FOR WIDEST DISTRIBUTION - 6 NOVEMBER 2002 THE WAY FORWARD TO AN HIV/AIDS TREATMENT PLAN * TAC will start a campaign of non-violent civil Disobedience if Government has not adopted an HIV/AIDS treatment plan, that includes antiretroviral therapy in the public sector, by the end of February 2003. * We call on all our supporters and all of civil society to participate in a march to support the implementation of an HIV/AIDS treatment plan at the opening of Parliament in Cape Town on 14 February 2003. Our members have begun discussing the document copied below. Initially the TAC was planning to begin a campaign of civil disobedience commencing in December, if Government had not agreed to an HIV/AIDS treatment plan. In our meeting with Deputy-President Zuma, he stated that Government needs until February to adopt a treatment plan. We believe that it is feasible to reach an agreement on a treatment plan by 1 December, via the current negotiations at Nedlac. However, the TAC National Executive Committee has taken a decision to postpone civil disobedience until the end of February, 2003. This is in response to the Deputy-President's request for time until February to develop a plan. In the meanwhile, the TAC will increase mobilisation efforts for a treatment plan. We call on all our supporters to take part in a march on the 14th of February at the opening of Parliament in Cape Town. Below is the document being discussed among our members. -------------------- TAC REPORT-BACK ON MEETING WITH DEPUTY-PRESIDENT AND DISCUSSION ON THE ROAD FORWARD OCTOBER/NOVEMBER 2002 The Treatment Action Campaign's (TAC) actions over the next few weeks and months will have a direct impact on the government's final commitment to a national treatment plan. We face very difficult obstacles and choices in dealing with government in this period. TAC has always aimed to secure government provision of the prevention and treatment of opportunistic infections and antiretroviral therapy when clinically indicated. We have also maintained that treatment cannot happen overnight and immediately everywhere. Therefore, we have campaigned for a national treatment plan. In order to reach the millions of people who will need treatment, government resources and leadership are essential. But, government cannot be successful without organizations such as TAC, the unions, the faith-based organizations and all of civil society. Government also needs to secure active private sector participation in a treatment plan. The seriousness and scale of the epidemic ties all of us t! ogether to prevent infections and to save lives. Every TAC activist is urged to discuss this document in branches, PEC meetings and meetings with our partners over the next few days and to recommend what action to take. This discussion document is the product of dialogue across the organization. Members of TAC NEC (Zackie Achmat, Mark Heywood, Nonkosi Khumalo, Mandla Majola and Sipho Mthathi) met with Deputy-President Jacob Zuma, his legal advisor Ms Linda Makhatini, the director-general of health Dr Ayanda Ntsaluba, his spokesperson Ms Lakela Kaunda and his special advisor on HIV/AIDS, Mr Siyatonga Mcetywa on 15 October 2002 at Tuynhuys. The meeting was in direct response to several letters addressed to the President and Deputy-President over the last two months. The memorandum handed over at the Langa Partnership Against HIV/AIDS meeting on 05 October 2002 sets out the background to the meeting. "Since our inception in December 1998 we have addressed calls and memoranda to government on the treatment of HIV/AIDS. Only after enormous frustration and innumerable calls from civil society and specifically the TAC did we proceed with legal action against government on the prevention of mother-to-child transmission. In the last two years for instance, we have written letters and handed over the following memoranda to call for a treatment plan: · in January 2001, Dr. Abe Nkomo MP received a memorandum calling for a treatment plan at Parliament in Cape Town; · on 11 June 2001 two months after the joint historic victory over the drug companies in the Pretoria High Court, we again handed over a memorandum to government at a meeting with the Minister of Health; · in May 2002, we handed over a memorandum to the Gauteng Provincial Health Department for the attention of the Deputy-President; · in May 2002, we addressed several invitations to the Deputy-President, the Health Minister and others to participate in the National Treatment Congress. In fact, we moved the date of the Congress from 16 June to the end of the month after a request from the ANC secretary-general Mr. Kgalema Motlanthe to ensure effective participation from the ANC and government; · the resolutions of the Congress have been forwarded to the Health Ministry, the Deputy-President, the Director-general of Health and others; · in August 2002, we again addressed a memorandum to the national government to commit to a treatment plan and to immediately begin pilot programmes using anti-retroviral therapy. These are a few examples of the countless calls for a treatment plan, pilot anti-retroviral programmes, the issuing of compulsory licences and the restructuring of SANAC. We have never had the courtesy of a considered response to any of our memoranda or letters. To date, our protests have been models of civic restraint and we have never stepped outside the law in mass demonstrations or meetings. Millions of lives depend on our co-operation and joint work between government and civil society. Failure by government to commit to a treatment plan using anti-retroviral therapy and commitment to pilot two community anti-retroviral programmes in every province by the 01 December 2002 will continue to jeopardise the lives of our people. We urge the government to steer away from confrontation and to accept the challenge of the Constitutional Court: "The magnitude of the HIV/AIDS challenge facing the country calls for a concerted, co-ordinated and co-operative national effort in which government in each of its three spheres and the panoply of resources and skills of civil society are marshalled, inspired and led." The TAC will use all its resources to support Government and SANAC with meeting these objectives. We will also act to save live! Let us work together in a genuine partnership against HIV/AIDS. We urge a meeting with the Deputy-President at the earliest possible opportunity." All comrades will know that every word in the memorandum was carefully chosen. It reflects the anger and anguish of all our members, families, health care workers and friends over the daily illness and deaths caused by HIV. Most of these deaths are unnecessary and avoidable. Our concerns at government neglect and lack of urgency are also reflected in the unanimous National Executive Committee decision taken on 22 September 2002 regarding civil disobedience. Then, the TAC Executive agreed to prepare a rolling campaign of non-violent civil disobedience, if the government fails to commit to a national treatment plan before or on 1 December 2002. The TAC Executive also agreed that a new legal challenge to the drug companies through the Competition Commission would be supplemented by possible legal action on a treatment plan against government, if government fails to deliver before March 2003. Simultaneously, TAC allies in the labour movement (Cosatu, Fedusa and Nactu) began a process of good faith negotiations with government at NEDLAC. TAC is part of the community sector negotiations. This was the mandate of the Treatment Congress held at the end of June 2002. A special committee has been set up at NEDLAC to draft a framework agreement by 01 December 2002. Government is actively participating in the work of that committee. This is a significant breakthrough for TAC and all our allies. There is also a social process in which organizations such as the Nelson Mandela Foundation, the South African Medical Association, Médecins Sans Frontières (Doctors Without Borders), University of Natal and others will combine to improve existing ARV community treatment sites and develop new ones. TAC fully supports these initiatives. These actions and proposed actions need careful consideration in the light of the meeting with the Deputy-President and the NEDLAC process. In the meeting with the Deputy-President, a number of questions were discussed: SANAC; the KZN Global Fund application; the MTCT rollout and the implementation of the Court order. But, the most serious discussion centred on the treatment plan. It is clear that government understands the necessity of a treatment plan in the context of expanding the principle of the Five-Year Strategic Plan and other instruments. Deputy-President Dr Jacob Zuma and Director-General of Health Dr Ayanda Ntsaluba both agreed that the NEDLAC process is important and that they committed to negotiating in that forum. We agreed that the outcome of that process would be presented to government through SANAC. The Deputy-President asked us to consider delaying the deadline of 01 December 2002 by three months. This is what TAC members and allies must discuss. What can we do in good faith to ensure that the government fulfils its obligations and still maintain our freedom to act when we are convinced that government does not fulfil its commitments to us? First, we cannot agree to give our social power away. Social mobilisation, increased public awareness and pressure are the only guarantees of agreement and implementation of a treatment plan. In the absence of trust, continued social mobilisation is our only guarantee to save lives. What TAC and our allies can discuss is the form of our mobilisation: do we change from legal protest to civil disobedience? Legal protest and mobilisation has been central to our work until now (pickets, demonstrations, marches, meetings, inter-faith services). Many sectors of civil society have endorsed our campaigns of legal protest. In nearly four years of work, TAC has had two actions of civil disobedience. The first was the importation of generic fluconazole from Thailand and the second with MSF and Cosatu to import generic ARVs from Brazil for the Khayelitsha programme. These were both successful and recently, the Director of Public Prosecutions dropped all the charges relating to the fluconazole importation. Civil disobedience is not new to the tradition of politics in South Africa. But a sustained national programme of civil disobedience hunger strikes; occupations; disruptions of traffic, meetings and events that may lead to arrest and criminal penalties against participants; as well as, ensuring that groups of people are treated in defiance of government policy will be a new departure for TAC and broader civil society. Such action would be based on the principle of the right to life, dignity, equality and equitable access to health care services. We have the capacity to begin, escalate and sustain a campaign of civil disobedience because of the urgency of our epidemic and the history of engagement between TAC, government and the drug companies. The National Executive recommends that we continue social mobilisation for a treatment plan but that TAC postpones civil disobedience against government. But, we continue training all those who volunteer in the methods of non-violent civil disobedience in the event that no agreement is reached on a treatment plan. This recommendation is dependent on what we aim to achieve. Why, should we postpone civil disobedience? TAC and our allies are agreed that the right to life is not only constitutionally guaranteed but a fundamental principle of all social organization. We aim to save millions of lives through our work and the implementation of a treatment plan. A treatment plan will not fall from the sky. Resources for such a treatment plan will start with the need for about R300 million per year and increase over ten years to about R14 billion per year at current prices. Such financial resources can only come from government (initially) and later government with the private sector and international community. The best efforts of civil society alone will treat only a fraction of people who need medicines and care. Aside from the tremendous resources required of the State, government cannot do this on its own. Civil society will have to assist in every possible way to train doctors, nurses, pharmacists, lab technicians and counsellors. We will have to mobilise our resources to prepare communities to understand treatment. We will have to fight stigma, encourage voluntary counselling and testing, promote safer sex and support many other aspects of a treatment programme to ensure that government resources are spent to save lives and not wasted. This requires a sustained partnership between government, civil society, business and international agencies. We will also have to mobilise to ensure appropriate resources are committed from government, the private sector and the international community. This is a significant element of social mobilisation. Social mobilisation can be used to bring people together. It can also be used to change irrational policy of governments, the private sector, international agencies and other bodies. And, it can be used to replace existing government. TAC and our allies have used social mobilisation to bring people together against irrational policies. Despite paranoia in some quarters, TAC has no aim to replace the democratically elected government. Even if we used civil disobedience as a tactic, it would be aimed at changing government policy not changing government. We agree to delay civil disobedience without giving up social mobilisation and legal protest. But, we must ensure that government does not delay unnecessarily. We have lost too much time between the Cabinet Statement of 17 April 2002 and the Cabinet Statement on 09 October 2002 and far too many lives. Therefore, we recommend the following for discussion: a.TAC national executive unanimously recommends that we postpone our plan for civil disobedience against government until 28 February 2003. This is an important concession to show government our good faith; b.TAC asks for a Framework Agreement on a National Treatment Plan to be reached at NEDLAC by 01 December 2002 with governments full support; c.TAC and our allies organise provincial and local interfaith services, marches, activities to support the demand for a treatment plan on 01 December 2002; d.We invite government to endorse the complaint to the Competition Commission against the drug companies. Specifically, we demand that the Ministry of Trade and Industry puts its weight behind the complaint; e.TAC and our allies organise a national mass demonstration people at the opening of Parliament on14 February 2003 in support of a national treatment plan; f.TAC an our allies immediately organise a petition campaign for a treatment plan across the country for presentation to Parliament on 14 February 2003; g.We maintain our monitoring of the MTCT sites and clinics for OI treatment. Postponing civil disobedience does not preclude us from taking any legal action or social action should the Constitutional Court order on MTCT not be implemented by health authorities such as Mpumalanga, Eastern Cape, Limpopo and Free State Provinces; h.We continue to mobilise for community treatment programmes, the NEDLAC process, the KZN Global Fund application and additional resources for the Global Fund; and i.We call on all TAC activists to participate in SANAC sector meetings to ensure that the body becomes an open, democratic, responsive and accountable agency. CONCLUSION An exciting period opens up before all of us. There is a serious chance to win a treatment plan and to tackle the real barriers to treatment: drug and diagnostic prices; human resource constraints; equitable allocations for health; under-spending by provinces and community treatment preparedness. The dangers of public relations spin by government are also very real. But, we can give government its last chance to prove that it will allow every person with HIV/AIDS the right to life. This is necessary because both civil society and government are central to the effective implementation of a treatment plan that uses anti-retroviral therapy in the public sector. TAC will not rest until we have achieved a treatment plan as a monument to all our people who have died of AIDS-related illnesses and we have given hope to all people living with HIV/AIDS that their right to life and dignity will be equally valued, respected and protected. TAC NATIONAL EXECUTIVE 24 OCTOBER 2002 Zackie Achmat, Sharon Ekambaram, Nathan Geffen, Sindiswa Godwana, Mark Heywood, Verie Johnson, Teboho Kekana, Nonkosi Khumalo, Sipho Mthathi, Makhosini Mpofu, Buyi Ndhlovu, Ncumisa Nongogo, Dr Grace Ramadi, Pholokgolo Ramothwala, Theo Steele, Cati Vawda, Portia Vimbayi bayi