The case for saving the TAC is compelling

Dear global donors,

Fulfilling the right to health depends on common purpose between researchers, clinicians and activists.

On the eve of World Aids Day 2014, we write this letter as globally recognised researchers, scientists and academics who are concerned about reports of the possible closure of the Treatment Action Campaign (TAC) in South Africa as a consequence of serious funding difficulties.

We believe that health and access to health services is a human right. But we want to state unequivocally that, as much as the fulfilment of the right to health requires investment into new scientific breakthroughs and sound research discoveries, it also requires investment and support of strong, independent, organised and relevant civil society movements.

Civil society, particularly people living with HIV, has played a pivotal role throughout the response to HIV. In the 1980s, it was the activists’ demands for treatment that increased funding for HIV research and created a sense of urgency in the medical community; in the 1990s and 2000s, the loud global voice of activists helped to create political commitment for the response to HIV, which in turn released funds for research into many of the scientific breakthroughs we can since claim.

Activists have also ensured that new science, such as that on both treatment and prevention, has been turned rapidly into delivery of care and services, and they have maintained oversight of the health systems needed to deliver this.

As a result, in the arena of HIV we have witnessed something unique: global social justice in the response to one disease. We believe the lessons of HIV need to be expanded upon. A similar alliance of activism and scientific inquiry is needed for tuberculosis (TB), Ebola, malaria, cancer and the myriad other health challenges that confront the globe.

Many activist organisations have contributed to this change, but undoubtedly one of the most excellent health and human rights movements has been the TAC.

Through its campaigns for anti-retroviral treatment (ARV), the TAC helped to change the response to the HIV epidemic in South Africa, the epicentre of the global epidemic, from one that was mired in political denialism to one that wins praise for South Africa all over the world.

We also salute the role the TAC has played and continues to play in treatment literacy, educating communities about HIV, their treatment and the importance of adherence. Consequently, 2.5-million people are now on ARV treatment in South Africa.

However, this is no cause for complacency or for the dismantling and demobilisation of civil society. New challenges have replaced old ones, new science requires new activism and vice versa. Sustaining and expanding this intervention to all six million HIV-infected people in South Africa requires that the TAC now focuses its activism on TB, on exercising oversight over the quality of public health services, ensuring accountability and a continued sense of urgency.

This is why it is alarming to hear that the TAC is facing closure apparently because many donors and governments mistakenly believe either we are nearing the end of Aids or because they view South Africa as a middle-income country not in need of donor support. Nothing could be further from the truth.

Allowing the TAC (and other organisations like it in other countries) to die for lack of funding will have grave consequences. Without activist monitoring, the South African Aids response could go into reverse. Precious gains could be lost. Poor adherence, loss to follow-up and medicine stock-outs could go unreported. If this happens, there will be little to celebrate by the time the 21st International Aids Conference returns to Durban in 2016, the city in which the TAC first organised a global march for access to treatment.

Outside of the scientific community, many leaders we admire and respect have added their voices to save the TAC. These include Archbishop Emeritus Desmond Mpilo Tutu, Graça Machel and Stephen Lewis, a former United Nations special envoy for HIV/Aids in Africa.

We are now adding our voices to their appeal. Please, let us in 10 years time look back at this moment as one of inspiration and renewal, not of one of failure.

In 2014, let us mark 10 years of antiretrovirals in South Africa as a moment at which we were reinvigorated and as a moment at which we give civil society the support it needs and deserves.

We close our appeal by remembering words used by Nelson Mandela 10 years ago, specifically in relation to HIV: “The more we lack the courage and the will to act, the more we condemn to death our brothers and sisters, our children and our grandchildren.

“When the history of our times is written, will we be remembered as the generation that turned our backs in a moment of global crisis or will it be recorded that we did the right thing?”

Yours in health,

Professor Peter Piot, director of the London School of Hygiene and Tropical Medicine, and founding executive director of UNAids;
Professor Françoise Barré-Sinoussi, Nobel Prize laureate;
Professor Salim S Abdool Karim, director of the Centre for the Aids Programme of Research in South Africa;
Dr Chris Beyrer, president of the International Aids Society;
Professor Francesca Conradie, president of the Southern African HIV Clinicians’ Society;
Dr Eric Goemaere, senior regional HIV/TB support co-ordinator of Médécins Sans Frontières South Africa;
Professor Glenda Gray, department of paediatrics, University of the Witwatersrand;
Professor Valerie Mizrahi, director of the Institute of Infectious Disease and Molecular Medicine, University of Cape Town;
Professor Helen Rees, executive director of the Wits Reproductive Health Institute and ad hominem professor in the department of obstetrics and gynaecology, Wits University;
Professor Olive Shisana, chief executive of the Human Sciences Research Council, South Africa;
et al

For the full list of signatures, go to tac.org.za