Speech by Zackie Achmat at 58th Session of the UN Commission on
Human Rights

3rd April 2002

Realising the right to health: Access to HIV/AIDS-related
mediciation

The role of civil society in South Africa 58th session of the
Commission on Human Rights

Zackie Achmat TAC Chairperson
[email protected] [2]
http://www.tac.org.za [3]

1.Madam Chairperson, High Commissioner Robins, distinguished
members, guests and friends, Ms. Miriam Maluwa, I want to thank you
on behalf of the Treatment Action Campaign (TAC) for this
opportunity to address you. TAC is a campaign of people with
HIV/AIDS, our friends and families and the broader community.
Alongside the organisations of women, children, health
professionals, TAC is supported by the Congress of South African
Trade Unions, the National Council of Trade Unions, the South
African Council of Churches, Southern African Catholic Bishops
Conference and many other community-based organisations. The AIDS
Law Project is one of the leading partner organisations of TAC. We
work for HIV treatment access, the elimination of new HIV
infections and an affordable, quality health care system for all
people in our country and beyond.

2.For children, women and men with HIV/AIDS the rights to dignity,
life, equality and their inter-connection with the right to health
care access, particularly access to medicines including
anti-retrovirals stands between us and death. This is particularly
true in poor countries and poor communities in wealthy countries.
These rights - dignity, life, equality - are essential tools in our
struggle to remove the barriers to HIV treatment and health care
for all. What are these barriers?

3.The lack of scientific and treatment literacy is a major obstacle
in our work to gain access to treatment. Governments, health care
professionals and people with HIV/AIDS are often unaware of the
treatments for opportunistic infections and how anti-retrovirals
work. Our professionals in all spheres lack the understanding of
how clinical trials work, the basics of pharmacology and so on.
However, this obstacle is not insurmountable. When we started our
campaign for access to AZT for pregnant women, people including
doctors and nurses asked us what AZT was. Today millions of people
in our country know of AZT, Nevirapine and other anti-retrovirals,
as well as fluconazole, acyclovir and cotrimoxazole. TAC has
learnt from the experiences of Northern NGOs in particular GMHC,
TAG and Project Inform. But, we apply these lessons to our own
cultural context. Today, people without education in our country
speak of treatment literacy and though we have a great deal of work
to do, our experience has shown that this barrier can be overcome
by civil society working where possible in partnership with
government and the private sector.

4.Patents and prices: In our country herpes has not been treated
for many years because of the high prices resulting from the
patents on acyclovir. The patent has expired but the guidelines for
the management of syndromic treatment of STDs do not yet include
acyclovir. Our government has committed itself to changing this
situation. Fluconazole for the treatment of systemic thrush and
crytococcal meningitis was beyond the reach of the vast majority of
people with HIV/AIDS because of the price and patent. This is
also true of anti-retrovirals for HIV treatment.

5.The government of President Nelson Mandela and the able Health
Minister Dr. Nkosazana Dlamini-Zuma developed a programme to reform
the health care system. This included the medicines legislation -
the Medicines and Related Substances Control Amendment Act of 1997.
As you are aware, the world's multinational pharmaceutical
companies took our government to court for that legislation. In
particular, they objected to measures such as generic substitution
of off-patent medicines (widely practised in the US, Europe and
elsewhere), a pricing committee and parallel importation. Together
with ACT-UP New York, Philadelphia, HealthGAP Coalition, IGLHRC,
MSF, Consumer Project on Technology who mobilised public opinion in
Europe and North America, TAC mobilised civil society in South
Africa to support the legislation and the government. We were
joined by OXFAM, ACTSA, countless other NGOs and from Windhoek to
Manila, from London to Delhi, Paris to Rio de Janeiro civil society
heeded our call for a global day of action and sustained pressure
on the drug companies. Almost exactly a year ago, the drug
companies capitulated. What were the immediate results of that
campaign?

6.Not since the campaign on breastmilk 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.

7.Drug prices plummeted in South Africa and internationally. The
majority of our people who are employed (30% people are unemployed)
earn less than R2000.00 per month. In 1998, when TAC started its
campaign a months supply of antiretrovirals cost between R4500.00
and R2500.00 per month. Now, they cost between R1800.00 and R700.00
per month. The generic ARVs used by MSF in its pilot ARV project
in Khayelitsha, Cape Town costs R450.00. Private medical schemes
provide ARV therapy in our country - our members of Parliament and
their families have access to them. Since the access campaign
started and since the court case last April, the number of people
in our country on ARV therapy has increased from 5 000 to 20 000.
However, diagnostic and monitoring tools remain the biggest
problem. We believe that with initiatives such as that of the Thai
GPO and the Brazilian government the cost of ARVs can be reduced to
R250.00 per month. International support for the efforts of the
governments of Thailand, Brazil, Nigeria and others who use generic
ARVs was strengthened following civil society mobilisation on the
SA court case.

8.Political will in our country remains the single largest obstacle
to access to ARVs and the proper treatment of opportunistic
infections. This lack of political will is an obstacle to dealing
with the drug companies - the government has failed to use its hard
won legislation. It has the legal power through the Patents Act,
the Medicines Act and the Competition Act. It also has the support
of the DOHA Agreement to use compulsory licences for generic
production - it has failed to do this.

9.Most significantly, as we speak - the Constitutional Court in our
country is hearing an urgent appeal from our government against an
interim order asking it to provide Nevirapine to pregnant women
with HIV where health professionals have the capacity to test and
counsel pending an appeal. More than 70 000 children in our country
are infected with HIV through pregnancy and breastfeeding every
year. Fewer than 10% of all pregnant women have access to
counselling, testing and information on breastfeeding and HIV.

TAC regretfully took our government to court to provide Nevirapine
or any other appropriate ARV to pregnant women to help reduce
mother-to-child HIV transmission, and, to develop a plan over two
years to provide counselling, testing, feeding information and
where possible alternatives to breastmilk throughout the country.
We took this decision with pain and regret after five years of
negotiation.

TAC and all its partner organisations have helped the South African
government establish one of the best legal and human rights
frameworks to deal with the epidemic. No-one can lose their job
because of their HIV status, no-one can be excluded from medical
aid schemes, schools, housing and any social services. These are
the products of partnership.

But since, 1998 and specifically since October 1999 when our
President, Mr. Thabo Mbeki questioned the link between HIV and AIDS
- the health system has been paralysed. Political will has been
absent to deal with another significant barrier to HIV treatment --
health care infrastructure. Finance, access to medicines and
development of human resources can be achieved through sharing the
burden with the private sector, medical schemes and civil society.

10.We know universal coverage is not possible overnight. A
commitment to universal coverage, a treatment plan and political
commitment will save the lives of millions of people in our
country. We appeal to everyone to assist us in changing the
difficult circumstances we face in our country where the position
of HIV denialists has become an orthodoxy.

11.However, there is a greater challenge than the denial of the
South African government. As we speak of human rights and access
to HIV/AIDS medicines and treatment for malaria, TB, leishmaniasis
and other neglected diseases, we also have to speak of
international responsibility.

The greatest challenge is to countries such as the USA, Britain,
the European Union, Japan, Switzerland and others to provide
funding to the GFATM as requested by UN secretary-general Mr. Kofi
Annan. The fund needs $10-12 billion annually. It is a shame that
it has received less than a quarter of this money.

12.In conclusion, the power of the drug companies to dictate their
terms has been temporarily halted. The international community
needs to be galvanised to provide the funds needed to deal with
HIV/AIDS. Significant development assistance including debt
cancellation is essential. This can be achieved through
organisation of civil society in Africa, Asia and Latin America, as
well as North America and Europe to assist our governments as
partners and where necessary to convince them through action.

Thank you

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