of patients are receiving at least 3 months supply of ARVs, there has been a 30% increase in those receiving 6 months supply as of 2021.

Other PEPFAR-supported countries have reached this goal. Their plight, as is the case with ours, is unacceptable! We are with you in spirit, comrades!  

New technologies

There is also a need to harness new technology and move with the times, as has been shown by Modern ART, through the use of street art and QR codes as well as through the use of cellular phone applications available on Play Store and Apple Store.

I urge everyone to log onto the Modern ART app!

These strategies will ensure that we reach out to some parts of the urban youth.

Using the law and policy submissions

As we continue to engage in the amendment to Intellectual Property rights as well as the fulfilment of universal health coverage through the National Health Insurance (NHI), which I have argued  falls short in its current guise, it is important to draw inspiration from comrades in Argentina, who have fought for many years for progressive inter-sectoral laws that protect the rights of PLHIV.

This all-encompassing Bill includes guarantees around access to medicines, TRIPS health safeguards, labour rights, among other critical issues. 

We congratulate comrades, community activists and people living with HIV and Hepatitis in Argentina on this momentous victory! It highlights the importance of the law in radically transforming a society.

Health systems strengthening

The Health Care System of our country has moved from bad to worse and we see less of a response from  our duty bearers. In 2021 TAC Gauteng spent two cold nights trying to get the attention of the Premier of Gauteng to address the issue of Charlotte Maxeke Academic hospital and other hospitals whose infrastructure is in shambles.

It is worth remembering that many such as Gogo Tsotetsi and Shonisani Lethole died before their time as a result of staff attitudes.

We are in the process of releasing a comprehensive report on the state of healthcare in hospitals in the province to supplement the excellent work being done by Ritshidze and TAC monitors.

Ritshidze data for Quarter 4 shows that only 7 out of 10 public health users (68%) think that facility staff are always friendly and professional. There is a long way to go.

In Cape metro, more than 4 clinics have been closed down for months  because of crime in areas like Nyanga and Khayelitsha. Duty bearers closed the clinics without appropriate communication with the community regarding the reasons for the closure and the plan to remedy the situation.

Most importantly there is no plan for them to access healthcare in the meantime.

Following the closure of these clinics, anecdotal reports of Mother To Child Transmission of HIV increased and the Department of Health has not responded to these.

Mpumalanga and North West provinces are perennially affected by stockouts,  which again affect us poor people more as we rely on the public healthcare facilities.

Conclusion

In Conclusion, as we are starting the 7^th Treatment Action Campaign National Congress, I call for every member of the society to join hands and fight the injustices we are facing in the country and worldwide.

It is sad that we are here today and our comrades in India continue to fight for treatment. While we are thinking of international advocacy we need to think of them and from this congress we are committed to continue to support comrades in countries like India, Argentina and other parts of the world who are working tirelessly to advocate for our lives.

But WE can only rest for a moment, for with freedom come responsibilities, and WE dare not linger, for OUR  long walk is not ended.

Long live  the undying spirit of comrades in India

Long Live the undying spirit of comrades in Argentina

Long Live PLHIV

Long Live Womxn Amandla!!!!!!