7 October 2002 On Saturday, TAC members participated in the 4th anniversary of the South African National AIDS Council (SANAC) Partnership Against AIDS in Langa, Cape Town. We went to the event hoping that Minister of Health Manto Tshabalala-Msimang or Deputy President Jacob Zuma would make a commitment to developing a treatment plan. Unfortunately, neither of them made a meaningful mention of treatment in their speeches. There was immense disappointment among TAC members, most of whom - in frustration - walked out of the meeting after the speeches, leaving the meeting with less than half its original attendants. We handed over the following memorandum to Linda Makhatini, the Deputy-President's Legal Advisor, who promised to deliver it to the Deputy-President. 5 October 2002 MEMORANDUM TO SANAC CALLING FOR THE TRANSFORMATION OF SANAC AND A NATIONAL TREATMENT PLAN TO DEPUTY PRESIDENT, MR. JACOB ZUMA (MP) THE MEMBERS OF SANAC: Mr Y Abba Omar (GCIS), Prof A K Asmal (Minister of Education), Miss Henrietta Bogopane, Ms Dana Cooper (General Manager, Action Stations), Dr Sibongiseni Dhlomo (Mayor, Newcastle Local Council), Ms A T Didiza (Minister of Agricultural and Land Affairs), Mr. Thanduxolo Doro (NAPWA), Ms G J Fraser-Moleketi (Minister of Public Services and Administration), Ms Nomonde Gongxeka, Ms Loretta Jacobus (Chairperson, Select Committee on Social Services), , Mr Majoro Lehasa, Mr M G P Lekota (Minister of Defence), Ms Elise Levendal, Mr T A Manuel (Minister of Finance), Rev Cedric Mayson, Mr Lucky Mazibuko, Mr M M S Mdladlana (Minister of Labour), Ms P Mlambo-Nguka (Minister of Minerals and Energy), Mr John Moeti, Mr F S Mufamadi (Minister of Provincial and Local Government), Inkosi M B Mzimela (Chairperson, House of National Traditional Healers), Dr B S Ngubane (Minister of Arts, Culture, Science and Technology), Ms Nobulawo Nhlapo, Dr L. V. Ngculu (Chairperson, Portfolio Committee of He! alth, Parliament of SA), Ms Ncumisa Nongogo (AIDS Legal Network), Mr A M Omar (Minister of Transport), Dr Mark Ottenweller (Hope Worldwide), Mr Sizwe Shezi (President, SA Youth Council), Mr B M Skosana (Minister of Correctional Services), Dr Z S T Skweyiya (Minister of Welfare and Population Development), Dr M E Tshabalala-Msimang (Minister of Health), Mr Zwelinzima Vavi (COSATU), Mr J G Zuma (Deputy-President), Dr Nono Simelela (Chief Director, HIV/AIDS and STDs), Ms Thami Skenjana (Government AIDS Action Programme), Dr J H O Pretorius (Deputy Director-General, Corporate Services and External Relations) Dr Ayanda Ntsaluba (Director-General, Department of Health) The Treatment Action Campaign (TAC) is here again today to declare our support for the South African National AIDS Council and the Partnership Against AIDS. However, this support is not unconditional. Approximately 5 million South Africans live with HIV/AIDS. Most of them will die over the next decade, unless Government develops and implements a Treatment Plan that includes the use of highly active antiretroviral therapy. Recently released research by the University of Cape Town Centre for Actuarial Research demonstrates that a plan that includes treatment and prevention interventions can prevent nearly three million AIDS deaths and new HIV infections by 2015. The TAC has advocated for such a plan since its inception. As members of the South African National AIDS Council (SANAC), it is your duty to lead the development of a National Treatment Plan. However, the history of SANAC indicates that it has to be transformed to be able to deal with the tremendous challenges that lie ahead. SANAC's mandate is to formulate and oversee the implementation of an adequate response to the HIV epidemic. It is meant to advise Government on policy, co-ordinate and monitor responses to HIV/AIDS from all sectors of South African society, recommend appropriate research, mobilise resources and develop capacity to alleviate the epidemic. Unfortunately, SANAC is far from achieving these goals. In the last two and a half years it has done little to respond to the HIV epidemic. During this time a further 500,000 people have been infected with HIV, and almost as many have died of AIDS. We regard it as a tragedy that SANAC seldom meets and members complain that meetings are often cancelled at short notice. The few meetings that have been held have generally lacked transparency. The Minister of Health and the Provincial MECs for health frequently take decisions without consulting SANAC. The body has little funding and no full-time employees, an untenable situation given the magnitude of its mandate. Critically, SANAC has not pursued the development of a Treatment Plan nor has it sufficiently assisted the implementation of the 17 April Cabinet Statement. Regrettably, SANAC civil society members have not been able to actively influence the agenda of this body and have remained prisoner to the agenda of the government. Equally seriously, the reports of the Technical Task Teams have been largely ignored - the national secretary of TAC, Mark Heywood is the chair of the technical task team on legal and human rights and the chairperson of TAC, Zackie Achmat is a member of this task team. Their experience shows lack of respect for the work of these task teams. The TAC believes that for SANAC to operate successfully, it must be immediately transformed: ·SANAC must be turned into a materially functioning body, with paid staff and sufficient funding. A SANAC trust fund must be put into operation. ·Its membership must be modified to include greater representation of people with HIV/AIDS and people who have demonstrated commitment to alleviating the epidemic. ·While it is crucial that SANAC works with Government, it must have a mandate and courage to act independently. While the Minister of Health and the President's Office have a legitimate role in SANAC's decisions, they must not dominate or marginalise its decision-making processes. ·SANAC must fulfil its mandate to increase co-operation between all sectors of society, religious organisations, NGOs, labour, business and communities. It must meet regularly and transparently, and be held accountable for its decisions. ·The most important immediate challenge facing SANAC is to develop and facilitate the implementation of a national treatment plan that includes antiretroviral therapy. Part of this plan must be the implementation of antiretroviral community treatment programmes in an urban and rural health facility in every province during the next six months. Other essential components of, or closely related to, a treatment plan include voluntary counselling and testing, mother-to-child transmission prevention of HIV/AIDS, better management of sexually transmitted infections, post-exposure prophylaxis for occupational injuries and rape survivors, substantial increases in public health-funding, unfreezing of essential health-care posts and poverty relief measures, such as the Basic Income Grant. · SANAC members should widely publicise the existence of the Global Fund for AIDS, TB and Malaria (GFATM) and co-ordinate applications at local, provincial and national government levels that include all the elements above. In particular we call on SANAC to take seriously its responsibility as the Counrtry Co-ordinating Mechanism (CCM) and to immediately endorse the full KwaZulu Natal proposal, including those components that will begin to provide access to anti-retrovirals. This controversy must be ended now. ·NEDLAC has begun the process of negotiating the development of a Treatment Plan and it is crucial that SANAC assists with this. We urge SANAC to ensure that this plan is developed by 1 December 2002, World AIDS Day, which is a deadline that NEDLAC has set. ·SANAC should support the TAC, and even take the lead, in campaigns to reduce the prices of essential life-saving medicines. In particular, we ask for SANAC to support the complaint at the Competition Commission against the excessive pricing of AZT, Lamivudine and Nevirapine by GlaxoSmithKline and Boehringer Ingelheim. Generic production of patented medicines for treating HIV/AIDS is essential for ensuring that treatment becomes as affordable as possible. There are adequate provisions in the TRIPs agreement (strengthened by the Doha Declaration) and the Patents Act to ensure this is done legally and with international support. Once again, we urge the government to immediately ask the multinational companies for voluntary licences and within six weeks to issue compulsory licences for anti-retrovirals in terms of section 4 of the Patents Act The World Health Organisation's 2001 report on Macroeconomics and Health states: Improving the health and longevity of the poor is an end in itself, a fundamental goal of economic development. But is it also a means to achieving the other development goals relating to poverty reduction. The linkages of health to poverty reduction and to long-term economic growth are powerful, much stronger than is generally understood. The burden of disease in some low-income regions, especially sub-Saharan Africa, stands as a stark barrier to economic growth and therefore must be addressed frontally and centrally in any comprehensive development strategy. The AIDS pandemic represents a unique challenge of unprecedented urgency and intensity. This single epidemic can undermine Africa's development over the next generation... The WHO has also called for the scaling up of anti-retroviral therapy in resource-poor countries, it has developed scientific guidelines for the use of ARVs in the public sector. We urge SANAC to meet the challenge of the HIV epidemic and the WHO, to ensure that South Africa's development regresses as little as possible due to the epidemic and to meet the challenge of "improving the health and longevity of the poor." But, our experience urges caution in this regard. Since our inception in December 1998 we have addressed calls and memoranda to government on the treatment of HIV/AIDS. Only after enormous frustration and innumerable calls from civil society and specifically the TAC did we proceed with legal action against government on the prevention of mother-to-child transmission. In the last two years for instance, we have written letters and handed over the following memoranda to call for a treatment plan: · in January 2001, Dr. Abe Nkomo MP received a memorandum calling for a treatment plan at Parliament in Cape Town; · on 11 June 2001 two months after the joint historic victory over the drug companies in the Pretoria High Court, we again handed over a memorandum to government at a meeting with the Minister of Health; · in May 2002, we handed over a memorandum to the Gauteng Provincial Health Department for the attention of the Deputy-President; · in May 2002, we addressed several invitations to the Deputy-President, the Health Minister and others to participate in the National Treatment Congress. In fact, we moved the date of the Congress from 16 June to the end of the month after a request from the ANC secretary-general Mr. Kgalema Motlanthe to ensure effective participation from the ANC and government; · the resolutions of the Congress have been forwarded to the Health Ministry, the Deputy-President, the Director-general of Health and others; · in August 2002, we again addressed a memorandum to the national government to commit to a treatment plan and to immediately begin pilot programmes suing anti-retroviral therapy. These are a few examples of the countless calls for a treatment plan, pilot anti-retroviral programmes, the issuing of compulsory licences and the restructuring of SANAC. We have never had the courtesy of a considered response to any of our memoranda or letters. To date, our protests have been models of civic restraint and we have never stepped outside the law in mass demonstrations or meetings. Millions of lives depend on our co-operation and joint work between government and civil society. Failure by government to commit to a treatment plan using anti-retroviral therapy and commitment to pilot two community anti-retroviral programmes in every province by the 01 December 2002 will continue to jeopardise the lives of our people. We urge the government to steer away from confrontation and to accept the challenge of the Constitutional Court: "The magnitude of the HIV/AIDS challenge facing the country calls for a concerted, co-ordinated and co-operative national effort in which government in each of its three spheres and the panoply of resources and skills of civil society are marshalled, inspired and led." The TAC will use all its resources to support Government and SANAC with meeting these objectives. We will also act to save live! s. Let us work together in a genuine partnership against HIV/AIDS. We urge a meeting with the Deputy-President at the earliest possible opportunity. On behalf of the TAC National Executive. Thembeka Majali (Western Cape Co-ordinator) Nomfundo Dubula (Project Ulwazi Co-ordinator) Nathan Geffen (National Manager)