The government will not elevate HIV/Aids above other diseases by giving it priority attention, says Minister of Health Manto Tshabalala-Msimang.
In an interview with the Mail & Guardian this week, Tshabalala-Msimang said while she had seen the draft treatment plan drawn up by the government, labour and business negotiators, no one would compel her to sign as the state had many pressing issues to deal with.
Tshabalala-Msimang was speaking as trade unions and Aids lobby groups turned up the pressure on the government to sign the National Economic Development and Labour Council (Nedlac) framework agreement calling for a national treat-ment plan for HIV/Aids sufferers. The plan calls for universal access to antiretrovirals.
The Treatment Action Campaign (TAC)has threatened a campaign of civil disobedience if the government and business fail to sign the agreement by April. The Congress of South African Trade Unions (Cosatu) could also join in the protests.
Tshabalala-Msimang admitted she had seen the draft Nedlac document.
“But I saw the government was already implementing what it says it should, so why should I sign it?” asked the health minister. “Why must the government enter into agreements with everyone? Tomorrow, must I enter into an agreement with asthma sufferers?”
Tshabalala-Msimang went on to say that prescribing antiretrovirals was a complicated matter. Factors such as cost, infrastructure and side-effects had to be taken into consideration, she maintained.
“It is not like giving out aspirin, like Jerry says,” she said, referring to Jerry Coovadia, head of paediatrics at the University of Natal’s medical school, who has repeatedly called for a government roll-out of antiretrovirals.
Tshabalala-Msimang said that the Department of Health was still dealing with “the already large problem” of the side-effects of tuberculosis treatment.
The minister pointed out that her department was still observing the private sector’s use of antiretrovirals before finalising its own plans.
When it was pointed out that KwaZulu-Natal MEC for Health Zweli Mkhize had indicated that dispensing the antiretroviral nevirapine had brought a 50% reduction in mother-to-child transmission of HIV in the province, Tshabalala-Msimang retorted: “I don’t know what studies he has based his statement on. He has not reported his findings before Minmec [the national and provincial ministers’ forum]. When he does, I will look at it.”
Senior health officials said Mkhize reported his findings to Minmec last year.
The minister questioned reports that Deputy President Jacob Zuma had said the Cabinet was considering the Nedlac document.
“I would be the one to draft the Cabinet memo, and I have done no such thing,” she said.
Health sector insiders say the deputy president, who holds orthodox views on HIV/Aids, has been driving the Nedlac process.
Tshabalala-Msimang’s questioning stance on antiretrovirals also contradicted the position of her director general, Ayanda Ntsaluba, at a press conference during the week.
Ntsaluba told journalists that the government has moved beyond the provision of antiretrovirals to pregnant women and prophylaxis for rape survivors and health-care workers.
The “dispute” now revolved around a public sector anti-retroviral programme, he said.
In what was clearly a damage-control exercise, following the row over whether the government, business, labour and community groups agreed on the Nedlac document, Ntsaluba said the government had not signed the accord because it called for a public sector anti-retroviral programme.
The cost of this was still being calculated, he said.
The Nedlac treatment plan had set April this year as the deadline for completion of the process and recommendations.
The TAC’s Zackie Achmat said there had been consensus between the various parties, including the government, in Nedlac’s technical committee.
Nedlac’s Phillip Dexter said there was a “draft agreement” in place when the parties decided to go back to their principals for a mandate to sign.
Speaking to the Mail & Guardian this week Minister of Labour Membathisi Mdladlana accused Cosatu and the TAC of “destroying Nedlac” by not respecting the forum and instead going out on the streets to march against the government.
“You cannot then leave the process and threaten civil disobedience. That is being anti-government,” he said.
He said he believed in negotiations, but in this instance there had been no agreement yet.
Mdladlana said that before the agreement could be signed off, it needed buy-in from all government departments.
“I have to await input from the minister of finance, the minister of health and the minister of social development — these things take time.”
Mdladlana went on to claim that the civil society organisations were themselves divided over whether the pact had been thoroughly canvassed with their own constituencies. He said he was aware that the National Association of People Living with HIV/Aids was concerned that it had not been able to canvass its own constituency about the document.
Health workers questioned this week said they believed the government was reluctant to sign the deal because it will “upstage” its own announcement on a public sector antiretroviral plan.
A senior health official said he had seen documents detailing a budgetary allocation of several million rand over three years for antiretrovirals. There is an expectation in government circles that Minister of Finance Trevor Manuel could make a significant announcement in his budget speech next week.
However, given Tshabalala-Msimang’s position on the efficacy of antiretrovirals, “influenced no doubt by the president’s own position”, others doubt the budget will make such provision.
Asked about the possibility of an announcement next week, Tshabalala-Msimang retorted, in a voice dripping with sarcasm, that the media were “perhaps getting exclusive briefings from the Finance Ministry on information I’m not privy to”.
She said she was not aware of such an allocation.
However, Ntsaluba confirmed at the press conference that a task team comprising officials from the Treasury and the Department of Health were looking at the cost of providing antiretrovirals in state facilities.
He said TAC representatives had made an input into the research.
Deputy Minister of Finance Mandisi Mphahlwa told the M&G the team had prepared a report that he had not yet seen. “We are looking at it very seriously.”
Ntsaluba and the director general of labour, Rams Ramashia, stated their commitment to the Nedlac process.
Sources said that Ramashia, and Ntsaluba, accompanied by two other officials, were among those who had agreed with the contents of the document last year.
“Clearly the problems lie with their bosses,” said one insider.
Reacting to Tshabalala-Msimang’s stance on signing the document, the TAC’s Nathan Geffen and Cosatu Vukani Mde asked why the minister was refusing to approve the agreement if it was already government policy.
“Why doesn’t she sign it then?” Mde asked.