TAC Electronic Newsletter, 4 April 2002 *************************************** To subscribe/desubscribe email subscribe@tac.org.za Two items in the newsletter: * Constitutional Court denies Government's appeal against Pretoria High Court's execution order. Today, TAC won an important court victory in its case against the Minister of Health regarding mother-to-child transmission prevention. The Constitutional Court upheld the Pretoria High Court ruling that government must, in the interim, provide nevirapine to hospitals and clinics that have the capacity to administer the drug to pregnant women until the Constitutional Court has made a ruling on the Government's appeal against the Pretoria High Court's judgment. The main appeal in this case will be heard in May by the Constitutional Court. -- Government has no legal means of overruling this judgment which takes immediate effect. -- The responsibility of determining the capacity of a hospital or clinic to administer Nevirapine lies with the doctors and superintendant of the hospital. Women to whom the drug is prescribed must have had access to voluntary counseling and testing. ********* * Tac Chairperson, Zackie Achmat, has delivered a speech to the UN Commission on Human Rights Realising the right to health: Access to HIV/AIDS-related medication The role of civil society in South Africa 58th session of the Commission on Human Rights 1.Madam Chairperson, High Commissioner Robins, distinguished members, guests and friends, Ms. Miriam Maluwa, I want to thank you on behalf of the Treatment Action Campaign (TAC) for this opportunity to address you. TAC is a campaign of people with HIV/AIDS, our friends and families and the broader community. Alongside the organisations of women, children, health professionals, TAC is supported by the Congress of South African Trade Unions, the National Council of Trade Unions, the South African Council of Churches, Southern African Catholic Bishops Conference and many other community-based organisations. The AIDS Law Project is one of the leading partner organisations of TAC. We work for HIV treatment access, the elimination of new HIV infections and an affordable, quality health care system for all people in our country and beyond. 2.For children, women and men with HIV/AIDS the rights to dignity, life, equality and their inter-connection with the right to health care access, particularly access to medicines including anti-retrovirals stands between us and death. This is particularly true in poor countries and poor communities in wealthy countries. These rights - dignity, life, equality - are essential tools in our struggle to remove the barriers to HIV treatment and health care for all. What are these barriers? 3.The lack of scientific and treatment literacy is a major obstacle in our work to gain access to treatment. Governments, health care professionals and people with HIV/AIDS are often unaware of the treatments for opportunistic infections and how anti-retrovirals work. Our professionals in all spheres lack the understanding of how clinical trials work, the basics of pharmacology and so on. However, this obstacle is not insurmountable. When we started our campaign for access to AZT for pregnant women, people including doctors and nurses asked us what AZT was. Today millions of people in our country know of AZT, Nevirapine and other anti-retrovirals, as well as fluconazole, acyclovir and cotrimoxazole. TAC has learnt from the experiences of Northern NGOs in particular GMHC, TAG and Project Inform. But, we apply these lessons to our own cultural context. Today, people without education in our country speak of treatment literacy and though we have a great deal of work to do, our experience has shown that this barrier can be overcome by civil society working where possible in partnership with government and the private sector. 4.Patents and prices: In our country herpes has not been treated for many years because of the high prices resulting from the patents on acyclovir. The patent has expired but the guidelines for the management of syndromic treatment of STDs do not yet include acyclovir. Our government has committed itself to changing this situation. Fluconazole for the treatment of systemic thrush and crytococcal meningitis was beyond the reach of the vast majority of people with HIV/AIDS because of the price and patent. This is also true of anti-retrovirals for HIV treatment. 5.The government of President Nelson Mandela and the able Health Minister Dr. Nkosazana Dlamini-Zuma developed a programme to reform the health care system. This included the medicines legislation - the Medicines and Related Substances Control Amendment Act of 1997. As you are aware, the world's multinational pharmaceutical companies took our government to court for that legislation. In particular, they objected to measures such as generic substitution of off-patent medicines (widely practised in the US, Europe and elsewhere), a pricing committee and parallel importation. Together with ACT-UP New York, Philadelphia, HealthGAP Coalition, IGLHRC, MSF, Consumer Project on Technology who mobilised public opinion in Europe and North America, TAC mobilised civil society in South Africa to support the legislation and the government. We were joined by OXFAM, ACTSA, countless other NGOs and from Windhoek to Manila, from London to Delhi, Paris to Rio de Janeiro civil society heeded our call for a global day of action and sustained pressure on the drug companies. Almost exactly a year ago, the drug companies capitulated. What were the immediate results of that campaign? 6.Not since the campaign on breastmilk substitutes has there been such a widespread mobilisation of international civil society on a health issue. For the first time, one of the most powerful multinational corporation lobbies became accountable to civil society, government and their shareholders for profiteering at the expense of health and lives. 7.Drug prices plummeted in South Africa and internationally. The majority of our people who are employed (30% people are unemployed) earn less than R2000.00 per month. In 1998, when TAC started its campaign a months supply of antiretrovirals cost between R4500.00 and R2500.00 per month. Now, they cost between R1800.00 and R700.00 per month. The generic ARVs used by MSF in its pilot ARV project in Khayelitsha, Cape Town costs R450.00. Private medical schemes provide ARV therapy in our country - our members of Parliament and their families have access to them. Since the access campaign started and since the court case last April, the number of people in our country on ARV therapy has increased from 5 000 to 20 000. However, diagnostic and monitoring tools remain the biggest problem. We believe that with initiatives such as that of the Thai GPO and the Brazilian government the cost of ARVs can be reduced to R250.00 per month. International support for the efforts of the governments of Thailand, Brazil, Nigeria and others who use generic ARVs was strengthened following civil society mobilisation on the SA court case. BUT? 8.Political will in our country remains the single largest obstacle to access to ARVs and the proper treatment of opportunistic infections. This lack of political will is an obstacle to dealing with the drug companies - the government has failed to use its hard won legislation. It has the legal power through the Patents Act, the Medicines Act and the Competition Act. It also has the support of the DOHA Agreement to use compulsory licences for generic production - it has failed to do this. 9.Most significantly, as we speak - the Constitutional Court in our country is hearing an urgent appeal from our government against an interim order asking it to provide Nevirapine to pregnant women with HIV where health professionals have the capacity to test and counsel pending an appeal. More than 70 000 children in our country are infected with HIV through pregnancy and breastfeeding every year. Fewer than 10% of all pregnant women have access to counselling, testing and information on breastfeeding and HIV. TAC regretfully took our government to court to provide Nevirapine or any other appropriate ARV to pregnant women to help reduce mother-to-child HIV transmission, and, to develop a plan over two years to provide counselling, testing, feeding information and where possible alternatives to breastmilk throughout the country. We took this decision with pain and regret after five years of negotiation. TAC and all its partner organisations have helped the South African government establish one of the best legal and human rights frameworks to deal with the epidemic. No-one can lose their job because of their HIV status, no-one can be excluded from medical aid schemes, schools, housing and any social services. These are the products of partnership. But since, 1998 and specifically since October 1999 when our President, Mr. Thabo Mbeki questioned the link between HIV and AIDS - the health system has been paralysed. Political will has been absent to deal with another significant barrier to HIV treatment -- health care infrastructure. Finance, access to medicines and development of human resources can be achieved through sharing the burden with the private sector, medical schemes and civil society. 10.We know universal coverage is not possible overnight. A commitment to universal coverage, a treatment plan and political commitment will save the lives of millions of people in our country. We appeal to everyone to assist us in changing the difficult circumstances we face in our country where the position of HIV denialists has become an orthodoxy. 11.However, there is a greater challenge than the denial of the South African government. As we speak of human rights and access to HIV/AIDS medicines and treatment for malaria, TB, leishmaniasis and other neglected diseases, we also have to speak of international responsibility. The greatest challenge is to countries such as the USA, Britain, the European Union, Japan, Switzerland and others to provide funding to the GFATM as requested by UN secretary-general Mr. Kofi Annan. The fund needs $10-12 billion annually. It is a shame that it has received less than a quarter of this money. 12.In conclusion, the power of the drug companies to dictate their terms has been temporarily halted. The international community needs to be galvanised to provide the funds needed to deal with HIV/AIDS. Significant development assistance including debt cancellation is essential. This can be achieved through organisation of civil society in Africa, Asia and Latin America, as well as North America and Europe to assist our governments as partners and where necessary to convince them through action. Thank you Zackie Achmat TAC Chairperson