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The Treatment Action Campaign and the History of Rights Based Patient-Driven HIV/Aids Activism in South Africa: Mandisa Mbali



Over five million South Africans today are HIV positive.1 In the post-apartheid era, the AIDS policy-making process has been characterised by a well-documented conflict between AIDS of South Africa (NACOSA) to further their aims.

However, the post-apartheid era brought much greater scope for AIDS activism as it brought with it a free press and the Constitutional Court, which were used to maximum potential by TAC activists, especially in advocating HIV treatment access for all, as the second and third sections of this Report argue. In using these democratic institutions, TAC defended and extended Ďfirst generationí political rights.

It should also be noted that South African AIDS activists used rights-based discourses to attain different goals in different periods. Whereas during the early 1990s the focus was on confidentiality, by the late 1990s openness was used to push for access to treatment. This suggests that activist uses of rights-based discourse are contested and changing. Despite these historical legacies of AIDS activism of the late 1980s and early 1990s, TACís formation in 1998 was based much more upon distinctly post-apartheid democratic cultures and institutions.

Similarly, TACís success in pushing for wider access to HIV treatment using the language of socio-economic rights poses wider theoretical questions about the potential power and meaning of discourses of human rights, when used by new social movements to fight for socio-economic justice in post-apartheid South Africa. activists aligned with the Treatment Action Campaign (TAC) and the government over official denialism and inadequate access to HIV treatment.2 Contemporary AIDS activists aligned to the TAC have framed their struggle for HIV treatment access in terms of the human rights of people living with HIV/AIDS. They insist that access to such life-saving combination antiretroviral drug treatment for all HIV positive people is a human right, in as much as it fulfils their rights to life and the socio-economic right to access to health care. As a result of the TACís campaign, in September 2003 the South African Cabinet instructed the health ministry to develop a comprehensive HIV treatment and prevention plan.

The government has since begun to roll-out HIV treatment at public health care facilities across South Africa. TAC is now seen by many commentators as perhaps the most successful example of civil society pushing for South African Ė and indeed international - government policy to reflect socio-economic and health rights in the post-apartheid era.

What receives less attention is the way in which the history of HIV/AIDS activism in late apartheid and transition South Africa fundamentally shaped TACís strategies, tactics and use of rights-based rhetoric. This Report explores two ways in which the history of AIDS activism in the 1980s and 1990s shaped TACís politics. Firstly, it examines the influence of Ďpatient drivení, anti-apartheid, gay rights activism on TAC. Secondly, it looks at how the early openness of gay rights activists living with HIV has shaped TACís work against HIVrelated stigma and its creation of a large and visible constituency of HIV positive people demanding their rights.

In asserting these continuities, it is not this Reportís aim to underplay the discontinuities between anti-apartheid, gay rights activism in the 1980s and early 1990s and TACís militant AIDS activism in post-apartheid South Africa.

Conservative gay AIDS activists affiliated to Gay Activists of South Africa (GASA) tried and failed to gain access to the apartheid governmentís AIDS committees during the 1980s. In the early 1990s, anti-apartheid gay AIDS activists used transition-era negotiating spaces such as the National Aids Convention of South Africa (NACOSA) to further their aims.

However, the post-apartheid era brought much greater scope for AIDS activism as it brought with it a free press and the Constitutional Court, which were used to maximum potential by TAC activists, especially in advocating HIV treatment access for all, as the second and third sections of this Report argue. In using these democratic institutions, TAC defended and extended Ďfirst generationí political rights.

It should also be noted that South African AIDS activists used rights-based discourses to attain different goals in different periods. Whereas during the early 1990s the focus was on confidentiality, by the late 1990s openness was used to push for access to treatment. This suggests that activist uses of rights-based discourse are contested and changing. Despite these historical legacies of AIDS activism of the late 1980s and early 1990s, TACís formation in 1998 was based much more upon distinctly post-apartheid democratic cultures and institutions. Similarly, TACís success in pushing for wider access to HIV treatment using the language of socio-economic rights poses wider theoretical questions about the potential power and meaning of discourses of human rights, when used by new social movements to fight for socio-economic justice in post-apartheid South Africa.
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