Zackie Achmat of the Treatment Action Campaign (TAC) is literally fighting for his life — as well as for the lives of the roughly five million South Africans infected with HIV/Aids. Achmat has vowed to forgo using anti-retroviral drugs until they are more widely available to poor South Africans.
This week he was reportedly ”very sick” with a chest infection following a punishing schedule that culminated in the national HIV/Aids treatment congress in Durban last weekend. Achmat faces tough odds in the battle to shift the government’s position on anti-retrovirals before the virus consumes him.
The treatment congress, held jointly with the Congress of South African Trade Unions (Cosatu), was a triumph for Achmat and the TAC, but it was not quite a turning point. The government was completely absent, except for the well-meaning but impotent Dr Nono Simelela, chief director for HIV/Aids in the Department of Health, and Dr Zweli Mkhize, MEC for Health in KwaZulu-Natal. The SABC — a barometer of the nation’s power politics — largely cold-shouldered the event.
The congress mapped out a national treatment plan, which Cosatu will take as a demand to the National Economic Development and Labour Council for discussion and which will also be submitted to the South African National Aids Council. The plan calls for Aids to be recognised as a national emergency and for state intervention to be massively scaled up.
A treatment pyramid is proposed, beginning at the base with a vastly extended campaign for education, voluntary counselling and testing. On top of that comes more focused campaigns of a national mother-to-child transmission prevention programme, better treatment for opportunistic infections, widely available Highly Active Anti-retroviral Therapy (Haart) and proper care for the dying.
Because of the large numbers of infected people in South Africa, the costs are enormous. Assuming that Haart might extend to up to two million people a year, the TAC concurred with a government estimate that this can be achieved at a cost of about R7000 a patient — that is, R14-billion a year — a figure that includes the costs of counselling, testing and patient management. But actually this may be achievable, given that in this year’s budget Minister of Finance Trevor Manuel saw fit to announce personal income tax cuts amounting to R15-billion.
The infrastructure costs associated with re-equipping the health care system to be able to deliver this level of care, plus the welfare costs involved, including decent end-of-life and orphan care, would probably double this figure. And the TAC and Cosatu say no proper assessment has been done of the social and financial costs of the government’s current approach, which amounts to ”shunting people towards home-based care and preparing to live with the social consequences of millions of deaths”.
The TAC has not completed the ”opportunity cost” calculations, but the conference revealed that the Brazilian Aids programme, which includes anti-retroviral treatment, has been able to reduce hospitalisation costs related to HIV/Aids by 80%. In South Africa these are currently running at something like R4-billion a year, according to the Department of Health’s estimates.
But, as Judge Edwin Cameron pointed out in his closing address, the attempts to debate the costs are almost trite in the face of the enormous moral outrage of simply allowing millions of people to die when the means exist to assist most of them via anti-retroviral therapy. In that sense the main aim of the conference was to build on the TAC’s growing stature as a social movement and to cement what one might call the ”Alternative Alliance” with Cosatu — a partnership that arguably has the potential to split the trade union federation away from its tripartite alliance with the South African Communisty Party and the African National Congress.
In fact, the Aids treatment campaign is at the centre of the country’s most obvious political divide: the post-apartheid ”realpolitik” of the ANC and most other parties, and the (human) rights-based politics of the TAC and other NGOs. Cosatu uncomfortably straddles both these camps and is fairly obviously split.
Cosatu president Willie Madisha tacitly acknowledges that the treatment campaign is also a political campaign in that it directly attacks government spending priorities and seeks a mass mobilisation outside the formal ambit of the alliance. Madisha was explicit in his sympathies, referring caustically in his closing address to the single reference to HIV/Aids in line 125 of the New Partnership for Africa’s Development document and calling the struggle against Aids a ”struggle for democratic accountability, which is being ignored in a number of instances here at home”.
In his address to the conference, Cosatu general secretary Zwelinzima Vavi, on the other hand, was more concerned to build bridges with the government — an approach that carries inevitable contradictions, given the sheer size of the fiscal shift the Aids epidemic demands and the government’s solid disinclination to make such shifts.
The battle for treatment — and for continued Cosatu backing — is only just beginning. The TAC may yet need to beg Achmat to keep himself alive — and with him, the hopes of millions.