[Ip-health] Speech by Zackie Achmat at 58th Session of the UN Commission on Human Rights

[Nathan Geffen]

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

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.   BUT?  
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

Zackie Achmat TAC Chairperson
zackie@pixie.co.za
3rd April 2002