UNAIDS: The First 10 Years

Chapter 5Fighting for AIDS treatment in South Africa109The story of South Africa’s response to AIDS is complex. Before Mbeki’s discovery of, andinvolvement with, the AIDS denialists’ viewpoint, the South African Government passed itsMedicines and Related Substances Control Act in the autumn of 1997, allowing it to overridepatents and produce and import generic drugs such as antiretrovirals. But by February1998, 39 drug companies had filed suit in Pretoria’s High Court to stop South Africa frommanufacturing generic drugs including antiretrovirals. For four years, the legislation was heldup and South Africa was placed on a US list that threatened trade penalties. Bart Gellmanwrote in the Washington Post: ‘What for South Africa was an exploding health emergency …the United States treated mainly as a problem of trade’.UNAIDS and the UN worked behind the scenes to try to persuade the drug companies towithdraw their lawsuit which, apart from anything else, was giving these companies terriblemedia coverage.A particularly influential voice in this debate belonged to the activist group, the TreatmentAction Campaign (TAC). Founded on 10 December 1998 (Human Rights Day) bySouth African activist Zackie Achmat, it campaigned for equitable access to affordabletreatment for all people with HIV and to reduce new HIV infections. TAC supported thegovernment’s Medicines Act against the pharmaceutical companies, but soon there wasgrowing hostility between the government and TAC. The government refused to providethe drug nevirapine for preventing mother-to-child transmission of HIV. This drug reducesthe risk of transmission by 50%. The government was taken to court by TAC and, eventually,in July 2002, a landmark ruling by the Constitutional Court ordered the government toremove restrictions, to permit and facilitate the provision of nevirapine, and to extendtesting and counselling services at hospitals and clinics in the public health sector.Achmat explained the need for TAC: “AIDS service organizations play an important role… but we need to recognize that … the epidemic is going to be far broader, it needs afar broader response, and [it] needs to become the job of the ANC [African NationalCongress], the Communist party, the head of Anglo American, the head of the corner shopto understand what the issues are”.TAC’s next move was to demand antiretroviral treatment for all those in need. Publicdemonstrations and a civil disobedience campaign followed but the government pleadedlack of funding. Eventually, permission was granted to international generic manufacturersChemical, Industrial and Pharmaceutical Laboratories (CIPLA) and Ranbaxy to importgenerics and, finally, in November 2003, the Cabinet announced a national treatment rolloutplan to provide comprehensive care and treatment for people living with HIV and tohelp strengthen the country’s national health system.