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South Africa: AIDS Treatment Green Light

AfricaFocus Bulletin
Nov 23, 2003 (031123)
(Reposted from sources cited below)

Editor's Note

Last week the South African government approved a comprehensive plan for treatment as well as prevention of HIV and AIDS. The result of years of pressure by the Treatment Action Campaign (TAC) and other activists, this step gives the green light for free public treatment of all those in need of it. Implementing this decision, however, still requires enormous efforts.

This issue of AfricaFocus Bulletin includes a statement by the Treatment Action Campaign on the way forward, and excerpts from the statement by the South African Cabinet.

"On behalf of the TAC National Executive, we wish to thank the thousands of individuals and organisations, including TAC members, MSF, the South African trade union movement, the churches, NGOs, our funders and activists around the world, too numerous to name, who have made these achievements possible." - TAC, November 20, 2003

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

The Way Forward for the Treatment Action Campaign

20 November 2003

Treatment Action Campaign
http://www.tac.org.za

Dear TAC Volunteers, Members, Supporters, Allies and Friends

TAC Welcomes Cabinet Adoption of Treatment Plan

Decision Gives Hope to Poor Communities Across South Africa

The South African Cabinet has approved the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS. The plan envisages that "within a year, there will be at least one [antiretroviral] service point in every health district across the country, and within five years, one service point in every local municipality." [Cabinet Statement, 19 November 2003]. The plan also commits government to investing substantial finance into "upgrading our national healthcare system" via "recruitment of thouands of professionals and a very large training programme to ensure nurses, doctors, laboratory technicians, counsellors and other health workers have the knowledge and the skills to ensure safe, ethical and effective use of medicines." Government has also committed to a massive public education campaign, improved prevention efforts and improved treatment of opportunistic infections.

The Treatment Action Campaign (TAC) welcomes the Cabinet decision. This is a wonderful day for all in South Africa. There is now real hope for millions of people with HIV and their families. It is tragic that for many people this decision has come much too late, such as a founding member of TAC's Samora branch in Cape Town who died of AIDS today.

The challenges ahead for all of us are to ensure that the plan is implemented as speedily as possible and to mobilise our communities around counselling, testing and understanding how treatment works. Critically, we need to develop and implement more sophisticated prevention messages.

We urge government to release the full treatment plan so that civil society can study its details and assist with its implementation.

The Cabinet Statement and a Question and Answer document on the Operational Plan handed out by government are [available at: [http://www.gov.za/issues/hiv/cabinetaidsqa19nov03.htm]

The Way Forward for the Treatment Action Campaign

Nearly five years after the launch of the TAC, we have reached a crucial turning point in our struggle. We stand on the brink of the implementation of a treatment plan that has the potential to save millions of lives. This is what we have worked for since the TAC began. It is therefore a good opportunity to examine what the TAC has achieved and what the way forward is.

Together with our allies in South Africa and internationally we have successfully changed our government's policy, challenged the power of the pharmaceutical industry and made many important international organisations and governments realise that people with HIV/AIDS in poor countries have a right to have access to medicines and must be treated with dignity.

On behalf of the TAC National Executive, we wish to thank the thousands of individuals and organisations, including TAC members, MSF, the South African trade union movement, the churches, NGOs, our funders and activists around the world, too numerous to name, who have made these achievements possible.

We also pay tribute to our many comrades who died because of HIV before we reached this turning point.

You can all feel justly proud that your immense efforts, to build a more equitable and just world, have been worthwhile.

The combination of the Constitutional Court decision on mother-to-child transmission prevention, the Stand Up for Our Lives march in February, the civil disobedience campaign and the international protests around the world have convinced Cabinet to develop and implement an antiretroviral rollout plan.

But government must do much more including implementing better prevention programmes, better opportunistic infection treatment and greatly improved work-conditions for health-care workers. We also need clear messages of support for prevention and treatment from President Mbeki and all Cabinet ministers. We have come a long way but we must be ready to put more pressure on government if it does not implement the treatment plan properly.

Hundreds of our members across the country live openly with HIV. They tell their friends, family and work colleagues they have HIV. They even say it in newspapers, on radio and on television. Our HIV-positive t-shirt, a sign of openness and solidarity, is worn by thousands of people.

Nevertheless, many people with HIV still experience discrimination and cannot be open. We still have much to do to create openness.

Before we began our campaign, antiretrovirals cost over R4,000 per month. Patented antiretrovirals now cost about R1,000 per month. TAC, MSF and GARPP also purchase generic antiretrovirals, in breach of patent, at R300 or less per month. The deal announced by the Clinton Foundation will bring the prices of generic antiretrovirals down to less than R90 per month for government.

We still cannot get these generic medicines, but our pressure on the drug companies through the Competition Commission will surely succeed in the near future.

A few years ago, the dominant view was that prevention of HIV was all that was necessary for the developing world. This has changed. UNAIDS, the European Union and the United States now say that treatment is critical. The Global Fund has been established to help poor countries improve their health care systems so that AIDS, TB and malaria can be treated. Furthermore, HIV/AIDS activism is taking route in many African countries strengthened by the Pan-African Treatment Access Movement.

The global political will to treat people in poor countries is unprecedented.

Where to from Here for the TAC

The TAC's struggle is seen as a model by many organisations and people in South Africa and across the world because of the commitment we demonstrate and our ability to mobilise poor people across the country. Although we can be proud of this, we should also be careful because the expectations upon us are enormous. We must not become complacent because this can easily lead to errors which will destroy the good reputation and work of the TAC. We must live up to the expectations upon us that are realistic. After five years of struggle and the loss of many comrades to AIDS, most of us are tired. We must rest but there is hard work ahead.

The success of the treatment plan rollout depends on our ability to mobilise our communities. Because of this fact, we are going to focus much of our energy at the level of the District Health Service. We are going to assist with service delivery but keep up our pressure through mobilisation and demonstrations when needed.

Branches must work with clinics and campaign for their problems to be rectified. For this to succeed, TAC structures have to function better than ever and our understanding of treatment literacy must improve.

Finally, we will keep up our capacity to mobilise at a national and international level. There are still people high in our government who oppose a treatment plan and will try to delay the rollout of antiretroviral therapy. Pharmaceutical companies will continue to try to profiteer from medicine. Laboratory costs have not yet come down sufficiently. We will have to monitor all of these things closely and be able to apply pressure when needed. The TAC is not going away.

Making Our Structures Work

Each structure has a clear mandate of what is expected from it.

Our provincial offices must ensure that each district has the resources they need to perform their duties. We must ensure that people of all races participate in our provincial activities. NGOs, religious organisations and unions must continue to be involved in our work.

Our district committees are responsible for the functioning of TAC branches within their jurisdiction. Every TAC district should have at least 30 activists who are trained on treatment literacy to be able to educate their own communities.

Each branch should have an outdoor and indoor programme. The indoor one should include workshops on improving clinics in the branch area, antiretrovirals, opportunistic infections, social grants and prevention. The outdoor one should involve pamphleteering, public speaking and door-to-door campaigns. Critically, we need to learn to use the clinic checklist and to work with our clinics so that we can improve them.

Comrades from different areas must understand their responsibilities and be visible in their communities. We must understand our provincial government's rollout plans so we can intensify our treatment literacy and openness campaigns in clinics where antiretroviral therapy is implemented.

Many clinics will not implement antiretroviral therapy immediately. We need to get those clinics ready so that they can begin treatment. This means we must make sure that they have enough nurses and doctors who are properly trained on HIV/AIDS. HIV and CD4 tests must be available. Appropriate medicines must be given to patients with opportunistic infections. There must be high-quality counselling, including information on safer sex. Condoms must be distributed at all clinics.

Here are some things to be done:

  1. TAC meetings must be held in every district to brief activists about our role in the rollout.
  2. Every provincial office must assess the role TAC is playing in the existing pilot programmes and what lessons could be learnt in order to prepare us for the rollout.
  3. District general meetings should be held every month to brief organisations of the progress made and how they can help.
  4. HIV support groups groups must be challenged to work with the TAC to address stigma and improve clinic services.
  5. We need to work closely with government institutions distributing food parcels and help speed up delivery of this programme.
  6. Social Grant education should be done at branch level and in support groups and form part of our door-to-door campaigns.
  7. We must organise events at district level to keep people mobilised and ensure that we deal with stigma and discrimination.
  8. The TAC Treatment Project must be integrated into the activities of the TAC, especially the wellness programme, so that our activists with HIV can stay healthy. By integrating the TAC and the Treatment Project we will also assist the treatment plan rollout.
  9. TAC people should speak at public forums and create more awareness about the challenges lying ahead and the solutions.
  10. Volunteer exchange programmes between branches, districts and provinces will help activists to exchange knowledge and skills to better equip us for the challenges ahead.

We have come a long way and achieved magnificent successes, but the hardest work is ahead of us. Let us mobilise for the treatment plan rollout. A luta Continua!

Yours in the struggle for health and human rights

Mandla Majola, Sipho Mthathi, Mark Heywood and Zackie Achmat

On Behalf of the TAC National Executive Committee

20 November 2003

[END OF LETTER]


Cabinet statement on treatment plan for HIV and AIDS

19 November 2003

[Presented by Minister of Health, Dr Manto Tshabalala-Msimang]

Issued by: Government Communication and Information System (GCIS) For further enquiries contact: Joel Netshitenzhe 082 900 0083

[Excerpts only: the full document is available at: http://www.gov.za/issues/hiv/cabinetaidsqa19nov03.htm]

Cabinet today in principle approved the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS, which it had, on 8 August this year, requested the Department of Health to prepare. Amongst other things, the Plan provides for Anti-retroviral Treatment in the public health sector, as part of the government's comprehensive strategy to combat HIV and AIDS.

The meeting instructed the Department of Health to proceed with implementation of the Plan.

It is envisaged in the Plan that, within a year, there will be at least one service point in every health district across the country and, within five years, one service point in every local municipality. Some areas will be able to start sooner than others, and the Department of Health will keep the public informed of the progress of the rollout.

These service points will give citizens access to a continuum of care and treatment, integrated with the prevention and awareness campaign which remains the cornerstone of the strategy to defeat HIV and AIDS.

Concretely this far-reaching decision of government will mean:

  • Stepping up the prevention campaign so that the 40 million South Africans not infected stay that way
  • A sustained education and community mobilisation programme to strengthen partnership in the fight against the epidemic
  • Expanding programmes aimed at boosting the immune system and slowing down the effects of HIV infection, including the option of traditional health treatments for those who use these services
  • Improved efforts in treating opportunistic infections for those who are infected but have not reached the stage at which they require antiretrovirals
  • Intensified support for families affected by HIV and AIDS
  • Introduction of antiretroviral treatment for those who need it, as certified by doctors

BUILDING CAPACITY

To deliver this kind of care across the country, with equitable access to all, will require a major effort to upgrade our national healthcare system. This includes the recruitment of thousands of health professionals and a very large training programme to ensure that nurses, doctors, laboratory technicians, counsellors and other health workers have the knowledge and the skills to ensure safe, ethical and effective use of medicines. ...

Over half of the total budget that will be spent over the next five years in implementing this programme will go to upgrading health infrastructure, emphasising prevention and promoting healthy lifestyles. As such, the implementation of this plan will benefit the health system as a whole.

Cabinet agreed that the funds allocated for this programme should be "new money". The programme will and must therefore not detract from other programmes of health care and provision of social services. ...

CENTRALITY OF PREVENTION

Government wishes to reiterate that there is no known cure for AIDS. We cannot therefore afford, as a nation, to lower our guard. Prevention therefore remains the cornerstone of our campaign.

The eradication from the body of the HIVirus remains beyond reach. The mechanisms of HIV infections remain difficult to fathom, and the downhill plunge of the infected, to severe immune deficiency over the next 2-14 years is ill-understood. The co-factors that are thought to mitigate immune destruction of healthy CD4+ cells by the minority of infected CD4+ are still uncharacterised. In the South African context the immune systems is assaulted by a host of factors related to poverty and deprivation.

The Operational Plan places a high premium on strengthening prevention efforts and it underlines the critically important messages of prevention and of changing lifestyles and behaviour. These elements of our Comprehensive Strategy remain the starting point in managing the epidemic.

At the same time, it should be noted that not everyone who is HIV positive requires Anti-retroviral Treatment. As such, the plan also provides for enhanced care for those who are infected but have not as yet progressed to an advanced stage of AIDS.

At the same time, the challenges of home-based care, the campaign to combat discrimination against those who are infected and affected remain critical. So is the task of intensifying efforts to deal broadly with poverty and poor nutrition.

STRENGTHENING PARTNERSHIPS

Progress in implementing the Plan adopted by government today will depend, to a significant degree, on intensified mobilisation across society. Besides the legion of non-governmental and community-based organisations who are involved in constructive work in this regard, the media is an important partner, as it has the potential to communicate messages of awareness and hope, and to keep the nation accurately informed about the campaign against HIV and AIDS.

A cooperative relationship among all sectors of society, particularly in the implementation of this element of the comprehensive strategy, the spirit of letsema and vuk'uzenzele, a message of hope and responsibility as well as constructive engagement in the realm of practical work will ensure that South Africa advances even more decisively in this endeavour.

The Comprehensive Plan for Treatment and Care carves out a future for those infected with HIV, and for those suffering from immune deficiency; whilst assisting the vast majority of South Africans who are HIV negative to remain that way. The peculiarly South African nature of the problem demands South African solutions; solutions contained within this complex and detailed Comprehensive Plan for Treatment and Care.

Such an ambitious goal - targeting the immense complexity of the human immune system operating within the environmental milieu of Africa - predicates a multifaceted, integrated and intersectoral response in prevention, treatment and care. The Plan is the final piece completing the jigsaw puzzle of the National Strategic Plan for HIV and AIDS 2000 - 2005 whose four key areas of intervention were: prevention, treatment, care and support; research, monitoring and surveillance; as well as legal and human rights.

CONCLUSION

Cabinet wishes to express its appreciation of the work done by members of the Task Team - including in particular experts and specialists from inside and outside the country - whose contribution has helped shape this Plan. We are confident that, as with our national prevention efforts, this Plan will rank among the most comprehensive in the world.

Government is once more strengthening the hand of the nation in the fight against HIV and AIDS, in keeping with its mandate to build a better life for all. If correctly implemented this Operation Plan provides an excellent opportunity to complete the treatment sector of the National Strategic Plan for HIV and AIDS whilst also strengthening prevention. The challenge is immense but not impossible.

We are confident that, together, bound by a people's contract for a better life, we shall all continue to make progress in building South Africa into a land our dreams.

There is hope!


AfricaFocus Bulletin is a free independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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