SOURCE: AF-AIDS is the regional forum on HIV/AIDS in Africa, coordinated by the Health & Development Networks Moderation Team (HDN, www.hdnet.org) with technical support from Health Systems Trust (HST) on behalf of the AF-AIDS Steering Committee (HST, HDN & SAfAIDS), with the support of the Government of Ireland. Reproduction welcomed provided source is cited as follows: AF-AIDS eForum 2003: af-aids@healthdev.net Finally - a 'yes' for South African ARVs By HDN Key Correspondent 13th ICASA, Nairobi, Kenya, 22 September 2003 ************************* After years resisting demands to supply of antiretroviral drugs, the South African government will soon begin to provide ARVs through the public health system. By the end of September, an operational plan for ARV roll-out should be unveiled. It may be tempting fate to already declare this a victory for the people and activists of South Africa, or for celebration and optimism. But there is at least an assured hope of change. A National Task Team appointed by the Minister of Health, Dr. Manto Tshabalala-Msimang, is expected to complete a draft of an operational state plan to provide antiretrovirals in the public health sector within the next two weeks. The team will base its work on the recommendations of the Report of the Joint Health and Treasury Task Team on Treatment Options to Enhance Comprehensive Care for HIV/AIDS in the Public Sector, published a few months ago. The report estimated that between 500 000 and 1.7 million lives could be saved by 2010 through the introduction of antiretroviral therapy. It also estimated the cost of providing ARVs to be approximately US$1 billion by 2005. The report built on the premise that new developments regarding drug prices, the growing body of knowledge on the efficacy of ARVs, wide appreciation of the role of nutrition, and the availability of suitable budgetary resources, would permit the South African government to consider this enhanced response. It also addressed specific practical and clinical challenges. The Task Team's responsibilities are enormous considering the time constraints and expectations. It is expected to produce an operational plan addressing the challenges of universal ARV provision. This will include procurement and/or production of medications and consumables at as low a price as possible; increasing the capacity and sustainability of the drug distribution system; upgrading the national health laboratory system; and the development of standards for delivery. These tasks will go together with a system to monitor the efficacy of the program and detailed five- and ten-year programme budgets. The responses to descriptions of the Task Team process (and nomination of its members) were reminiscent of those that accompanied the creation of the South African Presidential AIDS Advisory Panel in mid-2000. That panel was established in an attempt to subdue the raging debate that was sparked when the South African President brought into question whether AIDS was caused by HIV. Due to conclude its high-profile deliberations in July 2000, the Panel's inconclusive report was finally published in March 2001 with little fanfare. The recent selection of the National Task Team members also raised concerns about insufficient representation from civil society, especially from people living with HIV/AIDS. Although AIDS activists in South Africa welcomed the announcements, they made it quite clear they would be monitoring every step of the process. "It's no longer about what the government can do, but what we all can do to assist," said a Treatment Action Campaign representative. While activists have argued for the roll-out of a comprehensive HIV/AIDS care, health care professionals have warned that significant challenges remain. Ironically, one of greatest will be the huge expectation the recent announcements have generated. The government Task Team has already warned against "creating false expectations" of an imminent ARV programme. One of the essential changes will also be to upgrade the voluntary testing and counselling programme throughout the country. "The South African government has had many opportunities to do the right thing in the past. It truly must take this opportunity. By doing so it will give meaning to the South African Constitution's most important protections: the rights to life and dignity," said Nonkosi Khumalo in an acceptance speech for the Jonathan Mann Award earlier this year on behalf of the Treatment Action Campaign. *********************** Chronology: One step forwards, two steps back - a diary of inaction 2000 JANUARY - MAY - President Thabo Mbeki brings into question the causal relationship between HIV and AIDS and the efficacy of ARVs. JUNE - Presidential AIDS Advisory Panel convened, bringing together top clinicians, researchers and AIDS 'denialists' to resolve supposedly unanswered questions about HIV/AIDS-related issues such as the sensitivity and specificity of existing HIV diagnostic tests, the efficacy of ARVs and the causal relationship between HIV and AIDS. JULY - World AIDS Conference in Durban, South Africa - World-renowned scientific journal Nature publishes 'Durban Declaration' signed by over 5000 leading doctors and scientists, including Nobel prizewinners, under the headline "HIV Causes AIDS." 2001 MARCH - Synthesis report of the deliberations by the Presidential AIDS Advisory Panel published DECEMBER - The Pretoria High Court orders the South African government to provide antiretrovirals (ARVs) to all HIV-positive pregnant women after a court case brought against the government by AIDS lobby group, the Treatment Action Campaign (TAC) 2002 28 MARCH - The government announces it will appeal the Pretoria High Court judgement ordering them to provide nevirapine to HIV-positive pregnant women, in the Constitutional Court. 1 FEBRUARY - International humanitarian organisation, Medecins Sans Frontieres (MSF) and TAC announce they are importing generic drugs from Brazil for their pilot ARV programmes in South Africa. 5 APRIL - The 2001 High Court decision ordering the state to provide nevirapine is upheld by the Constitutional Court, which points out that by restricting nevirapine to 18 pilot sites, the government is violating the constitutional rights of women and their babies. 26 APRIL - The Global Fund to Fight AIDS, TB and Malaria awards Kaw-Zulu Natal in South Africa a US$165.2 million grant. 25 DECEMBER - The National Association of People Living with HIV/AIDS (NAPWA) launch a fasting protest outside the offices of GlaxoSmithKline as part of its 'Black Christmas' campaign to demand ARVs. 2003 14 FEBRUARY - AIDS activists march to the opening of parliament to call for a national treatment plan to provide ARVs to all those who need them. AIDS advocacy groups say they have been left with no choice but protest action, after the government failed to sign a National Economic Development and Labour Council (NEDLAC) agreement for a treatment and prevention plan last year. 19 MARCH - In an update on the national HIV/AIDS plan, government says the work of a joint technical team tasked to look into the resource implications of an expanded response to HIV/AIDS, including antiretroviral treatment, is nearing completion and cabinet will be considering the findings. 20 MARCH - TAC launches its civil disobedience "Dying for Treatment" campaign. Activists lay charges of culpable homicide against Tshabalala-Msimang, and Minister for Trade and Industry Alec Erwin, for failing to prevent an estimated 600 AIDS-related deaths every day. 7 AUGUST - The agreement between the government and the Global Fund is finally signed, with the Fund committing US$41 million to the country over two years. 8 AUGUST - Cabinet issues a statement instructing the health department to develop a "detailed operational plan" for ARV roll-out. END OF SEPTEMBER 2003 - Pubication of the national operational plan for ARV provision???? [Source of the Chronology: IRIN News 19 Aug 2003] **************** HDN Key Correspondent Team To contact the HDN KC team during ICASA or to comment on the Conference coverage: info@hdnet.org = = = = = = = = = = = = = = = = AF-AIDS is supporting the 13th ICASA in Nairobi, Kenya (Sept 21-26 2003) http://www.icasanairobi2003.org/ = = = = = = = = = = = = = = = =