HIV/AIDS in South Africa: issue of anti-retroviral drug distribution

Author: Mohamedazad Essa

Paper No1: HIV/AIDS in South Africa: issue of anti-retroviral drug distribution

Abstract

The reality is that HIV/AIDS is at the crossroads. The economic and political niches of the contemporary modern condition provides both the possibility to raise scientific research to create means of effectively dealing with the pandemic, or alternatively, the new religion of globalized capital may only serve as to extend HIV/AIDS to become the biggest social issue of all history.

In this, anti-retroviral (ARTs): drugs designed to halt the dilapidation of the body’s immune system have been created but largely confined to the developing world. So much so that HIV/AIDS prevention strategies have lost intensity in some industrialized centres because of the availability of mechanisms and treatment in these countries. However, the developing world has no such option. In largely traditional societies, indecisive and confusing leadership, marred by the intense stigmatisation of HIV/AIDS status and the poor health infrastructures, resources and treatment capacities has presented a regressive circle of no escape.

Poor socio-economic background and conditions mixed with the HIV/AIDS crisis can only mean even more socio-economic and political upheaval, the regression of development and the collapse of societies: beginning with families, communities, regions and into subsequently economic social systems.

South Africa is a new democracy; nonetheless it is a stable political entity. However, the crude blend of neo-liberalist and socialist socio-economic framework adopted continues to falter and present the State with innumerable complicated decisions to ensue which, while aiming to fast-track development has not created the necessary conditions for such rapid economic development. The political economy of decision-making has filtered into all domains of South Africa’s resurgence not excluding government position on HIV/AIDS. It is in this context and under the vast blanket of holistic realities that HIV/AIDS thrives and in which this paper must be read. Of course – no such short document may be able to analyse or comment conclusively on every dimension, however the HIV/AIDS crisis worldwide and its solutions in localized entities must be read with a clear sense of history and context.

This paper focuses on the HIV/AIDS crisis in South Africa, with specific focus on the ‘unending’ dilemma of anti-retroviral drug distribution in the country. The country now has the unenviable position of being host to the highest number of HIV/AIDS infections on the planet, yet it was only in November 2003 that the South African government finally agreed to offer treatment through the creation of a strategic treatment plan in conjunction with existing preventative strategies.

For a country facing such a bleak socio-economic future because of the devastation of HIV/AIDS, the South African government’s position has been extremely startling. This paper critically discusses the drug debate in South Africa and will form as a precursor to my second paper that will essentially deal with the work of the Treatment Action Campaign (TAC) as an institution and social movement that has been at the forefront of pressurising government policy transformation.

What is HIV/AIDS?

According to most historians and health researchers, it is generally accepted that the first case of Acquired Immo-deficiency Syndrome widely known as AIDS, was first reported in the United States in 1981. AIDS has been conclusively found to be the result of or alternatively induced by a virus called HIV or Human Immunodeficiency Virus. HIV progressively destroys the body’s ability to fight infections through the subsequent annihilation of the body’s immune system. Effectively, HIV has been scientifically proven to induce AIDS – meaning that those HIV infected individuals are susceptible to a range of cancers and diseases including tuberculosis.

HIV/AIDS has transcended the scourge of relatively small groups such as intravenous drug users and homosexuals in rich countries to become arguably the biggest threat to life and prosperity in the developing world. It is estimated that approximately 53 million people worldwide are HIV positive (Mail & Guardian, 2004). Two-thirds of infections reside in sub-Saharan Africa (approximately 29.4 million) with an increase of 13.5% since 2001. According to UNAIDS, in 2003 alone, there were 5 million new infections.

The disease has reached pandemic proportions worldwide, based on the mammoth devastation that it has induced. In 2003 alone, HIV/AIDS associated illnesses caused the deaths of approximately 3 million people worldwide, including a reported 500 000 children younger than 15 years (NIAD online). However, it is not altogether a bleak situation. Effective and decisive leadership in developed countries and in Uganda as a ray of hope for the developing world, illustrated the disease can be contained. However, while this may be so: containment through preventive strategies and modern day technology in regards to treatment – may insinuate possible solutions – yet the reality is that there are countries in the developing world, from Eastern Europe to Asia and Africa where the disease continues to spread. In other regions, like South of the Sahara, where the disease continues to spread so fast, and so violently, that putting aside human pain and suffering, HIV/AIDS threatens to not merely disrupt but alter and regress a region further into the doldrums of human development.

To briefly outline the crisis of HIV/AIDS in South Africa is akin to a sort of blasphemy: a need to outline and discuss the entire story is almost a moral concern. The situation in South Africa – although largely inaccurate and exaggerated at times, is indubitably the most pressing issue since the demise of Apartheid and formation of a democratic state in 1994. Therefore, being brief is not the most ideal manner to ever approach the HIV/AIDS issue in South Africa – for the pandemic has reached such a tumultuous levels and caused such devastation, that a supposed health problem has entered the realm of a social issue with political, economic and historical consequences. While this paper due to constraints of time, space and resources, focuses on drug distribution (largely) – the author hereby notes that any investigation into HIV/AIDS requires a multifaceted approach, especially because HIV/AIDS does not exclude implications for economic growth, democratic ideology and values and subsequent social unrest. The dilemma may be likened to researching the phenomenon ‘globalization’ whereby the understanding of such would be rather incomplete if not discussed as a whole while the running the risk of becoming rather superfluous with so many ideas, concepts and theories running concurrently and over one another. The author hence acknowledges the limitations of this paper and advocates that this paper focuses on merely on part of a grand puzzle – that of South Africa’s ARTs drug dilemma. However, this discussion focuses on government, ie. Internal debate and policy and not those espoused by and/or pressurised by the influential bodies, like the WTO on drug manufacturing and distribution.

AIDS Crisis in South Africa

According to demographic work carried out in 2000, it is estimated that 500 000 South Africans have died of AIDS related causes (Arndt et al, 2000). Moreover, it is further estimated that current trends, if not halted in any substantial manner, would lead to 10 million deaths by 2015. In this, life expectancy is expected to fall from pre-epidemic levels of 65 years to merely 40 years.

Arndt et al (2000) argue that the AIDS epidemic is expected to reduce the overall size of the economy. The consequences of such a large and ever increasing infected population, will effectively reduce factors of production, investment and productivity is bound to lower in effectiveness. In a sense, the economy may be smaller, but this would correlate with a smaller population, meaning that GDP might actually rise.

However, this perverse economic logic finds no place in South Africa, as Arndt et al (2000) illustrate, the GDP will surely decline. By 2010, GDP per capita in the AIDS ...

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However, this perverse economic logic finds no place in South Africa, as Arndt et al (2000) illustrate, the GDP will surely decline. By 2010, GDP per capita in the AIDS scenario is approximately 7% lower than the non-AIDS scenario. This effectively implies that, as Arndt et al explain, ‘survivors of the AIDS epidemic with a smaller economic ‘pie’, and more of this ‘pie’ is directed towards health and food expenditure, so that discretionary expenditures decline dramatically’ (2000:11).

Today, South Africa has more HIV positive citizens than any other country: 5.3 million people out of a population of 45 million. Such is the magnitude of the pandemic that economists predict that South Africa is heading for an economic collapse within three generations. The statistics are simply staggering. HIV prevalence increased from 0.7% in 1990 to 24.8% in 2001. While teenage prevalence has dropped from 20.1% in 1998 to 15.4%, the most susceptible age-group, the earning group of 15-49 years remains extensive at 20.1% (UNAIDS). According to research conducted by the TAC, this figure 12 yrs ago – resided at a mere 1%.

According to Bond (2000), HIV/AIDS is killing workers and low-income consumers. However, this is the case in the context of elites adopting capital-intensive export oriented accumulation strategies. If this trend continues, wage earners – the productive composition of the society would be wiped out before their offspring would be mature enough to look after themselves. The reality is such the pandemic has been perpetuated by a tumultuous past engulfed within a culture of violence, unprotected sex, multiple sex partners, and migration and gender discrimination.

Rivire (2002) argues that although the AIDS explosion was rather belated in South Africa, as compared to elsewhere, it has been nonetheless violent. The low status of women and the fact that violence to women, including approximately a million reported rape cases per year is indicative of this volcanic-like spread and has invariably exacerbated the rapid and continuous spread of the disease. Moreover, even more tragic is the rising number of orphans. Projections indicate that there will be as many as 1 million orphans in 2005, and 2.5 million in 2010. In KwaZulu-Natal, one of the most adversely affected province if not the most affected province in South Africa, it is estimated that 36% of all pregnant women are HIV positive. In 1990, this figure was 1%. (Rivira, 2002). It is thus no coincidence that 50 000 children are born in South Africa every month with HIV.

Anti-retroviral/anti-Aids treatment

Anti-retroviral treatment (ARTS), as it is commonly known, is not a cure or an absolute preventive measure towards HIV/AIDS. However, ARTS may be used to prevent the transmission of HI virus from mother to child during childbirth. Scientific research indicates that without treatment, 30% of infants will contract the HIV virus during pregnancy or labour. while it may also be a measure to retard the degradation of the immune system for a considerable amount of time, hereby allowing the HIV/AIDS patient to enjoy a longer and relatively illness free life. Essentially, antiretroviral slows down the reproduction of HIV in the body, increases the body’s viral load and boosts the body’s ability to fight infections allowing the body to function normally. There are ranges of antiretroviral treatments, but the most common medications and that which incidentally will be discussed during the course of this paper, are: AZT & nevirapine. Effectively, ARTs may be used to prevent MTCT of the virus or/and to adult patients to affect a better and longer life.

The South African Government, AIDS & treatment

Brief sense of History

While the HIV/AIDS pandemic is a rather recent phenomenon, the depth of debate and controversy that has accompanied any opinion on the topic is as vast and as classified of a disease that might have hampered human kind for more than a century. The South African government, from the inception of HIV/AIDS, were always in some controversy or another involving the manner in which they approached the epidemic. The introduction of anti-AIDS drugs, only plunged the country into more chaos over government stance that has been characterized by indecision, inconsistency and to run the risk of sounding dramatic: their approach may likened to a ‘cut your nose to spite your face’ logic.

The history of South African and anti-AIDS drugs begins with Virodene PO58, an abandoned cancer treatment (due to toxicity and ineffectiveness). A group of researchers administered the drug to HIV patients without clearing the normal ethical and scientific protocols. Patients saw a complete reversal of their ill health condition and at a cabinet meeting the researchers were awarded SAR 3.7 million ($550 000) to conduct further research.

Government had effectively allowed the continued research and development of the drug yet the drug repeatedly failed clearance at the Medical Control Council (MCC) for not matching up to Medical standards. It was found later that government was financially to gain from the production of the drug and the outrage that followed sparked a raging suspicion of all following government policies This served only to confuse and divide rather than unify the fight against the epidemic. From elation of knowledge of a cheap medication to desperation for its access, to finally anger and disillusionment when government motives were known.

Virodene marks the beginning of a condition of perplexity in the South African government’s position and attitude towards treating HIV/AIDS infected patients. In 1998, the government formed ‘Partnership against AIDS’, an initiative meant to revitalize the country’s waning AIDS program. According to observers, it was an implicit attempt to divert responsibility to independent organizations and civil society (Vliet, 2001), and highly representative of the ‘under-prioritisation’ given to the issue.

However, the essence of the drug dilemma came to the fore with the advent of anti-retroviral drugs to prevent mother to child transmission (MTCT) of HIV. With a predominantly heterosexually transmitted epidemic, women of child bearing age were commonly infected and stood a 25-35% chance of passing the infection on to babies. In developed countries the use of AZTs is administered from the 14th week of pregnancy and to the infant for the first 6 weeks. This has reduced the MTCT to virtually nil (Vliet, 2001). In developing countries, it is far too expensive to follow such a scheme. Thus, a short course from 36 weeks of pregnancy and for six weeks to the infant. This has also affected a decline in MTCT transmission, albeit more gradually.

Further research led to the development of a new more effective drug called nevirapine, which was said to achieve even better results with not more than a single dose during labour and one dose to the infant within 72 hours of birth. While such scientific dispositions seemed both an opportunity to address a human issue as much as being within the paradigm of cost-affectivity – the Minister of Health (in 1998) announced that the drug would neither be made available nor would the government continue the pilot project tests (Vliet, 2001). Government stance was resolutely on prevention, rather than treatment, yet the prevention of MTCT was the objective of using AZT or nevirapine. Prices of the drugs were dropped, yet the Ministry insisted that the drug was still too expensive to administer.

Directors of the Perinantal HIV Research Unit at Soweto’s Chris Hani Baragwanath Hospital noted ‘that while South Africa guaranteed free maternity treatment, and free treatment for children under six years…”specifically excludes the provision of R300- R400 drug treatment which prevents half the cases of paediatric HIV”’ (Vliet, 2001: 167).

Government attitude and approach to the treatment of an ever increasing HIV/AIDS infected population led to the sudden formation of effective lobby groups. In a country where lobby groups had been essential in the struggle for political and social freedom for the majority, individuals were quick to recognize a ‘new struggle’ (Vliet, 2001), and a new order of inequity that threatened devastating the population. The Treatment Action Campaign, beginning with a mere 15 individuals, became the leading lobby and government pressure group [Refer to Appendix A].

Understanding Government Policy Perplexity

Noah (2003) argues that there are a range of practical obstacles that hinder the provision of AIDS drugs to South Africans. In this, Noah (2003) acknowledges the pragmatic reality that drug in take assumes the close monitoring of patients by expert health providers to ensure the correct administration of the drug. Effectively, South Africa does not have the infrastructure to support patients as per required by the drugs – which, if not followed correctly, increases the risk of side-effects resulting in the patients becoming resistant to the drugs. Noah (2003) argues that it is not simply about affording the drugs, but rather the medical infrastructure that is required.

Moreover, Noah (2003) concedes that generic drugs can have the tendency to experience quality problems, which can invariably add to toxic levels and create ever more (increasing) complications. The salient point in Noah’s (2003) argument however, is that medical experts have taken all of the above obstacles into consideration and have proposed that government adopt an intermediate approach to providing therapy of a manageable nature. In this, there are drugs that can be distributed through the existing structures and facilities, and Noah (2003) advocates that this balanced approach is far more constructive rather than simply dismissing the entire idea. It is further argued that preventing MTCT is a controllable project, and an effective one at that, as it clearly reduces the transmission of the virus from Mother to child.

There is also the real concern of complacency that accompanies knowledge of medication and treatment that must feature as a consideration. According to Noah (2003), not only are people in developed countries illustrating resurgent risk behaviour, there is a genuine concern of patients developing resistance towards anti-retroviral medication. Developing resistant viral strains would be tantamount to disaster, as future treatment options would be curtailed. However, Noah (2003) is quick to point out, ‘the obvious benefits of treatment outweigh concerns about antiretroviral resistance’.

In the Western Cape, provincial authorities decided to divert from national policy. In January 1999, pilot projects to provide AZT and free formula at two clinics in Cape Town communities began. The Western Cape provincial government were accused of playing with people’s lives, yet the Western Cape branch of the National AIDS Co-ordinating Committee of South Africa (NACOSA) disagreed. Instead, NACOSA felt that the initiation of MTCT drugs had at last given some meaning to the much vaunted idea of a partnership against AIDS.

Dr Manto Tshabalala-Msimang replaced Dr Zuma as health Minister after the 1999 elections. Government sent a panel to review the success of nevirapine in Uganda, and this positive start was followed by Dr Tshabalala-Msimang conceding that the government were examining a suitable AZT program for MTCT prevention (Vliet, 2001).

However, President Mbeki, after the debacle of Virodene, argued that caution should be applied with AZT, as there was enough scientific basis to suggest the toxicity of the drug. The South African government sought the advice of negative publicity of AZT rather than considering the fact that AZT was endorsed by the Medicines Control Council of South Africa, the U.S Food and Drug Administration and was on the essential drug list of WHO, amongst other recommendations. Invariably, the South African government stated that AZT weakened the immune system and created the chance of producing children with disabilities. Response from AIDS activists both within South Africa and around the world was one of disbelief, with notions of ‘morally bankrupt’, misinformed and unconstitutional being associated with S.A government policy on HIV/AIDS treatment. Dr. Coovadia, chair of the AIDS 2000 Conference in Durban (South Africa), referred to the government response as ‘quixotic’, noting ‘that they stand on their own, in conflict with every informed opinion, including my own, in South Africa’ (Vliet, 2001: 169). Dr Coovadia argued that this misinformed disposition had to be the result of bad advice or a ‘preoccupation with the pharmaceutical industry’s impact on South Africa’ (169).

The South African National AIDS council was created in January 2000, and was hoped to become a basic framework of multi-sectoral response of the pandemic. Instead of the envisaged council of experts – the council was a mere duplication of the existing partnership iniative. Six Hundred NGOs and ASOs that dealt with AIDS were allowed just one representative. There were no experts, no medical practitioners, nor representatives from the Medical Research Council or Medicines Control Act, or the leading lobby group – the TAC.

To make matters worse, it was revealed that President Mbeki’s suspicion was more about a wider mistrust of the ‘whole science of AIDS’, rather than merely the toxicity of AZT. Government, under the leadership of President Thabo Mbeki and a set of HIV/AIDS dissidents thwarted the HIV/AIDS research endeavours and created mass confusion when it was publicly announced that HIV does not cause AIDS. Without entering into technical details over their stance, it is salient to the holistic understanding of HIV/AIDS in South Africa: its spread, its resilient stranglehold of the populace, government’s reluctance to release a strategic treatment plan and the continuing poor behaviour of those infected with others in similar circumstances – to note that indecisive leadership and an over emphasis on debating the ‘HIV causes/does not cause AIDS’, has resulted in the pandemic and its consequences, moving rapidly ahead and incensing more problems than creating dialogue for solutions.

Baylies et al (2000) argue that critical thought towards HIV/AIDS is not unimportant, but they invariably divert attention from the practical realities that surround the context. These realities include the rising number of deaths, especially amongst the young, vibrant and productive members of society. In this, the Presidency maintained over a span of 2 years – that ‘HIV does not cause AIDS’, and it was the poor living conditions, including poverty, poor nutritional in take and poor health services that led to the advent of AIDS as a full blown disease instead. Baylies et al adds, ‘while poverty may enhance vulnerability in several ways, it is not itself the cause of the epidemic in Africa…conversely poverty is everywhere deepened by the impact of AIDS’ (2000: 483).

Clearly, government insistence and approach was an unintelligible approach in regards to rooting out the pandemic’s devastation. Internal critics argued that government approach was akin to a perverse economic logic whereby short term expenses sought avoidance in order to satisfy economic interests of foreign activity in the country. This mindset was followed without much reflection over the long-term social, economic and political upheavals and effective genocide that stared South Africa in the face.

In relation to anti-retroviral or specifically towards creating a treatment plan, HIV/AIDS dissidents argue that ‘HIV is a harmless ‘passenger’ virus and that AIDS is a ‘lifestyle’ disease, where, for instance, recreational drugs, or even AZT, cause the breakdown of the immune system, and that the increased morbidity and mortality of the disease in Africa result from poverty, which aggravates old disease patterns’ (170).

Developing from such a stance was an idea of dealing with the AIDS pandemic in a uniquely African way. The Ministry issued a statement that blind acceptance to mere conventional wisdom in HIV/AIDS would be akin to irresponsibility. Vliet (2000) argues that the Mbeki government seemed to misunderstand the reality of scientific enquiry, whereby unlike politics - science is based on proving or disproving hypotheses, devoid of consensus. In this, President Mbeki had effectively issued his opinion to a scientific issue and appropriately, the President of the Medical Research Council of South Africa, argued that the extension of politically driven decisions regarding the HIV/AIDS crisis in South Africa was rapidly making the country into a pseudoscience arena for politicians. However, government responded by accusing their critics of being on the ‘frontline of the pharmaceutical industry’, indicating that the old tensions and rifts of the pharmaceutical industry were once again clouding the debate and delaying effective mechanisms. As Vliet (2001) reiterates, even the reduction in the price of drugs made government look at activists suspiciously.

The Presidency had embarked on a quest for intellectual discourse over a conclusive scientific reality. It is rather optimistic to interpret such a disposition as ‘misunderstanding the reality of scientific enquiry’. Instead, it might be more accurate to advocate that the South African government had purposively and intentionally diverted attention and focus on a reality that had surpassed the managerial capacity of the State. In this, the Presidency was willing to re-invent a mythical disposition on HIV/AIDS to save face economic wise. How exactly the government thought ‘they get away with it’ is incredible, considering we live in an age where information and research has made almost any endeavour unequivocally transparent.

South African High Court Judge Edwin Cameron, ‘[South Africa is] a shining example to Africa and the World in its commitment to human rights and democracy…[yet] at almost every turn mismanaged the epidemic…it [has] created an air of unbelief amongst scientists, confusion among those at risk of HIV, and consternation amongst AIDS workers’ (Vliet, 2001:177-8).

Effective Change?

It was only after mounting criticism and pressure from within that President Mbeki decided to withdraw from the public debate on the science of HIV & AIDS (Vliet, 2001). This effectively paved the way for a move towards a treatment plan. In 2003, the South African government agreed to administer medication to reduce MTCT to public hospitals. The reality of course is that there is a vast shortage, and the infrastructural problems envisaged have now been used as an excuse by government to merely justify their earlier disposition.

However, the reality pertains to the facts that the Health Ministry along with the Presidency chose to work against and relinquish responsibility by delaying the release of a comprehensive treatment plan as part of the national strategy to combat HIV/AIDS. It is hardly comprehendible to the understand the logic of a strategic plan devoid of a treatment clause. Cost affective perhaps, but unsustainable.

In November 2003, the Department of Health released a comprehensive strategy, including a serious and long term treatment plan, with theoretically, a sufficient economic and political framework to provide all HIV/AIDS infected citizens with anti-retroviral drugs. This is a rather big step and one that is indubitably overdue as it much as it may be historic. The treatment plan proposed is to cost an estimated SAR 680 million ($95 million) a year by 2007, for the collective distribution of drugs, setting up of clinics and the training of thousands of health workers (The Economist, 2003).

Interestingly, the ‘treatment strategy’ by the Department of Health as guided by the South African government, no longer denies the HIV/AIDS link, however, it is rather implicit that government still strongly holds on to such dissident views. This is indicated by a continuous obsession with nutrition and the role of nutrition in HIV/AIDS treatment. This concern is accurate; for any drugs designed to stall the deterioration of the human immune system needs to be supplemented by a healthy surrounding, including a healthy and consistent nutritional diet. However, the emphasis and preoccupation with nutrition in the treatment plan, is indicative of government’s reluctance to issue such a report or effectively spending billions of South African Rands (SAR) on treating their population.

International criticism, the rise of social movements, nationally and internationally and the reality that HIV/AIDS infections continues to proliferate at an alarming rate meant that government was forced to react. Moreover, a continued insistence on nutrition is not the answer, nor the justification for not rolling out the necessary drugs to those in need. Effectively, a concernible suspicion had become the justification and impetus for avoiding expenditure and responsibility.

While the Department of Health Treatment plan illustrates an increase in allocated funding for the health sector response to HIV/AIDS, amounting to approximately SAR 6 Billion ($900 Million) by 2004 (which is SAR 1.5 billion more than 2001/2), the document concedes that the amounts are a baseline ‘estimate only, and that its effectively impossible to measure directly actual expenditure on HIV/AIDS via general health services’ (DOH, 2003: 9). In the context of this paper, it is rather important to note that there has not been a funding problem (even with the perverse economic logic espoused by government) – however, funding has largely been placed into mechanisms of prevention and the development of health centres rather than treatment or the advent of care and support for HIV/AIDS infected people. Billions of SAR into HIV/AIDS prevention, including education, media publications, condom distribution, but yet devoid of a strategic treatment plan for those already with the virus.

According to the TAC, the government operational treatment plan is a welcomed development and one where tangible progress in respect to policy improvement, budgetary transparency and adequate prevention and treatment plans are visible albeit slow (TAC, 2004). The TAC further argues that while the plans are theoretically sound, less than 40 000 people out of a 5 million infected populace are on treatment. Roll out has been, after 5 months since release of the treatment plan, has been largely ineffective.

The role of Independent Organizations

The nature of HIV/AIDS, in terms of the complex and far reaching consequences thereof, requires a multi-faceted response. If anything, this is perhaps the only point of consensus worldwide. Governments require the NGOs and organizations of international standing like the United Nations bodies to work in conjunction with another in tackling the vast spectrum of causes and effects of HIV/AIDS. International NGOs have been important in promoting initiatives and innovations in the global fight against AIDS. UNAIDS has assumed a leadership role in monitoring, theorising, spreading information and marketing a serious global response to the pandemic. According to Baylies (2000), the idea of partnership and indeed the International Partnership on AIDS in Africa (formed in 1999), ‘purports to put pressure on the global community-not least on the private sector-to take up moral and material responsibility in respect on AIDS, while at the same time calling for agendas to be set by African governments’ (2000: 495).

Baylies (2000) adds that such a multi-sectoral understanding calls for collaboration and yet insists that governments display a political will to create programs to alleviate the pandemic with a genuine intention to work with independent organizations.

The HIV/AIDS virus is like none other – those infected may not be quarantined literally or metaphorically. And the South African government’s reluctance to create a worthy treatment approach is indicative of a lack of foresight into a disease that is social as much as it is global, with the potential to spread in ways, means and in manners since unheard of.

The TAC, as mentioned was borne out of a need for civil society to intervene and lobby for an improved government response to the pandemic. The association of organizations, involving influential individuals to grass-root bodies has acted primarily as a watch dog rather than as a complementary asset to government approach. The perplexing approach adopted by government has effectively meant that the TAC has effectively energised majority efforts towards lobbying rather than working alongside the state. The TAC, is a non-aligned political entity, and is devoid of links with pharmaceutical company. Their claims and their work suggests that their concern regards action towards treatment accessibility and action towards eradicating the pandemic’s stranglehold in society. The rapid and effective mobilization of this movement has stunted social movement sceptics and cynics, for their work has been effective and their pressure on government has proven to be more than mere alternate talk.

Conclusion

This paper aimed to critically discuss the issue of anti-retroviral drug distribution in South Africa, more specifically the problem thereof. In this, the South African government’s indecisive and perplexing policies towards treatment for 5 million HIV + citizens were outlined, leading to the historic decision to distribute drugs towards reducing MTCT transmission and later, to all adult HIV/AIDS patients. The TAC has been a salient and integral feature in the fight for treatment distribution, and in pressuring government to change and rejuvenate policies. While policy has changed, effective and real change is yet to be seen. The author’s following paper will critically discuss the role of the TAC, as a major institution leading the fight against AIDS and more specifically, the distribution of medical treatment.

Appendix A

The Treatment Action Campaign

From humble beginnings, the TAC – now the leading HIV/AIDS lobby association of organizations and individuals in South Africa – has been at the forefront of opening a new chapter in AIDS politics in South Africa. The TAC, a non-profit organization formed in 1998, has moved in leaps and bounds over the last 6 years to effectively lobby and pressurise the South African government to continuously reassess, re-think and formulate policy changes to otherwise paltry and ineffective HIV/AIDS strategies. However, the TAC is not only about campaigning for treatment it has attempted to bridge the information divide by offering education on HIV/AIDS, training those infected to lead healthy lives, creating better health facilities and to extinguish mother to child transmission.

The TAC was formed by a group of individuals – gradually sickened by the reality that developed has access to drugs that fought the virus with successful results while South Africa, like the rest of the developing world were made to believe that treatment was impossible, or at least access to such was improbable. The need for treatment in a country where it is estimated that approximately 1.5 million people will die between 2000-2005, and approximately 1 million children will contract the virus from their parents over the same time period – needed no more clarification.

The TAC has been largely responsible for effectively challenging government and has been successful in luring government to alter and review HIV/AIDS budgets, plans and mechanisms. In fact, the drug dilemma in South Africa has only advanced through the pressures induced by the TAC and the resilience of their supporters.

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(Accessed: 24/02/04)

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The advent of the TAC, its work and its successes/failures as effectively dealing with the AIDS treatment issues of South Africa will be discussed in the author’s forthcoming paper)