Three Important Items: 1. A statement by Africa Action, TransAfrica and actor/activist Danny Glover calling on the South African Government to change its approach to HIV/AIDS. 2. A letter from TAC to doctors and hospital superintendants with an explanation of the constitutional court case decision and a request to apply for Nevirapine where capacity exists. 3. An example of a letter that hospital superintendants can use to write to local provincial departments of health, asking for Nevirapine. *********************** FOR IMMEDIATE RELEASE Contact: Salih Booker 202-546 7961 http://www.africaaction.org Leading Africa Activists in U.S. seek new AIDS policy from South African Government Tuesday, April 9, 2002 (Washington, DC) In a letter released today to South African President Thabo Mbeki, Africa Action, TransAfrica and actor-activist Danny Glover criticize the South African governments HIV/AIDS policies for blocking needed medical efforts to address [the AIDS] crisis. The letter charges that the shortcomings of Mbekis approach are responsible for the loss of countless lives and for undermining the larger global fight against the AIDS pandemic and the structural inequities that sustain it. The letter to President Mbeki emphasizes the urgent need for strong policies that cover treatment as well as prevention. It also highlights the important role that the South African government must pay in the larger struggle to defeat the pandemic in Africa and globally. The letter reads in part: As President of South Africa, ground zero of the global AIDS pandemic, your government is in a unique position, and with that comes a unique responsibility... The position of your government in addressing South Africas AIDS crisis has implications far beyond your own country. It continues: Your governments failure to provide strong leadership on this issue is allowing the U.S. and other rich countries to evade their responsibility to address this human catastrophe. The letter recognizes the close link between poverty and disease which Mbeki himself has sought to highlight. However, the signatories urge President Mbeki to clarify his controversial stance on HIV/AIDS by representing himself with a clear-cut acknowledgment of the catastrophic nature of the crisis, and with a proactive policy to confront it that includes the provision of anti- retroviral medicines. The letters signatories share a long history of solidarity work with the African National Congress (ANC) and the South African struggle against apartheid, including support for the government of South Africa in its efforts to tackle the legacy of poverty and inequality. Indeed, the significance of this letter lies in this very relationship. ********************** April 8, 2002 His Excellency Thabo Mbeki President of the Republic of South Africa Private Bag X1000 Pretoria 0001 SOUTH AFRICA Dear President Mbeki, We write to you today because we are alarmed about the unnecessary loss of life resulting from the South African government's stance on combating the HIV/AIDS crisis. We are concerned that your government's approach lacks the effectiveness of the HIV/AIDS policies of other developing countries such as Brazil, Uganda and Senegal. As you know, we share a long history of solidarity work with the South African struggle against apartheid, including support for the ANC and the new government of South Africa. We salute your governments efforts to address the cruel legacies of apartheid, especially the fight against poverty and inequality. We support these efforts as well as much of what your government has done to address the public health crisis that South Africans face, and that is also a part of apartheids legacy. We agree that the AIDS crisis is closely related to poverty. Indeed the pandemic, and the larger health emergency that it represents, is the most visible manifestation of a system of global apartheid and vulgar corporate greed. Where we disagree with your governments AIDS policies, however, is so important that we believe it must be publicly contested. We are convinced that the shortcomings in the position of the South African government are responsible for the loss of thousands - perhaps millions of lives and tragically undermine the larger worldwide fight against the AIDS pandemic and the structural inequities that sustain it. As you are aware, Mr. President, South Africa is the country with the highest number of HIV-positive people in the world. An estimated five million of your citizens are currently living with HIV/AIDS. While the spread of the disease is fueled and exacerbated by poverty and other systemic factors, it can be greatly reduced by strong government policies on prevention and treatment. We are aware of, and applaud, the initiatives undertaken by your government to prevent the transmission of the virus and to educate the public against unsafe practices. However, a nearly exclusive emphasis on prevention is fatal for the millions in South Africa and elsewhere already living with the virus. The provision of anti-retroviral (ARV) treatments has been proven to save lives and to safely and effectively inhibit transmission. Your governments hesitation regarding the expansion of ARV programs, especially those designed to reduce mother-to-child transmission, is contributing to the unnecessary and unacceptable loss of life, and hindering the advancement of national development. An accelerated roll-out of the South African governments existing program to expand access to Nevirapine could prevent as many as 35,000 babies from contracting the virus every year. Your governments victory over the international pharmaceutical industry last year proved to be a pyrrhic triumph when the opportunity was not seized to advance a strategy, including parallel imports and compulsory licensing, to ensure the provision of essential medicines for all your people. The global justice movement suffered a serious setback when the South African government failed to provide leadership for the global regulation of socially irresponsible corporations. We and millions of other activists share your concern about the sustainability of treatment programs. But in the face of a health crisis of this magnitude, it is imperative that each government do all it can to save lives now. Moreover, treatment helps cut overall costs by reducing hospital stays, decreasing the numbers of HIV cases, and enabling thousands to stay in the workforce. The inability to provide treatment to all who require it is not an excuse to discriminate against those who can be reached, especially when such discrimination leads to death. Treatment programs strengthen prevention efforts, expand local health infrastructure, and improve overall delivery of care and support. The availability of treatment is an incentive for HIV testing, and it helps remove the stigma and discrimination against individuals living with HIV. Failure to provide treatment now to all those you can, and to urgently press for access for all, is tantamount to imposing a death sentence. And there is no greater stigma than this. Mr. President, the position of your government in addressing South Africas AIDS crisis has implications far beyond your own country. The AIDS pandemic is now recognized as the worst plague in human history. And while AIDS does not discriminate by race, gender or geography, at present it is mainly killing Africans and people of African descent across the globe. This is the cruel truth about why the Western world has failed to respond with the urgency required. Your governments failure to provide strong leadership on this issue is allowing the U.S. and other rich countries to evade their responsibility to address this human catastrophe. It is critical that African governments be at the forefront of the war on AIDS. As President of South Africa, ground zero of the global AIDS pandemic, your government is in a unique position, and with that comes a unique responsibility. The country worst affected must rise to define the response to the global threat of HIV/AIDS. The terms in which you choose to frame the debate matter tremendously. At the moment, the impression among many of your supporters internationally, as well as among medical leaders within South Africa, is that you and your government do not believe that HIV causes AIDS and that you are blocking needed medical efforts to address this crisis. If you feel that you or your government have been misrepresented, represent yourself with a clear-cut and consistent acknowledgment of the catastrophic nature of this crisis, and with a proactive policy to confront it. The great moral standing of your government and your people affords your government the authority to challenge the injustices and the obstacles that fuel the pandemic and hinder an effective response. Indeed the historic and structural causes of poverty in Africa must be primary targets in the war on AIDS. We are well aware that we cannot afford to win the war on AIDS and lose the war on poverty. Victory in both requires the following: (1) unconditional cancellation of Africas illegitimate foreign debt, (2) full funding for the United Nations global fund to fight AIDS, Tuberculosis and Malaria, in order to ensure access to essential medicines and effective localized treatment for all, (3) a renewed global emphasis on public investment in social services, (4) an end to international discrimination on the basis of race, gender and HIV status, and (5) the promotion of a public discourse on reparations to emphasize the need for the West to invest in Africas healthcare as an obligation not charity. Though the New Partnership for African Development (NEPAD) shares much of this vision, we strongly believe that it is impossible to promote sustainable social and economic development in Africa without defeating HIV/AIDS as an essential first step. Mr. President, please act now so that no one can doubt any longer your unswerving commitment to addressing this most devastating crisis. We must save who we can with what we have now. Our communities and organizations do support you, and will continue to support you, in the larger struggle for human security for all. Truly, our destiny is tied to what happens in South Africa. Yours in struggle, Rev. Dr. Wyatt Tee Walker, President Salih Booker, Executive Director Danny Glover, Actor and Activist Bill Fletcher, President, TransAfrica --------------------------------------------- Letter From TAC to Doctors and Hospital/Clinic Superintendants Dear friends Attached and below is an explanation of what the recent decision on the Con Court actually means. I hope that it is not too legalistic. We urge you to send it on to other e-mail lists of medical practitioners in SA. It is intended as a guide on how practically to take advantage of the new situation. The following points are very important to understand: FOR THE DURATION OF THIS COURT ORDER THE DECISION ABOUT WHETHER THERE IS CAPACITY TO USE NEVIRAPINE PROPERLY BELONGS WITH YOU, THE MEDICAL PRACTITIONERS AND SUPERINTENDANTS, NOT WITH THE PROVINCIAL OR NATIONAL HEALTH DEPARTMENT. OUR ADVICE THEREFORE SHOULD BE THAT : 1. WHERE HEALTH WORKERS FEEL THERE IS CAPACITY THEY CONSULT THE HEAD/SUPERINTENDANT OF THAT INSTITUTION; 2. WHERE THE HEAD/SUPERINTENDANT AGREES THEY IMMEDIATELY REQUEST A QUANTITY OF MEDICINE FROM THE PROVINCIAL HEALTH DEPARTMENT; 3. THE ATTACHED LETTER IS INTENDED AS A GUIDE TO HOW TO MAKE A REQUEST; 4. THAT AS FAR AS POSSIBLE TAC IS INFORMED OF ALL REQUESTS. 5. PLEASE NOTE THAT TAC HAS A TEAM THAT CAN RESPOND TO ALL REQUESTS FOR ADVICE, TRAINING, ASSISTANCE. YOU CAN MAKE THEM BY E-MAIL TO: info@tac.org.za or by phoning Sharon at 083 634 8924 or Nonkosi at 072 231 1422. It is urgent that we move on this to show that all our effort was not in vain. ---------------------- URGENT TAC BRIEFING ON: The implications of the Constitutional Court order in Minister of Health and Others v Treatment Action Campaign and Others On Thursday, 4 April 2002, a unanimous Constitutional Court dismissed the state's application for leave to appeal against the execution order made by the Pretoria High Court on 11 March 2002. This means that national government and all provincial governments -with the exception of the Western Cape and KwaZulu-Natal-must immediately comply with order 2 of the original judgment made by the Pretoria High Court on 14 December 2001. This briefing is intended to guide doctors, nurses and TAC volunteers on steps that can - and must -- be taken following the Constitutional Court decision. Now is the opportunity to save lives and to strengthen health services. We must not waste it. What has the Constitutional Court actually ordered? Order 2 of the original High Court judgment reads as follows: "The [Minister of Health and the Provincial MECs for Health] are ordered to make Nevirapine available to pregnant women with HIV who give birth in the public sector, and to their babies, in public health facilities to which the [government's] present programme for the prevention of mother-to-child transmission of HIV has not yet been extended, where in the opinion of the attending medical practitioner, acting in consultation with the medical superintendent of the facility concerned, this is medically indicated, which shall at least include that the woman concerned has been appropriately tested and counseled." The order is of a temporary nature. It applies only until the Constitutional Court makes a final decision on the appeal. The Court will hear argument on the appeal on 2-3 May 2002, but in all likelihood will only deliver a judgment some time later, probably not before June. Until the judgment is delivered, order 2 must be implemented by the government.[1] Where must Nevirapine be made available? Nevirapine must be made available in all "public health facilities where in the opinion of the attending medical practitioner in consultation with the medical superintendent of a clinic or hospital, it is medically indicated and the preconditions for its prescription already exist." At minimum, this requires that the pregnant woman can be appropriately tested for HIV and counseled - or that a woman has already been appropriately tested and counselled. What are the roles of attending medical practitioners and medical superintendents? Nevirapine is medically indicated if, after proper counseling, a woman consents to an HIV test and turns out to be HIV positive, and it is in the interests of her baby that Nevirapine be administered. There are two situations where Nevirapine may be medically indicated: where the woman concerned has already been tested and counseled, or where the hospital or clinic has the capacity to do the testing and counseling. If either of these situations is likely to arise at the hospital or clinic concerned, then doctors or nurses working in ANC or maternity wards should consult with the superintendent and then jointly request that the government supply Nevirapine. A draft letter that could be sent to the responsible person in a Provincial government is at the bottom of this briefing. The superintendent is entitled to require (but does not have to require) that the administration of Nevirapine be done under general conditions prescribed by him or her (for example, according to the protocol used by the Department of Health in pilot sites), or that his or her consent be obtained in each individual case. What is the role of the government? Government's role is to supply nevirapine when it is requested. Note: It is not for government to determine whether the preconditions for the prescription of nevirapine exist, but rather to make the drug available where this determination has already been made. There is nothing in the order, however, that stops government from taking proactive steps to ensure that all "residual capacity" in the public health sector is exploited. Government is therefore entitled to offer assistance in determining whether the preconditions for the prescription of nevirapine exist. It does not have to wait for requests for nevirapine. However, when medical practitioners-acting in consultation with their respective medical superintendents-determine that the preconditions for the prescription of nevirapine exist, government's role is limited to the supply of the drug. What about in KwaZulu Natal and the Western Cape? The Provincial Government in KwaZulu-Natal did not oppose the execution order sought by the TAC. In fact, they provided an affidavit to the Court saying that Nevirapine would be supplied to all health facilities in the Province that have capacity. Where TAC volunteers or health professionals require Nevirapine, they should request it in exactly the same manner as in all the other Provinces. In the Western Cape it is already the policy to allow doctors to supply Nevirapine to pregnant women who know they have HIV, or request HIV testing - even if it is in an area that has not been reached by the Province's roll-out programme. Is Nevirapine all that is needed in an MTCT programe? Definitely not. An MTCT programme has several components including offering HIV testing, proper counseling before an HIV test, the HIV test itself, the prescription of Nevirapine and ongoing counseling to mother and support to the child. The government and TAC have produced pamphlets that explain this process and we will help you to get these important documents. However, in this equation Nevirapine plays a very important part because it is a medicine that gives a woman an opportunity to reduce the risk of HIV infection to her child. The court order is intended to give this opportunity to many more women. For further information or assistance contact: Sipho Mthathi: 021 788 3507(E Cape, Western Cape, N Cape plus for requests for assistance with training) Cati Vawda : 083 791 7676 (KZN) Sharon Ekambaram : 083 634 8806 (Gauteng) Nonkosi Khumalo 072 231 1422 (Limpopo Province, North West) Dr Haroon Saloojee 082 863 4274 (Gauteng) [1] In relation to order 2, the Constitutional Court has three options. First, it may decide to uphold the order completely. In effect, such a decision would transform the interim execution order into a permanent order. Second, the Court may decide to amend the order. This could entail adding or removing specific conditions attached to the order. Third, the Court could overturn the order. In such a case, while government would be entitled to permit the execution order to continue, it would also be entitled to restrict the prescription of nevirapine in the public health sector to its 18 pilot sites. What is clear from the order of the Constitutional Court is that it has not yet decided how it will deal with order 2. [Ends] *********************************************** Here is the format of the letter we are asking hospital superintendants with the capacity to distribute nevirapine to send to their local Provincial Dept. of Health: HOSPITAL OR CLINIC ADDRESS: DATE: TO: Provincial Department of Health ADDRESS: CC: MEC of Health REQUEST FOR NEVIRAPINE We are writing to request that you supply our health facility with Nevirapine for the purposes of preventing Mother-To-Child-HIV transmission. We also ask that you send us copies of manuals and protocols prepared by the Department of Health dealing with MTCT, so that we can work according to accepted standards and guidelines. The Superintendent or head of this Clinic / Hospital in consultation with medical practitioners has determined that this facility has the capacity to implement a Mother-To-Child HIV prevention programme through the administration of Nevirapine in those cases where it is medically indicated. We would like to offer Nevirapine to pregnant women at our facility who have had an HIV test and have been counselled about their HIV status, and to their babies after delivery. This facility estimates that we care for number) of pregnant women per month. We therefore require (number) 200mg Nevirapine capsules and (number) ml of Nevirapine Syrup. This will be sufficient for (number) patients. We look forward to the speedy delivery of the requested supply of Nevirapine. Signed (POSITION) CC: Nonkosi Khumalo, TAC Executive Secretary (011-4032106) --------------------------------------------------------------------------------