In May 1994, a month after being sworn in as the ruling party, the African National Congress drew up a national health plan, with technical assistance from the World Health Organisation and the United Nations Children’s Fund.
The plan dealt at length with HIV/Aids, pointing out that: “In view of the devastating implications of the epidemic for South Africa, it is mandatory to define prevention and control interventions, plus comprehensive care for those already infected, within the context of the Bill of Rights.”
The ANC called for the development and implementation of an effective HIV/Aids strategy by the end of 1995.
Only now, a decade later, is a comprehensive treatment plan being rolled out.
By the end of 2002, an estimated 5,3-million South Africans, in a population of more than 42-million, were infected with the virus.
As a result of HIV/Aids, the South African Bureau for Economic Research predicted in 2001 that growth would decrease by half a percent for each year until 2015, production costs could rise by up to 2,3% annually and prime interest rates could increase by 2,9% per year between 2002 and 2015.
According to the bureau, by 2015, South Africa’s total labour force would decrease by 21%, including a 16,8% decline in highly skilled workers, a 19,3% drop in skilled workers and a 22,2% decrease in semi-skilled and unskilled workers.
Not only the work force is being affected: a recent survey revealed that one in every five young South Africans aged between 15 and 24 is infected, with the epidemic disproportionately affecting women.
The study, conducted by the University of the Witwatersrand’s Reproductive Health Research Unit, found that nearly one in four women aged 20 to 24 are testing HIV-positive, compared with one in 14 men of the same age. By the age of 22, one in four South African women has HIV.
The ANC had a “sound policy in place regarding its approach to HIV/Aids. Unfortunately, other priority needs, such as education, diverted our resources, and then the subsequent confusion about the causal link between HIV and Aids delayed the process towards treatment of people living with HIV/Aids”, says Sadiq Kariem, the secretary of the ANC’s health secretariat.
Critics point the finger of blame over the delays and “confusion” at President Thabo Mbeki and his willingness to listen to the views of Aids dissidents.
The emergence of the TAC
In 1994, with Nkosazana Dlamini-Zuma at the helm of the Department of Health, access to cheaper Aids drugs was a priority.
She moved for the amendment of the Medicines and Related Substances Control Amendment Act, allowing compulsory licensing that would enable the government to use a patent without the consent of the patent-holder in certain cases, and parallel imports, which meant the government could shop around for patented drugs at cheaper prices from foreign suppliers of anti-retrovirals (ARVs), rather than sourcing them from the manufacturer’s local subsidiary. The legislation came into effect in 1997.
The Pharmaceutical Manufacturers’ Association (PMA) challenged the amendment in court.
That year saw the emergence of an Aids activist group, the Treatment Action Campaign (TAC).
“Realising the need to lobby for cheaper [ARVs], [the] TAC was formed in November 1998,” recalls Mazibuko Jara, the organisation’s spokesperson at the time. The TAC stood with the government in the court case.
The organisation led a series of demonstrations outside several pharmaceutical companies that were party to the lawsuit. The PMA acquired an interdict in 1998, preventing the government from implementing the amended Act until the court case had been resolved.
“Dlamini-Zuma was a people’s minister — her priority was to provide access to cheaper medicines. She came to our meetings, wanted to attend our demonstrations — we worked together,” said Jara.
The trial dragged on for three years. In the meantime, power at the Health Ministry changed hands after the second general election in 1999. Dlamini-Zuma moved on to take charge of the foreign affairs portfolio, with Manto Tshabalala-Msimang replacing her at the Health Ministry.
The relationship between the TAC and the government began to deteriorate during that period, says Jara.
“The president’s [Mbeki’s] views on HIV/Aids had become known by then. The government began dragging its feet on the court case involving the amendment to the Medicines Act — it was no longer a priority,” he points out.
So the TAC began lobbying the pharmaceutical companies nationally and internationally, sparking a series of global demonstrations.
“The entire world community was watching the court case now,” says Jara.
“Not since the campaign on breast-milk substitutes has there been such a widespread mobilisation of international civil society on a health issue. For the first time, one of the most powerful multinational corporation lobbies became accountable to civil society, government and their shareholders, for profiteering at the expense of health and lives,” recounted TAC chairman Zackie Achmat while addressing the United Nations Commission on Human Rights in 2002.
The relationship between the government and the TAC soured. The TAC’s hand was strengthened when the Congress of South African Trade Unions (Cosatu) joined its campaign. Finally, in 2001, the PMA dropped the lawsuit.
“Drug prices plummeted in South Africa and internationally. The majority of our people who are employed [40% are unemployed] earn less than R2Â 000 per month. In 1998, when [the] TAC started its campaign, a month’s supply of ARVs cost between R2Â 500 and R4Â 500 per month. Now they cost between R700 and R1Â 800 per month. The generic ARVs used by MSF [MÃ