3. Introduction
3.2 Overview of the Treatment Action Campaign
This section of the chapter provides an understanding of the case study. It gives an overview of the HIV/AIDS crisis in South Africa, the responses from the South African government and how this paved way to the formation of the Treatment Action Campaign in 1998. The chapter also explains various strategies employed by the TAC in advocating for universal access to HIV/AIDS treatment and anti-retroviral treatment in particular, and how this influenced the HIV/AIDS policy framework in South Africa. The evolution of the health policy framework in South Africa, with special emphasis on the HIV/AIDS policy in South Africa is also discussed.
Designed to coincide with the International Human Rights Day, and aimed at raising awareness for the treatment available for HIV/AIDS, a disease which was generally perceived as an untreatable and life-threatening; and to draw attention to the need for improved treatment access in South Africa, the Treatment Action Campaign emerged out of a demonstration on December 10, 1998 (http://www.tac.org.za). The catalyst for the demonstration was the November death of a long-time ANC member and gay rights activist Simon Nkoli who lacked access to the ARV
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drugs that were more commonly available in Europe and the United States (POLICY Project, 2003: 105). Among those involved in the demonstration were Zackie Achmat, director of the National Lesbian and Gay Alliance; Mercy Makhalemele, one of the first women in South Africa to disclose her HIV status; and Peter Busse, then director of the National Association for People Living with HIV/AIDS (NAPWA) (POLICY Project, 2003: 105).
The establishment of the TAC in 1998 was therefore in response to the increasing number of South Africans who were dying of AIDS because they were unable to afford life-saving medication. The primary purpose of this NGO was, and has remained, to advocate for and facilitate access to affordable treatment for people living with HIV/AIDS in South Africa (TAC, 2004). From its inception, the TAC has been one of the strongest voices for universal access to treatment in South Africa. Given that some people do not know that drugs can prolong life and enhance quality of life, the TAC’s advocacy work was aimed at reducing the cost of Antiretroviral drugs (ARVs), improving treatment literacy on HIV/AIDS, developing a scaled-up Prevention of Mother-To-Child Transmission (PMTCT) program, and making universal access of the medication an integral aspect of government policy (Africa News Service, 1999).
For instance, between November and December 2002, the TAC involved itself in negotiations with the business sector particularly the pharmaceutical companies; labour sector; and government to try to agree on a National Treatment Plan. However, the negotiations were sabotaged by the government and ultimately were unsuccessful (TAC, Newsletters, 2002). From the perspective of the TAC, first campaign it launched on 10th December 1998, was supposed to be understandable, tangible, emotive and life-saving. Also, the campaign demanded that the government of South Africa introduce a national programme to prevent mother- to -child HIV transmission. As a result, the TAC called for pregnant women’s right of access to a basic medical intervention- a short course of the HIV drug azidothymidine marketed under the names Zidovudine or Retrovir (AZT), the drug that could significantly reduce the risk of HIV infection from a pregnant woman to her baby (TAC, Newsletters, 2002). In other words, Zidovudine is a drug used for the treatment of HIV and the prevention of HIV transmission from an infected mother to her foetus before, during and after birth. However, the South African government’s
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response was that the primary barrier to the use of AZT was the drug’s high price (Heywood, 2009: 20). In response, the TAC argued that profiteering by the drug supplier GlaxoSmithKline or the patent holder of AZT, for the essential medicine was the violation of human rights-the right to life. The TAC therefore, demanded a significant price reduction for the medication. The campaign for the price reduction attracted the attention of HIV positive women in South Africa and as Heywood (2009: 20) observed that, for the first time in South Africa, this brought a galvanised social movement that comprised of “people who were predominantly poor, black and living with HIV”. This also attracted substantial media coverage which helped the TAC to amplify stories of the cost of denial of HIV medication to both the national and international audiences (Heywood, 2009: 20). The founders of the TAC also realised that although HIV is a virus, it is related to the deeper social and political crisis that faces the poor and that its increase (HIV rate) to pandemic proportional is because HIV transmission is through social fault lines created by social economic inequalities -poverty, social justice and inequality (Boulle, & Avafia.
2005).
Therefore, TAC’s primary realisation was that the privately owned pharmaceutical companies had an excessive pricing of essential ARV drugs (so they could profit from them) and had placed these medicines out of reach of the poor in developing countries such as South Africa (http://www.tac.org.za). Doubtless then that the starting point for the TAC was to insist that the excessive pricing of essential medicines by the multi-national pharmaceutical companies violated a range of human rights that had since, 1996 been enshrined in the South African Constitution (access to health care is a constitutionally recognised right, under section 27 of the South African Constitution). The TAC argued that intellectual property and patents, whose protection in law had been strengthened under the World Trade Organisation’s 1995 Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreements was not an inherent human right, but a mechanism granted by the state for public purpose (Myburgh, 2007; Heywood, 2009: 16). A few years later, the TAC’s experience in advocating for the right to health proved that when seriously pursued, health rights cannot be narrowly tailored or their violation blamed solely on profiteering from medications. In addition, the TAC also learned that the right to dignity for example, has significant impact upon every sphere of political governance and social life (Myburgh, 2007).
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Through its advocacy activities, the TAC was able to extend its voice to various forums at national, regional, and international levels (Friedman and Morttiar: 2004; Boulle and Avafia, 2005). Yet throughout its advocacy strategies on HIV/AIDS treatment campaign, the TAC has been both a partner of the South African government and as its opponent- as in the court challenge brought by the pharmaceutical industry to prevent the government’s attempt to regulate ARVs costs -and as its own lawsuit contesting the government’s approach to PMTCT programmes and the provision of the HIV drug- nevirapine respectively (Friedman and Morttiar:
2004).