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Achmat, Zackie (2002) Message from Zackie Achmat – Treatment Action Campaign (South Africa) to the 14th International AIDS Conference – Barcelona. 14th International AIDS Conference – Barcelona : 1-6.

Message from Zackie Achmat – Treatment Action Campaign (South Africa) to the 14th International AIDS Conference – Barcelona

Good morning. I am sorry not to be able to be with you today.

When we last met in Durban we had hope and we had arguments about HIV treatment. Today we have facts. In Khayelitsha outside Cape Town Medicins Sans Frontiers, Doctors Without Borders, have illustrated that people with HIV/AIDS, a majority with a non-existent or severely damaged immune systems, could recover life, health dignity with antiretroviral therapy.

Treatment Works

The majority of MSF’s patients who started ARV at primary health care level had fewer than 48 CD4 cells, and viral loads greater than a hundred and seventy thousand copies per millilitre. Over a six month period the majority of them, 90%, achieved undetectable viral loads and more importantly were able to re-constitute their immune systems. This follows on the success of Paul Farmer, Partners In Health and the people of Haiti. So today when we speak to you of ARV therapy access in poor countries we speak not only with arguments, not only with hopes, not only with desperation, but actually with facts and the lives of the people themselves.

The Durban Effect

The global community decided to campaign for affordable medicines and ARV access for poor countries and communities in the wake of the Durban 2000 conference. That campaign has given many of us the hope and the will to survive. Our movement has achieved many successes and met many challenges over the last few years. I want to highlight some of these successes and challenges.

In the constitutional court judgment on the issue of the mother to child HIV prevention, the court quotes the South African government’s assessment of HIV and AIDS as an “incomprehensible calamity”. Although the facts and arguments I will use are rooted in South African realities in many instances the arguments elsewhere are similar, or they can be used to illustrate the differences.

The Impact of HIV/AIDS on Morbidity and Mortality

In it’s annual budgetary request to the Finance Ministry, the Department of Health stated last September that “South Africa’s models of mortality from HIV/AIDS predict that cumulative deaths from AIDS will almost likely reach between 3.4 and 4.5 million by 2010 in the absence of a significant break through in preventative or curative technologies in the near future.”

The department then went on to look at the impact of HIV disease already upon our over-stretched and over-burdened health care system. It said “the largest single impact of HIV/AIDS in the public health sector lies in the hospital sector. Research commissioned by the Department of Health indicates that in the year 2000 an estimated 628, 000 admissions to public hospitals were for AIDS-related illnesses. This amounts to 24% of all public hospital admissions. Modelling indicates very clearly that this will increase as more people who are already HIV positive becomes sick every year. This demand for hospitalisation will increase steadily every year in the absence of significant alternative interventions.” We would like to ask, what are these interventions?

The department shows that in financial terms the cost of hospitalising AIDS patients in public facilities is already likely to be at least 3.6 billion Rand in the current financial year or 12.5% of our total public health budget. This cost to the public health care system is without treating people, without an effective programme of treating opportunistic infections, without using protocols and without any ARV therapy interventions.

To us this is not only a matter of the cost to the state, but the lives of mothers, the lives of women, the lives of children and the lives of men. Many of us in our productive years, many of us who have not yet have reached the prime of our lives. Central to all our work on HIV prevention and treatment are the issues of life, dignity and access to health care. HIV prevention and treatment cannot be separated. The impact of HIV and AIDS, of the already infected people on the health care system will make the system buckle under the burden of disease. Therefore not to treat HIV effectively will destroy the already weakened health care systems in poor countries.

Combine Prevention and Treatment

From a purely public health care perspective it is short-sighted not to treat HIV, to say that we must focus on prevention and exclude treatment. On the other hand it is unconscionable, because what we are speaking of are not cold statistics, but our lives. Our lives matter, the 5 million people in South Africa with HIV matter and the millions of people throughout the world already infected with HIV their lives matter. And so, it is not simply the question of the cold statistics that we are putting to you, but a question of valuing every person’s life equally. Just because we are poor, just because we are black, just because we live in environments and continents that are far from you, does not mean that our lives should be valued any less.

It is critical that every treatment activist also becomes a prevention activist. Active prevention of mother to child transmission, assisting rape survivors, all these issues and above all, the use of condoms everyone who is positive. Making clear to people with HIV that they should use condoms - such a prevention message is critical to all our treatment efforts. Therefore the dichotomy between prevention and treatment is one that this conference should lay to rest immediately. We need to stop this counter productive debate.

Let us return to the practical concerns. What are the obstacles to getting the vision of the World Health Organisation that 3 million people should be on treatment by the year 2005? What are the practical obstacles to this?

Voluntary Licenses for Generic Production

The partial price reductions and insufficient donations by drug companies will not assist in the long term to deal with the epidemic in a sustainable and an effective manner. What is required is generic competition and therefore we appeal to all the brand name drug companies to issue non-restrictive voluntary licenses at between of 3-4% royalty, to ensure that poor countries and communities have access to ARV therapy. This will eliminate the unnecessary conflict between the activist community, government and drug companies.

Health-care essential for development

To be able to deliver drugs to people, to be able to save the lives of the millions with HIV and AIDS, we need effective public health care systems. We can only start by endorsing both Amartya Sen and the World Health Organisation’s Commission on Macro-economics Report that regards health care as an essential public good. Not just an essential public good, but an absolute essential not only for dignity and life but as a component of a sustainable development strategy for most developing countries. We therefore endorse the request for additional funding for health care systems across the globe by the World Health Organisation to ensure that public health care systems are effective and that they deal with HIV and AIDS, with TB, with malaria and with all the diseases of poor people.

Support the Global Fund

A necessary element to enable public health care systems to deliver ARV therapy in poor countries, is the funding of Global Fund on AIDS, TB and Malaria. It is unfortunate that the fund has not received the necessary amount of between 7 and 10 or 11 billion dollars called for by the UN Secretary General, Kofi Annan. We believe that the United States, Europe, Japan and countries like South Africa and Brazil all have an important contribution to make to that fund, to ensure that all poor people get access to treatment with ARV. We appeal to you to step up the activism in your countries to ensure that the Global Fund has the money that it needs.

Political Will and Denialism

There is an additional element essential for all of us to get access to life saving treatment and that is political will. Many of you will know the South African government’s position on HIV and AIDS was not only scandalous, did not only reduce many of us to despair, did not only take away the hope of many thousands of people in our country, but it also, threw health care workers and our health system into disarray. That position has now fortunately changed however we still believe that we all have to be vigilant, that we should encourage the South African government and all its officials its representatives to maintain a position that HIV does cause AIDS in fact. And more importantly that HIV can treated as well be prevented.

Unfortunately our government has not yet committed formally to a national treatment plan - in a country where nearly three hundred thousand people will die this year of AIDS-related illnesses. However it is not only our government that is lagging behind.

Private Sector Responsibility

Regrettably, the richest corporation in our country, the Anglo American Corporation, cancelled its pilot programmes to treat gold miners and miners who have suffered, who live in single sex hostels on their mines far from their families and who have HIV. They cancelled their pilot ARV programmes. We appeal to them to reinstate those programmes and to treat those workers. Those workers have used their bodies and sacrificed their bodies and their families to ensure that that company makes the enormous amounts of profit it does on the world market for gold and other minerals. We appeal to the entire private sector to make it possible for people to be treated, including companies such as Coca Cola, Ford Motors, Daimler Benz, who has done a superb job, we appeal to all of them to work together to ensure that people across the globe have access to treatment, their workers in particular.


We have seen many successes. A tremendous example to all of us has been the Brazilian programme. And we commend the Brazilian government for a effective programme. As all of you will know, TAC supported MSF in importing generic ARV into South Africa for the programme in Khayelitsha. We will continue to support that action because we are opposed to patent abuse by the drug companies and we want to set an example that can work. However we appeal to the Brazilian government to lead a political campaign to enable them to export its drugs to other countries in Latin America and Central America. There are many poor people in Ecuador, Nicaragua and other countries of that region who needs these medicines urgently. This will sustain the Brazilian programme in the long run because of economies of scale and cost effectiveness. But most importantly it will give hope to the region itself.


On our doorstep in Botswana that government has committed itself to a comprehensive treatment programme for its people. However, it’s President Festus Mogae mentioned that he is not sure how sustainable that programme will be. We appeal to the Gates Foundation, to the Merck Corporation, and to the government of the United States to ensure that Botswana is able to use generic ARV to lower the prices and to be to make its programme sustainable, so that the more than one third of its population who are already infected will be able to have treatment on a sustainable and an effective manner.

Treatment Literacy

A critical element to be able to deliver treatment to people will be treatment literacy programmes. Everyday in our communities we are able to educate people in workshops about Nevirapine, about AZT and about side-effects. We are able to sing songs about these drugs, we are able to educate people about fluconazole and cotrimoxazole. These are things that none of us knew, medical terms and pharmacological names that none of us knew when we were first diagnosed or even much later. But fighting for our lives has made it essential and necessary for us to learn these things. Everyone can learn them. In our communities we have done workshops with people who have never opened a pharmacological text-book but most of our people can speak eloquently and articulately about the medicines that they need to take their side-effects and how to look after themselves.

We believe that by working together nurses, doctors, scientists, patients and government - all of us - we can achieve the necessary required treatment literacy that will make our adherence possible.

Over the last few years it has been the power of ordinary people that have held drug companies accountable and made governments accountable, that have made the global community accountable.

The TAC thanks the Health GAP Coalition, MSF, Gay Men’s Heath Crisis, All our African comrades, our Brazilian comrades, Pela Vidda and people across Asia and Europe – you have made our work much easier. We hope our work at home will be of some assistance to you. In the words of the labour movement “An Injury To One Is An Injury To All”.

Zackie Achmat
Cape Town
10 July 2002

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