[Peace] Fwd: South Africa: AIDS Treatment Gets Green Light

[Al Kagan]

>Date: Sun, 23 Nov 2003 12:27:06 -0600
>To: akagan at uiuc.edu
>Subject: South Africa: AIDS Treatment Gets Green Light
>From: africafocus at igc.org
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>South Africa: AIDS Treatment Gets Green Light
>
>AfricaFocus Bulletin
>November 23, 2003 (031123)
>(Reposted from sources cited below)
>
>Editor's Note 
>
>Last week the South African government approved a comprehensive plan 
>for treatment as well as prevention of HIV and AIDS. The result of 
>years of pressure by the Treatment Action Campaign (TAC) and other 
>activists, this step gives the green light for free public treatment 
>of all those in need of it. Implementing this decision, however, 
>still requires enormous efforts. 
>
>This issue of AfricaFocus Bulletin includes a statement by the 
>Treatment Action Campaign on the way forward, and excerpts from the 
>statement by the South African Cabinet.
>
>"On behalf of the TAC National Executive, we wish to thank the 
>thousands of individuals and organisations, including TAC members, 
>MSF, the South African trade union movement, the churches, NGOs, our 
>funders and activists around the world, too numerous to name, who 
>have made these achievements possible." - TAC, November 20, 2003
>
>++++++++++++++++++++++end editor's note+++++++++++++++++++++++
>
>The Way Forward for the Treatment Action Campaign
>
>20 November 2003
>
>Treatment Action Campaign
>http://www.tac.org.za
>
>Dear TAC Volunteers, Members, Supporters, Allies and Friends
>
>TAC Welcomes Cabinet Adoption of Treatment Plan
>
>Decision Gives Hope to Poor Communities Across South Africa
>
>The South African Cabinet has approved the Operational Plan for 
>Comprehensive Treatment and Care for HIV and AIDS. The plan 
>envisages that "within a year, there will be at least one 
>[antiretroviral] service point in every health district across the 
>country, and within five years, one service point in every local 
>municipality." [Cabinet Statement, 19 November 2003]. The plan also 
>commits government to investing substantial finance into "upgrading 
>our national healthcare system" via "recruitment of thouands of 
>professionals and a very large training programme to ensure nurses, 
>doctors, laboratory technicians, counsellors and other health 
>workers have the knowledge and the skills to ensure safe, ethical 
>and effective use of medicines." Government has also committed to a 
>massive public education campaign, improved prevention efforts and 
>improved treatment of opportunistic infections.
>
>The Treatment Action Campaign (TAC) welcomes the Cabinet decision. 
>This is a wonderful day for all in South Africa. There is now real 
>hope for millions of people with HIV and their families. It is 
>tragic that for many people this decision has come much too late, 
>such as a founding member of TAC's Samora branch in Cape Town who 
>died of AIDS today.
>
>The challenges ahead for all of us are to ensure that the plan is 
>implemented as speedily as possible and to mobilise our communities 
>around counselling, testing and understanding how treatment works. 
>Critically, we need to develop and implement more sophisticated 
>prevention messages.
>
>We urge government to release the full treatment plan so that civil 
>society can study its details and assist with its implementation.
>
>The Cabinet Statement and a Question and Answer document on the 
>Operational Plan handed out by government are [available at: 
>[http://www.gov.za/issues/hiv/cabinetaidsqa19nov03.htm]
>
>The Way Forward for the Treatment Action Campaign
>
>Nearly five years after the launch of the TAC, we have reached a 
>crucial turning point in our struggle. We stand on the brink of the 
>implementation of a treatment plan that has the potential to save 
>millions of lives. This is what we have worked for since the TAC 
>began. It is therefore a good opportunity to examine what the TAC 
>has achieved and what the way forward is.
>
>Together with our allies in South Africa and internationally we have 
>successfully changed our government's policy, challenged the power 
>of the pharmaceutical industry and made many important international 
>organisations and governments realise that people with HIV/AIDS in 
>poor countries have a right to have access to medicines and must be 
>treated with dignity.
>
>On behalf of the TAC National Executive, we wish to thank the 
>thousands of individuals and organisations, including TAC members, 
>MSF, the South African trade union movement, the churches, NGOs, our 
>funders and activists around the world, too numerous to name, who 
>have made these achievements possible.
>
>We also pay tribute to our many comrades who died because of HIV 
>before we reached this turning point.
>
>You can all feel justly proud that your immense efforts, to build a 
>more equitable and just world, have been worthwhile.
>
>The combination of the Constitutional Court decision on 
>mother-to-child transmission prevention, the Stand Up for Our Lives 
>march in February, the civil disobedience campaign and the 
>international protests around the world have convinced Cabinet to 
>develop and implement an antiretroviral rollout plan.
>
>But government must do much more including implementing better 
>prevention programmes, better opportunistic infection treatment and 
>greatly improved work-conditions for health-care workers. We also 
>need clear messages of support for prevention and treatment from 
>President Mbeki and all Cabinet ministers. We have come a long way 
>but we must be ready to put more pressure on government if it does 
>not implement the treatment plan properly.
>
>Hundreds of our members across the country live openly with HIV. 
>They tell their friends, family and work colleagues they have HIV. 
>They even say it in newspapers, on radio and on television. Our 
>HIV-positive t-shirt, a sign of openness and solidarity, is worn by 
>thousands of people.
>
>Nevertheless, many people with HIV still experience discrimination 
>and cannot be open. We still have much to do to create openness.
>
>Before we began our campaign, antiretrovirals cost over R4,000 per 
>month. Patented antiretrovirals now cost about R1,000 per month. 
>TAC, MSF and GARPP also purchase generic antiretrovirals, in breach 
>of patent, at R300 or less per month. The deal announced by the 
>Clinton Foundation will bring the prices of generic antiretrovirals 
>down to less than R90 per month for government.
>
>We still cannot get these generic medicines, but our pressure on the 
>drug companies through the Competition Commission will surely 
>succeed in the near future.
>
>A few years ago, the dominant view was that prevention of HIV was 
>all that was necessary for the developing world. This has changed. 
>UNAIDS, the European Union and the United States now say that 
>treatment is critical. The Global Fund has been established to help 
>poor countries improve their health care systems so that AIDS, TB 
>and malaria can be treated. Furthermore, HIV/AIDS activism is taking 
>route in many African countries strengthened by the Pan-African 
>Treatment Access Movement.
>
>The global political will to treat people in poor countries is unprecedented.
>
>Where to from Here for the TAC
>
>The TAC's struggle is seen as a model by many organisations and 
>people in South Africa and across the world because of the 
>commitment we demonstrate and our ability to mobilise poor people 
>across the country. Although we can be proud of this, we should also 
>be careful because the expectations upon us are enormous. We must 
>not become complacent because this can easily lead to errors which 
>will destroy the good reputation and work of the TAC. We must live 
>up to the expectations upon us that are realistic. After five years 
>of struggle and the loss of many comrades to AIDS, most of us are 
>tired. We must rest but there is hard work ahead.
>
>The success of the treatment plan rollout depends on our ability to 
>mobilise our communities. Because of this fact, we are going to 
>focus much of our energy at the level of the District Health 
>Service. We are going to assist with service delivery but keep up 
>our pressure through mobilisation and demonstrations when needed.
>
>Branches must work with clinics and campaign for their problems to 
>be rectified. For this to succeed, TAC structures have to function 
>better than ever and our understanding of treatment literacy must 
>improve.
>
>Finally, we will keep up our capacity to mobilise at a national and 
>international level. There are still people high in our government 
>who oppose a treatment plan and will try to delay the rollout of 
>antiretroviral therapy. Pharmaceutical companies will continue to 
>try to profiteer from medicine. Laboratory costs have not yet come 
>down sufficiently. We will have to monitor all of these things 
>closely and be able to apply pressure when needed. The TAC is not 
>going away.
>
>Making Our Structures Work
>
>Each structure has a clear mandate of what is expected from it.
>
>Our provincial offices must ensure that each district has the 
>resources they need to perform their duties. We must ensure that 
>people of all races participate in our provincial activities. NGOs, 
>religious organisations and unions must continue to be involved in 
>our work.
>
>Our district committees are responsible for the functioning of TAC 
>branches within their jurisdiction. Every TAC district should have 
>at least 30 activists who are trained on treatment literacy to be 
>able to educate their own communities.
>
>Each branch should have an outdoor and indoor programme. The indoor 
>one should include workshops on improving clinics in the branch 
>area, antiretrovirals, opportunistic infections, social grants and 
>prevention. The outdoor one should involve pamphleteering, public 
>speaking and door-to-door campaigns. Critically, we need to learn to 
>use the clinic checklist and to work with our clinics so that we can 
>improve them.
>
>Comrades from different areas must understand their responsibilities 
>and be visible in their communities. We must understand our 
>provincial government's rollout plans so we can intensify our 
>treatment literacy and openness campaigns in clinics where 
>antiretroviral therapy is implemented.
>
>Many clinics will not implement antiretroviral therapy immediately. 
>We need to get those clinics ready so that they can begin treatment. 
>This means we must make sure that they have enough nurses and 
>doctors who are properly trained on HIV/AIDS. HIV and CD4 tests must 
>be available. Appropriate medicines must be given to patients with 
>opportunistic infections. There must be high-quality counselling, 
>including information on safer sex. Condoms must be distributed at 
>all clinics.
>
>Here are some things to be done:
>
>1. TAC meetings must be held in every district to brief activists 
>about our role in the rollout.
>
>2. Every provincial office must assess the role TAC is playing in 
>the existing pilot programmes and what lessons could be learnt in 
>order to prepare us for the rollout.
>
>3. District general meetings should be held every month to brief 
>organisations of the progress made and how they can help.
>
>4. HIV support groups groups must be challenged to work with the TAC 
>to address stigma and improve clinic services.
>
>5. We need to work closely with government institutions distributing 
>food parcels and help speed up delivery of this programme.
>
>6. Social Grant education should be done at branch level and in 
>support groups and form part of our door-to-door campaigns.
>
>7. We must organise events at district level to keep people 
>mobilised and ensure that we deal with stigma and discrimination.
>
>8. The TAC Treatment Project must be integrated into the activities 
>of the TAC, especially the wellness programme, so that our activists 
>with HIV can stay healthy. By integrating the TAC and the Treatment 
>Project we will also assist the treatment plan rollout.
>
>9. TAC people should speak at public forums and create more 
>awareness about the challenges lying ahead and the solutions.
>
>10. Volunteer exchange programmes between branches, districts and 
>provinces will help activists to exchange knowledge and skills to 
>better equip us for the challenges ahead.
>
>We have come a long way and achieved magnificent successes, but the 
>hardest work is ahead of us. Let us mobilise for the treatment plan 
>rollout. A luta Continua!
>
>Yours in the struggle for health and human rights
>
>Mandla Majola, Sipho Mthathi, Mark Heywood and Zackie Achmat
>
>On Behalf of the TAC National Executive Committee
>
>20 November 2003
>
>[END OF LETTER]
>
>***************************************************************
>
>Cabinet statement on treatment plan for HIV and AIDS
>
>19 November 2003
>
>[Presented by Minister of Health, Dr Manto Tshabalala-Msimang]
>
>Issued by: Government Communication and Information System (GCIS) 
>For further enquiries contact: Joel Netshitenzhe 082 900 0083
>
>[Excerpts only: the full document is available at:
>  http://www.gov.za/issues/hiv/cabinetaidsqa19nov03.htm]
>
>Cabinet today in principle approved the Operational Plan for 
>Comprehensive Treatment and Care for HIV and AIDS, which it had, on 
>8 August this year, requested the Department of Health to prepare. 
>Amongst other things, the Plan provides for Anti-retroviral 
>Treatment in the public health sector, as part of the government's 
>comprehensive strategy to combat HIV and AIDS.
>
>The meeting instructed the Department of Health to proceed with 
>implementation of the Plan.
>
>It is envisaged in the Plan that, within a year, there will be at 
>least one service point in every health district across the country 
>and, within five years, one service point in every local 
>municipality. Some areas will be able to start sooner than others, 
>and the Department of Health will keep the public informed of the 
>progress of the rollout.
>
>These service points will give citizens access to a continuum of 
>care and treatment, integrated with the prevention and awareness 
>campaign which remains the cornerstone of the strategy to defeat HIV 
>and AIDS.
>
>Concretely this far-reaching decision of government will mean:
>
>* Stepping up the prevention campaign so that the 40 million South 
>Africans not infected stay that way
>
>* A sustained education and community mobilisation programme to 
>strengthen partnership in the fight against the epidemic
>
>* Expanding programmes aimed at boosting the immune system and 
>slowing down the effects of HIV infection, including the option of 
>traditional health treatments for those who use these services
>
>* Improved efforts in treating opportunistic infections for those 
>who are infected but have not reached the stage at which they 
>require antiretrovirals
>
>* Intensified support for families affected by HIV and AIDS
>
>* Introduction of antiretroviral treatment for those who need it, as 
>certified by doctors
>
>BUILDING CAPACITY
>
>To deliver this kind of care across the country, with equitable 
>access to all, will require a major effort to upgrade our national 
>healthcare system. This includes the recruitment of thousands of 
>health professionals and a very large training programme to ensure 
>that nurses, doctors, laboratory technicians, counsellors and other 
>health workers have the knowledge and the skills to ensure safe, 
>ethical and effective use of medicines. ...
>
>Over half of the total budget that will be spent over the next five 
>years in implementing this programme will go to upgrading health 
>infrastructure, emphasising prevention and promoting healthy 
>lifestyles. As such, the implementation of this plan will benefit 
>the health system as a whole.
>
>Cabinet agreed that the funds allocated for this programme should be 
>"new money". The programme will and must therefore not detract from 
>other programmes of health care and provision of social services. ...
>
>CENTRALITY OF PREVENTION
>
>Government wishes to reiterate that there is no known cure for AIDS. 
>We cannot therefore afford, as a nation, to lower our guard. 
>Prevention therefore remains the cornerstone of our campaign.
>
>The eradication from the body of the HIVirus remains beyond reach. 
>The mechanisms of HIV infections remain difficult to fathom, and the 
>downhill plunge of the infected, to severe immune deficiency over 
>the next 2-14 years is ill-understood. The co-factors that are 
>thought to mitigate immune destruction of healthy CD4+ cells by the 
>minority of infected CD4+ are still uncharacterised. In the South 
>African context the immune systems is assaulted by a host of factors 
>related to poverty and deprivation.
>
>The Operational Plan places a high premium on strengthening 
>prevention efforts and it underlines the critically important 
>messages of prevention and of changing lifestyles and behaviour. 
>These elements of our Comprehensive Strategy remain the starting 
>point in managing the epidemic.
>
>At the same time, it should be noted that not everyone who is HIV 
>positive requires Anti-retroviral Treatment. As such, the plan also 
>provides for enhanced care for those who are infected but have not 
>as yet progressed to an advanced stage of AIDS.
>
>At the same time, the challenges of home-based care, the campaign to 
>combat discrimination against those who are infected and affected 
>remain critical. So is the task of intensifying efforts to deal 
>broadly with poverty and poor nutrition.
>
>STRENGTHENING PARTNERSHIPS
>
>Progress in implementing the Plan adopted by government today will 
>depend, to a significant degree, on intensified mobilisation across 
>society. Besides the legion of non-governmental and community-based 
>organisations who are involved in constructive work in this regard, 
>the media is an important partner, as it has the potential to 
>communicate messages of awareness and hope, and to keep the nation 
>accurately informed about the campaign against HIV and AIDS.
>
>A cooperative relationship among all sectors of society, 
>particularly in the implementation of this element of the 
>comprehensive strategy, the spirit of letsema and vuk'uzenzele, a 
>message of hope and responsibility as well as constructive 
>engagement in the realm of practical work will ensure that South 
>Africa advances even more decisively in this endeavour.
>
>The Comprehensive Plan for Treatment and Care carves out a future 
>for those infected with HIV, and for those suffering from immune 
>deficiency; whilst assisting the vast majority of South Africans who 
>are HIV negative to remain that way. The peculiarly South African 
>nature of the problem demands South African solutions; solutions 
>contained within this complex and detailed Comprehensive Plan for 
>Treatment and Care.
>
>Such an ambitious goal - targeting the immense complexity of the 
>human immune system operating within the environmental milieu of 
>Africa - predicates a multifaceted, integrated and intersectoral 
>response in prevention, treatment and care. The Plan is the final 
>piece completing the jigsaw puzzle of the National Strategic Plan 
>for HIV and AIDS 2000 - 2005 whose four key areas of intervention 
>were: prevention, treatment, care and support; research, monitoring 
>and surveillance; as well as legal and human rights.
>
>CONCLUSION
>
>Cabinet wishes to express its appreciation of the work done by 
>members of the Task Team - including in particular experts and 
>specialists from inside and outside the country - whose contribution 
>has helped shape this Plan. We are confident that, as with our 
>national prevention efforts, this Plan will rank among the most 
>comprehensive in the world.
>
>Government is once more strengthening the hand of the nation in the 
>fight against HIV and AIDS, in keeping with its mandate to build a 
>better life for all. If correctly implemented this Operation Plan 
>provides an excellent opportunity to complete the treatment sector 
>of the National Strategic Plan for HIV and AIDS whilst also 
>strengthening prevention. The challenge is immense but not 
>impossible.
>
>We are confident that, together, bound by a people's contract for a 
>better life, we shall all continue to make progress in building 
>South Africa into a land our dreams.
>
>There is hope!
>
>*************************************************************
>AfricaFocus Bulletin is a free independent electronic publication
>providing reposted commentary and analysis on African issues, with
>a particular focus on U.S. and international policies. AfricaFocus
>Bulletin is edited by William Minter.
>
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>
>************************************************************


-- 


Al Kagan
African Studies Bibliographer and Professor of Library Administration
Africana Unit, Room 328
University of Illinois Library
1408 W. Gregory Drive
Urbana, IL 61801, USA

tel. 217-333-6519
fax. 217-333-2214
e-mail. akagan at uiuc.edu