Posts tagged HIV/AIDS
Many children live a short, hungry and brutal life in the richest country on the African continent and one of the wealthiest in the developing world.
In 2008, nearly 12 million or 64% of all children lived in households with a monthly income (excluding social grants) of less than R569.00 per month. This rate varies within and between provinces. The most rural provinces such as Limpopo had more than three times the number of children living in poverty (nearly 2 million) than children in the Western Cape (656 000).
The national racial breakdown shows that 71% of African children, 37% of Coloured children, 11% of Indian children and 4% of White children lived in households that had an income of less than R569.00 per month.
This data comes from the South African Child Gauge 2009/2010 published by the Children’s Institute at the University of Cape Town. Their survey is one of the most comprehensive annual evaluations on the lives of children in South Africa.
Unemployment is usually measured by the number of workers who are not economically active. In this report one learns that 6.4 million children live in households where not one adult is employed. one of the most important policies of the national government (despite resistance from the Treasury and conservatives in society) has been the introduction of the Child Support Grant (CSG). More than 9.6 million children access this and other grants such as the Foster Care Grant. Contrary to popular myth, the Children’s Gauge points out that:
There is substantial evidence that grants, including the CSG, are being spent on food, education and basic goods and services. This evidence shows that the grant not only helps to realise children’s right to social assistance, but also improves their access to food, educationand basic services.
These grants must stay in place until our economy employs many more people and income is more evenly distributed. The creation of employment and the building of an equal and quality education system for every child in South Africa are necessary conditions to reduce inequality in the long-term. Till then social justice activists have a duty to ensure that people have access to social security.
This Child Gauge focuses on the ill-health and death of children. According to the report, he prevention of mother-to-child HIV transmission and the provision of ARVs to children have assisted in the extremly slow reversal of the under-five mortality rate which remains unacceptably high.
Children under five account for over 80% of all child deaths in South Africa. UNICEF estimates that under‐five mortality increased from 56 deaths per 1,000 live births in 1990 to 73 in the year 2000. This increase has been ascribed to the HIV pandemic and deteriorating health care services. The increase was followed by a slow decline to 67 deaths per 1,000 live births in 2008, which coincided with the rollout of the prevention of mother‐to‐child prevention programme.
As a consequence, the report expects the Constitutional Court to address and remedy all the social injustices children in South Africa face. It argues:
The Constitutional Court has played a pivotal role in protecting children’s rights by ordering the State to roll out the prevention of mother‐to‐child transmission programme (PMTCT) in 2000. The comprehensive roll‐out of the PMTCT has contributed to reducing the numbers of babies that contract HIV from their mothers’ during birth or breastfeeding. However, the Constitutional Court did not prioritise children’s rights in its recent judgment on free basic water despite lack of access to water and sanitation contributing to the high number of children under five that die from diarrhoea. Given children’s lack of political power to influence the Executive or Parliament, the Constitutional Court needs to be more pro‐active as the upper guardian of children and actively consider children’s rights and best interests in all cases before it.
This is an argument with which I take serious issue. Active citizenship — the patient, hard work of movement building and insisting that Parliament plays an active role in transforming the social and economic inequalities in South Africa is the most sustainable way to ensure justice for children. Children do not exist in a political vacuum devoid of “political power to influence the Executive or Parliament” — they have parents or care-givers, they live in communities, they are the children of parents who pray and work. No court could substitute for the patient mobilising of people to transform social inequality.
The TAC PMTCT judgment followed five years of intense discussion, negotiations, petitions, alliance building with trade unions, religious bodies, students, nurses, doctors, women, children’s and other human rights organisations, international activists and agencies.
All this work was premised on the building of a social movement by women and men who were directly affected by HIV denialism — the members of the Treatment action Campaign then active in more than 100 townships and villages across the country. This has to be the lesson of the TAC PMTCT case — the Constitutional Court judgment was based on one of the most persistent and sustained campaigns of the last two decades. Even after the judgment, it took many marches and campaigns to really ensure delivery. To imagine that we can avoid this work to ensure that children are healthy, educated, safe, fed, clothed and happy is to live in a world that does not exist.
Despite this criticism — every activist and person who is interested in social justice for children should study South African Child Gauge for 2009/2010 — its economic, epidemiological, demographic and social analysis and evidence-gathering on children’s health is indispensable to transformation.
The South African Child Gauge is produced annually by the Children’s Institute, University of Cape Town, to monitor government and civil society’s progress towards realising the rights of children.
See news report below.
SA failing to keep tots alive by Philani Nombembe
Like Afghanistan, it has not reduced number of child deaths
South African infants are among the worst off in the world and have one of the lowest chances of survival.
A damning report, the “South African Child Gauge for 2009/2010″, released by the University of Cape Town’s Children’s Institute, blames the crumbling public health system for much of our children’s woes.
South Africa holds the dishonorable distinction of being one of only 12 countries – including war-torn Afghanistan – to have failed to reduce child mortality since 1990.
It ranks in the company of the Democratic Republic of Congo and Burundi.
South African child deaths have risen from 56 deaths per 1000 births in 1990 to 67 deaths per 1000 births in 2008, according to Unicef.
This is despite South Africa’s high GDP and the billions of rands pumped into providing public health services.
Unicef’s deputy representative in South Africa, Malathi Pillai, said the recent spate of infant deaths at the Charlotte Maxeke Academic Hospital, in Johannesburg, was shocking.
“It is important that we recognise that, in many of our communities, the poor quality of other basic services, such as water, sanitation, electricity and dwellings, along with health services, has a profound impact on child mortality and paediatric health.
“For example, a majority of neonatal deaths in South Africa could be averted by improving the quality of care at district hospitals,” said Pillai.
The report said that most 2007 child deaths, 81%, were of infants younger than five.
Experts from the Children’s Institute lambasted the government and its health department.
But Dr Nathaniel Khaole, the department’s acting cluster manager for maternal, child and women’s health, denied that the institute’s findings were shocking.
“We know what has been happening, we know what to do,” he said
He said his department will study the report.
This report appeared in The Times 27 July 2010 ENDS
Corporate profiteering has the protection of the state in South Africa, the European Union and India. This is illustrated in the two issues reported by the Treatment Action Campaign and Section 27 incorporating the AIDS Law Project in the posts below.
1) The first post deals with a court judgment on the 2008 ARV tender that has cost the state millions of rands.
2) Trade pressure by the European Union on the Indian Government to allow drug companies to make excessive profit for life-saving medicines for longer than the World Trade Organization demands.
THE IRREGULAR ARV TENDER AND THE US DRUG COMPANY
One of the world’s top ten drug companies Merck (MSD) and also one of the most lawless in pursuit of profit won the 2008 tender for the ARV drug efavirenz (EFV) from the South African government despite the fact that a good quality generic version was available.
In 2007, TAC and the ALP laid a complaint at the Competition Commission against Merck the US multinational drug company. The Competition Act holds that a dominant firm (holding more than 45% of market share) may not charge an excessive price to the detriment of consumers.
TAC argued that Merck was profiteering from efavirenz one of the most important drugs of the first line ARV regimen. In six months, between January to June 2007, MSD sold ± 296 000 units of EFV… at a cost of R46.3 million. Merck controlled 80% of the market.
ARV treatment involves using three or more drugs — efavirenz is one of at least four drugs that the government buys. However, 64 cents of every rand spent on ARV medicines by government was spent on Merck’s drug alone. Higher prices means less treatment. Less people on treatment means more illness and death.
In 2008, following the complaint Merck informed the Competition Commission that it would grant licences to four generic companies. TAC withdrew its complaint on the basis that Merck would follow the rules.
We were then surprised that Merck won the tender. The generic medicines were cheaper and this meant more than half of the ARV drug budget would go to Merck. The North Gauteng High Court has now exposed the irregularity of that tender. The Indian generic manufacturer Aurobindo approached the Court on the grounds that the tender was unfairly awarded. In a judgment handed down 02 July 2010 Court ruled against the government and Merck.
This case illustrates that a degree of collusion (between Merck, the US-based multinational and the South African government) ensured that it was awarded the licence. The statement from Section 27 incorporating the AIDS Law Project on the case and the judgment shows that government must guard against corruption from business.
THE EUROPEAN UNION PRESSURES INDIA
Trade pressure is the weapon of choice by rich countries when dealing with their poorer counter-parts.
When Bill Clinton took office in the US, President Mandela’s government wanted to make medicines more affordable in South Africa. The Mandela administration wanted to make generics available on the same basis as US law provides for people in that country.
The Clinton administration placed South Africa on a sanctions watch list until US activist and international pressure forced them to lift it.
Today, the European Union also places profit before life in the same way. Six of the twelve top drug companies are European and the others American. The EU drug companies use their governments to prevent Indian generic competition. In negotiations for a new trade treaty, they demand that India should give greater protection to drug companies than the World Trade Organization demands. In November 2001, the WTO members issued the Doha Declaration which states:
We agree that the TRIPS Agreement does not and should not prevent members from taking measures to protect public health. Accordingly, while reiterating our commitment to the TRIPS Agreement, we affirm that the Agreement can and should be interpreted and implemented in a manner supportive of WTO members’ right to protect public health and, in particular, to promote access to medicines for all.
Today, corporate European Union is again trying to take away the rights of people across the world to life, dignity and health. The Indian government should not give in to trade blackmail at the cost of people’s lives.
All drug companies “brand” or generic are interested in profits — it is the duty of governments to regulate them in the interest of people. Make your voice heard against the European Union’s blackmail and India’s willingness to compromise.
Transparency and fairness must be enforced in 2010 ARV tender process — Section 27 incorporating the AIDS Law Project
High Court finds part of 2008 ARV tender procedurally unfair
Company with lowest prices unfairly excluded from bidding
Questions raised as to motive for company’s exclusion
Invitations to bid for the next tender antiretroviral (ARV) tender are expected to be announced shortly. As previously indicated, SECTION27 supports the Minister of Health’s intention – as indicated in his budget speech of 13 April 2010 – to procure ARV medicines “at the lowest possible cost from whatever source that can guarantee us the lowest prices”. It is with this in mind that we are concerned about the findings in Aurobindo Pharma (Pty) Ltd v The Chairperson, State Tender Board and Others, a case which addressed one aspect of the 2008 tender for ARV medicines.
On 19 May 2010, the North Gauteng High Court handed down its judgment in this case which considered a challenge by Aurobindo – a local subsidiary of a major Indian-based generics manufacturer – to its disqualification from participating in the 2008 efavirenz tender. Efavirenz is a key ARV medicine that is used by over two-thirds of people accessing ARV treatment in the public sector.
In his judgment, Justice Prinsloo came to the conclusion “that there was a lack of procedural fairness in the process”. In other words, Aurobindo should not have been disqualified from participating. In addition, he found that Aurobindo would most likely have been awarded the efavirenz tender because its prices were significantly lower than those of its competitors:
It appears to be probable that, if the point scoring system had been correctly applied, the applicant could have been awarded the tenders in respect of each of the products tendered for, in that its tendered prices were significantly lower than the prices of its competitors. Had this happened, the tax payer may also have been saved a considerable amount of money.
The 2008 efavirenz tender was awarded to the following companies:
MSD (Pty) Ltd – 200mg capsules (100% of tender);
Adcock Ingram Healthcare (Pty) Ltd – 600mg tablets (70% of tender); and
Pharmacare Ltd (t/a Aspen Pharmacare) – 600mg tablets (30% of tender).
At the time of bidding, Aurobindo had secured Medicines Control Council (MCC) registrations for both products and had been licensed by Merck & Co. – MSD’s parent company – to bring generic efavirenz products to market. It was the only licensed generic company that had secured MCC approval for the 200mg product.
In a follow-up tender in mid-2009, which – like the 2008 tender – was to run until 31 May 2010, Aurobindo was awarded the contract for 50mg and 200mg versions of efavirenz. Interestingly, its 200mg product was to be delivered to the state at R142.50 for 30 days’ supply – some 52% lower than MSD’s 2008 price (R297.22) for the same product.
The judgment in Aurobindo v State Tender Board raises serious questions regarding the motive for Aurobindo’s exclusion from the process. Was the disqualification simply a technical error, or rather a deliberate attempt to exclude Aurobindo? If the latter, was the exclusion made to benefit any other company? At the very least, National Treasury needs to answer these questions, particularly in the light of the upcoming 2010 ARV tender and the urgent need for the Department of Health to be able to procure medicines at the best available prices.
Why was Aurobindo disqualified?
The official reason provided for Aurobindo’s disqualification is that the company “failed to submit a letter from the manufacturer confirming a firm supply of the items offered”. It was common cause that the products were to be manufactured by Aurobindo’s parent company in India.
Aurobindo argued that, as the authorised importer, it was not obliged to provide such a letter. It based this argument on its reading of the questions posed to potential bidders in the tender documentation. In expressing no firm view on whether such a letter should have been attached, Justice Prinsloo agreed as follows:
At worst for the applicant, the questions referred to, read with clause 7(a) , are ambiguous and create confusion which, if not responded to in a satisfactory manner, should have prompted the Bid Adjudication Committee to seek clarification rather than to disqualify the bid as unresponsive.
Why was this unfair?
MSD “also failed to comply with a condition that could invalidate its bid … but was afforded an opportunity to rectify the mistake before … the evaluation took place.” Its bid failed to provide particulars relating to price structure explanations – information on foreign currency, foreign exchange rate, import percentage and minimum order quantity. Yet instead of invalidating the bid, MSD was provided with an opportunity to supply the mandatory information – which it duly did.
In defending this unequal treatment, the Chief Director: Contract Management, National Treasury and the Minister of Finance – in the answering affidavit put up on their behalf – argued that after Aurobindo’s disqualification, MSD was “the only remaining tenderer offering [efavirenz 200mg] and it was necessary to ensure that the award was made.” A further, even less convincing argument, was also made – and dismissed by Justice Prinsloo. He therefore concluded as follows:
The present case may not involve “subterfuge and deceit” but it is common cause that was afforded the opportunity to augment its tender after the closing date and before the evaluation date. This opportunity was also granted to to overcome the problem caused by the disqualification of . In my view there was no equal evaluation of tenders in this case so that the tender process was “stripped of an essential element of fairness” …. Moreover, given the ambiguous nature of the questions posed to …, this is clearly a case where it would be “fair to ask a tenderer to explain an ambiguity in its tender” and “fair to allow a tenderer to correct an obvious mistake” and “fair to ask for clarification or details required for the proper evaluation of the tender” ….
What is the impact of the case on the ARV supply in the public sector?
By the time the case was argued in court on 28 April 2010, the 2008 ARV tender had almost expired – it was used to procure medicines for the period 1 June 2008 to 31 May 2010. Because of this, the application to review and set aside the tender had “for practical purposes, become moot.” In addition, setting aside such a tender may have had a serious impact on the supply of ARV medicines. With this in mind, Aurobindo decided to abandon the application and only focus on the issue of costs. To be able to make a decision on who should carry the costs of the litigation, Justice Prinsloo had to make a determination as to whether the tender process was flawed.
In short, therefore, this decision has no practical impact on the supply of ARV medicines in the public sector. However, it does raise concerns about the manner in which National Treasury conducted the 2008 ARV tender, what will be done to determine why this happened, and how the state will ensure that the upcoming 2010 ARV tender is not similarly flawed. As already indicated above, there is an urgent need for the state to be able to procure medicines at the best available prices. This requires fair tender rules and a fair application of those rules, as well as a guarantee that the various bid committees are appropriately constituted.
For more information, please contact Jonathan Berger on 011 356 4112, 083 419 5779 or email@example.com
 Case no: 59309/2008 (19 May 2010)
 At paragraph 51
 At paragraph 20
 At paragraph 40
 At paragraph 48
 See paragraph 48
LETTER TO THE HIGH COMMISSIONER FOR INDIA TO SOUTH AFRICA
1 July, 2010 – 20:47 — moderator
Mr R K Bhatia
High Commissioner for India to South Africa
Post Box No. 40216
Arcadia – 0007 Pretoria
By Fax: +27 12 342 5310
23 June 2010
Dear Mr Bhatia
OUR CONCERNS REGARDING INDIAN TRADE NEGOTIATIONS WITH EU
Over a million people with HIV in South Africa are receiving antiretroviral (ARV) treatment. At least 100,000 additional people receive treatment via private or non-profit sources. ARV treatment is saving lives and stemming the decline in life-expectancy that has occurred due to the HIV epidemic.
One of the main reasons this has happened is because the prices of ARV regimens fell from over R3,000 per month in the 1990s to less than R150 per month for a standard first-line regimen used in the public sector today. Even the private sector price of one of the best first-line regimens is R532 including VAT, a fraction of the lowest 1990s prices of far less optimal regimens. If these prices were corrected for inflation, the drop would be even more dramatic. Lower prices have made the HIV treatment programme affordable for the state. Lower prices have also allowed medical schemes and non-profit private organisations to cover HIV treatment, thereby alleviating some of the public sector’s treatment burden. Without these massive price reductions, nearly a million additional people would be dead or dying now in South Africa. But these price reductions have benefited people far beyond South Africa’s borders; there are programmes in many sub-Saharan African countries providing quality ARV drugs because they are now affordable.
As this letter explains, the prospect of making new ARVs available in South Africa at affordable prices is under threat because of events unfolding in India. In particular, pressure is being applied by the European Union on the Indian government to sign a bilateral trade agreement that will stifle competition on essential medicines still under patent. The problem goes beyond ARVs. It will apply to any new medicine that is developed, whether it be for cancer, diabetes, tuberculosis or a future epidemic. Undoubtedly, this will prove to be detrimental to everyone regardless of social class and geographic location. We should all be concerned.
How ARVs became affordable
Until the early 2000s, each ARV was marketed exclusively by at most one company in South Africa usually under patent or via an exclusive license agreement with the patent-holder. Consequently there was no competition on ARVs. There is a clear chain of causation that led to most of the price reductions. In general:
1. Generic manufacturers based mainly in India (but also in Brazil and elsewhere) produced dramatically cheaper generic versions of ARVs. They could do so because medicines were not patented in India. Previously, these drugs had not been available in South Africa.
2. Activists in South Africa, the rest of the African continent, and across the world forced patent holders to license generic manufacturers to sell their medicines in sub-Saharan countries and elsewhere. Such activism included protests, successful complaints at the South African Competition Commission and threats of litigation.
3. Following this pressure the companies manufacturing ARVs and other important HIV-related medicines under patent either dropped their prices substantially or allowed generic competition.
Many ARVs manufactured in India are now sold in South Africa at affordable prices. So too are ARVs manufactured in South Africa using active ingredients ordinarily imported from India. They are registered with the Medicines Control Council, the US Food and Drug Administration and approved by the World Health Organisation. Therefore they meet stringent requirements ensuring these are safe, effective and of good quality.
The Indian Patent Act
But in 2005, the Indian government passed legislation that allowed medicines to be patented, as it was required to do in terms of its World Trade Organisation (WTO) obligations. This means that medicines developed since 1995 cannot as easily be produced by generic companies operating in India. This essentially breaks step one in the above chain of causation and makes it much harder to campaign successfully for lower medicine prices. Notwithstanding these new limitations, Indian patent law – as permitted by the WTO – still contains a number of flexibilities that allow for the market entry of generic medicines prior to patent expiry.
Since 2005, the AIDS Law Project (now SECTION27) and TAC have worked closely with civil society organisations in India to ensure the existence and use of such flexibilities. In early 2005, for example, we were part of a group of international activists who met with Indian parliamentarians in New Delhi during final deliberations on the Patents (Amendment) Bill, 2005. Our intervention sought to ensure that India’s amended patent legislation took full advantage of the flexibilities permitted under WTO law. In early 2007, we supported an international call on the Swiss-based pharmaceutical company Novartis to drop its High Court challenge to one of the Indian Patents Act’s key flexibilities – section 3(d). Although the challenge proceeded, it was ultimately unsuccessful, resulting in a key public health safeguard remaining on the statute books.
Despite these flexibilities newer drugs are being patented in India. For example, raltegravir is a relatively new and important ARV, especially for people who are resistant to standard ARV regimens, which has been patented in India. It currently costs R2,396 including VAT monthly. It is priced far too high for the South African public health system or for general use in the private sector. There is no generic equivalent of it in India or anywhere else, nor does it look likely that one will be made in the short-term. This makes it extremely difficult for activists to apply pressure on the pharmaceutical company Merck, which owns the patent on it. With no competition there is no downward pressure on the price, and it is extremely unlikely to be accessible to people in South Africa in the near future.
At least two new tuberculosis drugs are likely to be ready for registration in the next few years. These are urgently needed especially in light of the growing drug-resistant TB epidemic. It is a matter of deep concern that they might not be accessible where they are most needed: in poor countries.
Bilateral trade negotiations with the European Union
This is a bad situation, which is about to get worse. The European Union (EU) is conducting trade negotiations with the Indian government. A leaked draft of the negotiating texts has shown that the EU is pushing for the following in a bilateral trade agreement:
• Data exclusivity: Generic medicines are usually registered by showing that they are bioequivalent to the original medicine. This is a relatively inexpensive procedure. It means that a generic drug does not have to be put through expensive clinical trials since these were already conducted for the purpose of registering the original version of the drug. The EU however wants a period of data exclusivity to be enforced for new drugs. During this period the Drugs Controller General of India (the equivalent of South Africa’s Medicines Control Council) will not be able to rely on available clinical data to register a medicine. Since it would be unethical and too costly to repeat a clinical trial during this period, this condition would essentially block the registration of a generic drug during the original drug’s data exclusivity period. The length of the data exclusivity period being negotiated is five to nine years. Of concern is that data exclusivity provisions apply even in cases where patents have not been granted or where licences have been granted to generic manufacturers, undermining the public health flexibilities and safeguards that currently exist in Indian patent law.
• Longer patent periods: Currently patents are granted for 20 years –at some point before the product is submitted to a drug regulatory authority for registration. The EU is pushing for patent periods to be extended by the length of time the drug regulatory authority takes to examine an application for registration, or by the length of time a patent office takes to examine a patent application.
• Border measures: The EU wants to be able to seize medicines that are in breach of EU patents at EU borders, even if these medicines are in transit on their way to a country outside the EU, such as a sub-Saharan African one, where their use would not infringe any patents. This is not a theoretical possibility. It has already happened where the EU seized a shipment of abacavir sulphate on its way from India to Africa. The shipment was procured by UNITAID and was funded by the Clinton Foundation. 17 such seizures took place until worldwide condemnation for the EU’s actions began. Now the EU wants to legitimise such laws by pushing them into the EU-India FTA. By doing so it threatens to stop at the Indian or EU borders the export of Indian generic medicines that most African countries rely on.
None of these measures are required by the WTO. All will critically hamper the prospects for generic competition on patented ARVs in sub-Saharan Africa.
We ask you to convey our concerns to the Indian government, in particular those responsible for the trade negotiations with the EU. We call on the Indian government not to limit the options available to it under the WTO Trade-Related Aspects of Intellectual Property Rights agreement.
TREATMENT ACTION CAMPAIGN
SECTION27 (incorporating the AIDS Law Project)
Five years ago Ronald Louw died of HIV-related TB. He was a friend and comrade. He is remembered by thousands of people whose lives he touched. Below is an obituary I wrote after his death and a video insert by Jack Lewis and the Community Media Trust team.
Ronald, why didn’t you get tested ?
One of my closest friends and a long-time comrade, Ronald Louw, has died. Two major Aids related factors caused his death: HIV denial and undiagnosed tuberculosis (TB). Denial meant that he did not test for HIV until almost too late. And unreliable TB diagnostics developed more than 100 years ago meant that as his immune system was destroyed by HIV, TB could not be detected until it was too late. He vomited, soiled his linen and his health did not improve. Sadly, he was not treated presumptively for TB until four weeks after his admission to hospital. His TB diagnosis was confirmed by a lung biopsy only three days before his death.
Early this year, as his sabbatical started, Louw learnt that his mother Doreen had cancer. Together with his siblings they took turns to travel from Durban, Cape Town and Johannesburg to look after their mother in Port Elizabeth. The experience was traumatic for all of them. As she lay in a coma on May 16, Louw collapsed and was admitted to hospital with AIDS. Until then, he did not know that he had HIV. His mother died on that day, but she had had a full life. He could not attend her funeral a few days later because at nearly half her age Louw was fighting for his own life.
Without any hesitation, Louw immediately told friends, family, colleagues and strangers that he had Aids and sought medical care. He was privileged. He had never gone hungry. He occasionally drank a glass of wine but had never done drugs. He was a workaholic. Smart, educated and surrounded by friends who understand HIV/AIDS, yet even Louw failed to get tested early.
In early May, with advanced Aids and a CD4 count under a hundred, all of us hoped that he would recover. Maybe his anti-retroviral medicines would work. But they did not because his TB was treated much too late. Although surrounded by countless friends, family and well-wishers, AIDS removes dignity and autonomy.
Louw had been exemplary in almost all aspects of his life, except the fact that he did not get tested for HIV. We all hoped that when he got better, Louw would himself explain this to all of us. His life shows that none of us are exempt from HIV infection and denial.
I remember the Saturday afternoon drizzle in Mowbray, Cape Town, that day in June 1981 when I met Ronald Louw. We attended an African Studies seminar run by Neville Alexander. Anne Mayne, Farid Essack and Shamil Jeppe were also class mates but it is only with Louw that I established the firmest bond of friendship that endured — endurance on his part, fullest enjoyment on mine.
Friendship has been the most remarkable part of my life. I have great friends and Louw’s illness and death allows me to reflect on what friendship means. Friendship means laughter, conscience, engagement with life — politics, philosophy, activism, romantic dreams and disasters, family issues, generosity and personal pain. Without friends, I would not have survived childhood, a different sexual orientation, political activism and HIV/Aids. I would not have been educated but for my friends. Louw was a friend in every one of the senses mentioned above. I can only hope my friendship meant as much to him.
Louw was a law lecturer and became an associate professor of law at the University of KwaZulu-Natal, but he was irritated at the sign in his hospital room that identified him as a professor. Back in 1981 he was employed as a teacher at Livingstone Senior Secondary School in Cape Town. Louw joined the Factreton Youth Movement, the nemesis of Minister of Finance Trevor Manuel and Lionel October, and was actively involved in struggles to lower rents, food prices and debates on the nature of a post-apartheid South Africa. He was a “workerist” and I was an African National Congress hack.
Over the years, Louw has also been active as an anti-militarist. He refused to serve in the apartheid military. Central to all his activism was a commitment to equality. This is evidenced by his legal work. He joined the law firm of Justice Joe Ebrahim in Athlone to complete his articles and his continued involvement in human-rights work — particularly in the areas of lesbian and gay equality, prisoner rights, criminal justice reform and HIV/Aids prevention, support and treatment work.
In December 1994, when the National Coalition for Gay and Lesbian Equality was formed, Louw represented the Sexual Orientation Forum at the University of Natal, Durban. Louw played a central role in the formulation of its principles, strategies and tactics. Louw, together with Nonhlanhla Mkhize, Vasu Reddy, the late McDivitt Hove and other activists, was responsible for the creation of the KwaZulu-Natal Coalition for Gay and Lesbian Equality. Today, they work in the Durban Lesbian and Gay Community and Health Centre.
Louw was also the consummate committee person. He was faultlessly fair and though he promoted consensus as the best solution, it was always done on the basis of principle.
He was also pedantic and pessimistic. But these were important qualities to ensure that neither people nor institutions were given false expectations. He always made up for this with a sense of humour — I remember when he taught at the Wittebome School for the Deaf, he told his friends how impressed he was with his own abilities to teach children whose hearing was impaired until he discovered that every time he entered the class they turned off their hearing aids.
He was a remarkable teacher. Loved by most of his students and as the Proctor of the University of KwaZulu-Natal, many of the students he prosecuted often turned to him for advice because of his sense of justice and fairness.
Despite legendary parsimony, his generosity has made him a great friend and comrade over the last seven years. Since the early days of the Treatment Action Campaign (TAC), I have stayed in Louw’s Queensborough house whenever I was in Durban for work (his more snobbish colleagues hated travelling to a former white working-class area).
TAC has never had to pay a cent of accommodation expenses and very rarely local transport costs for my work in KwaZulu-Natal. Louw always carried the cost and the burden of cups of tea, Marie biscuits, disruptive phone calls, an untidy bedroom, my ill-health and much more. Louw was also the first treasurer of TAC in KwaZulu-Natal, but work pressures and his commitment to the Durban Lesbian and Gay Community and Health Centre meant he became a passive TAC supporter.
I originally wrote this article (with Louw’s permission) to ask him to fight to live longer. He is now dead. He died because he did not get tested early. And, when he discovered his HIV status, his lungs and immune system were destroyed. I also write to ask every person to get tested. If you are HIV-negative, practise safer sex and stay negative. If you have HIV, live positively and openly — eat well, reduce stress, exercise, practise safer sex and get treated immediately for any infections. When you need it, start anti-retroviral treatment.
As he lay dying, Louw was surrounded by friends, colleagues and family who loved him — Vasu Reddy, Nonhlanhla Mkhize, Alan Rycroft, Imelda Diouf, Judy Parker, Libby Morris, Jonathan Berger, Nathan Geffen, Jack Lewis and many others. His siblings Patricia Leaver, Alan and Deon Louw gave their love and support.
Louw’s memory demands that we intensify the struggle for new, accurate diagnostics for TB. It demands that we mobilise to ensure that everyone gets tested for HIV to prevent and treat the illness. His death, together with hundreds of thousands of others in our country, demands that personal, cultural, scientific and political denial is ended. Above all, it requires that we reaffirm the struggle for freedom, equality, dignity and social justice.
This article was first published in the Mail and Guardian on 11 July 2005.
PRESIDENT MUTHARIKA WE OPPOSE HOMOPHOBIA AND PRESIDENT OBAMA’S ADMINSTRATION RESPONDS — Join Cape Town Malawi Protest Tomorrow & Read SA Health Minister’s Speech
Protest Malawi in Cape Town tomorrow
Comment on speech by SA Health Minister to World Health Assembly and President Obama adminstration
President Bingu Wa Mutharika
The unjust laws against LGBTI people in Malawi and throughout our continent Africa must be removed. Every person has a duty to speak out especially progressive people in Africa. Authoritarian African, Caribbean and Middle-East governments such as the Iranian theocracy with the Vatican have always used scapegoats for their failure to address social, class, gender and others forms of inequality.
* The oldest of these intolerant institutions the Vatican instituted the Inquisition and persecuted Jewish people, now it promotes homophobia and Islamophobia to distract from its Dark Ages theology and practices.
*The Iranian theocracy which has attempted to destroy the progressive elements of Ancient Iranian Civilization uses LGBTI people, democrats and antisemitic Holocaust denial as scapegoat for their social, political and economic crises.
Authoritarian African government use stateless people, ethnic cleansing, the “West” and LGBTI people among many others to distract attention from failure to govern and corruption. The attacks on LGBTI people is a part of this and we will build continent-wide coalitions to resist all hate crimes and lack of democracy.
JOIN THE COALITION TO END DISCRIMINATION PROTEST AGAINST THE MALAWI GOVERNMENT IN CAPE TOWN AT NOON 12:00 TOMORROW (THURSDAY 19 MAY 2010) AT THE HOME AFFAIRS DEPARTMENT ON BARRACK STREET BETWEEN PLEIN AND BUITENKANT STREETS CAPE TOWN CITY CENTRE
The behaviour of African Presidents and their governments is one-side of an unjust global order.
President Barack Obama’s New Policy of AIDS denialism
A new form of HIV denialism is being promoted by the US, one that will have far greater impact in new HIV infections and lives lost than President Mbeki’s denial that HIV exists. President Barack Obama’s PEPFAR Czar Eric Goosby responded to NY Times article (demonstrating the consequences in Uganda of letting people die by denying HIV resources) with a letter. His letter is copied below. The best response we have for President Obama is from Dr. Aaron Motsoaledi SA Health Minister because Obama’s Goosby avoids the real issues — cutting resources and the false argument of “competing priorities” of development, health, maternal and infant mortality against HIV/AIDS. This last argument is the favourite one of Zeke Emmanuel (President Obama’s Advisor on Global Health). Emmanuel’s argument is deceitful, disingenuous and dangerous because it sentences people to death while spending more than $700 billion a year on arms and war. As George Orwell said in 1946: “In our time, political speech and writing are largely the defense of the indefensible.” Motsoaledi’s speech addresses what is happening in countries where HIV is hyper-endemic — most of Southern and East Africa.
As a country, we also know that the main causes of maternal and child mortality are associated with HIV and AIDS and tuberculosis (TB). It is for this reason that our response to improve maternal and child mortality rates include effective measures to fight HIV and AIDS and TB. We are determined to launch ourselves on a trajectory that will dramatically bring about improvements in health.
HIV and AIDS is the most complex and the most devastating infectious disease that humanity has ever confronted. It has, and it still claims lives, it is a burden to the healthcare system and eats up resources. We have witnessed the devastating effects. We have seen the need to act. Our resolve is to turn the tide.
President Obama, the tide can only be turned with increased funds not their denial to countries whose health and development is being destroyed by HIV. Letting African people die while pursuing unjust wars, feeding banks and the arms industry is immoral.
FROM COALITION AGAINST DISCRIMINATION — JOIN ITS FACEBOOK GROUP
Tomorrow (Thursday 19th) we will speak out against the conviction of Steven Monjeza and Tiwonge Chimbalanga who were arrested in Malawi last year for celebrating the engagement to each other.
We will hand over a memorandum to the Ministers of Home Affairs and International relations and Cooperation demanding that they:
1. Issue a clear statement condemning homphobia and discrimination on the grounds of sexual orientation and gender
2. Negotiate the release of Steven Monjeza and Tiwonge Chimbalanga.
3. Offer Steven Monjeza and Tiwonge Chimbalanga asylum.
Join us at 12:00 tomorrow (Thursday 19 May) at the Department of Home Affairs on Barrack Street, Cape Town.
SPEECH OF DR. AARON MOTSOALEDI
Source: The Department of Health
Title: SA: Motsoaledi: Address by the Minister of Health, at the World Health Assembly plenary, Geneva
The Director-General, Dr Margaret Chan
On behalf of the South African delegation, I wish to congratulate you on your election and wish you all the best for the duration of your tenure. This year is a historic year for Africa. In 25 days time the first ever 2010 FIFA Soccer World Cup on the African continent will kick off in South Africa.
South Africa is ready to welcome the world. We wish those who will be joining us an enjoyable stay. The health sector has been preparing for years for this event and we have worked with World Health Organisation (WHO) and other partners.
I want to allay your fears regarding concerns that have been raised regarding Rift Valley fever. The recent case about a German tourist, which started pandemonium within some media circles especially in Europe, was really a false alarm. Both the Bernhard Nocht Institute for Tropical Medicine in Germany and our own National Institute of Communicable Disease (NICD) has confirmed that it was not Rift Valley fever viral infection. We are continually and effectively monitoring all diseases including Rift Valley fever, this is what any health system in any part of the world is expected to do anyway.
The World Health Assembly this year will review progress made towards achieving the millennium development goals (MDGs). Independent reviews have clearly shown that in Sub-Saharan Africa our goals will not be achieved by 2015; my country is one of those which were found to be lagging behind.
I am committed to changing this situation and I wish to share my hope and conviction with all my colleagues who have to meet these targets, that this situation can be reversed. We are hopeful that this will be within the five years we have until 2015.
We intend to introduce simpler, basic interventions to bring down the disgracefully high mortality rates. We will learn from the experiences of those countries and member states whose maternal mortality rates ranged from 250 and 450 in the 60′s and have significantly dropped to below 25 by 1990.
The simple measures we are referring to are mainly about doing the right things at the right places and at the right time, these interventions have been well documented. Our commitment is also to the number of children who are under five who die each year.
Sadly, most of them die from conditions which can be prevented and which are treatable. Every one of these children deserves an equal chance of survival. We all have a responsibility to act and we are doing so in South Africa. That is why massive child immunisation campaigns in my country have been launched last month.
As a country, we also know that the main causes of maternal and child mortality are associated with HIV and AIDS and tuberculosis (TB). It is for this reason that our response to improve maternal and child mortality rates include effective measures to fight HIV and AIDS and TB. We are determined to launch ourselves on a trajectory that will dramatically bring about improvements in health.
HIV and AIDS is the most complex and the most devastating infectious disease that humanity has ever confronted. It has, and it still claims lives, it is a burden to the healthcare system and eats up resources. We have witnessed the devastating effects. We have seen the need to act. Our resolve is to turn the tide. We acknowledge that there are impediments, but they should not deter us from acting nor prevent us from responding effectively.
South Africa is responding aggressively to the HIV and AIDS pandemic and as with many of the most successful public health interventions in the world, we are certain that it is the simple, sensible things that will bring about results in the war against HIV and AIDS and these are namely: everybody knowing their HIV status, prevention against infection, prevention of mother to child transmission, early uptake of treatment, accessible and uninterrupted treatment, we will put emphasis on the proper management and treatment of HIV and TB co-infected patients.
With the help of the WHO and other United Nations agencies, we have adopted a totally new policy on HIV, AIDS and TB whereby we regard them as more or less one disease to be treated under one roof. Hence we are busy integrating HIV and AIDS and TB treatment facilities into one.
Mr President World AIDS Day 2009 was a historic day for South Africa in the fight against HIV and AIDS. On this day, which was also attended by the Executive Director of the Joint United Nations Programme on HIV and AIDS (UNAIDS), Mr Michel Sedibe, President Zuma made far reaching announcements whereby treatment was to be upgraded for certain categories of vulnerable people, consistent with WHO guidelines, but also that massive prevention strategies need to be undertaken with civil society.
I am happy to announce that as from 1 April 2010, following this announcement:
* All pregnant women started receiving treatment at the CD4 count of 350 or less
* All HIV and TB co-infected people are also receiving treatment at CD4 count of 350 or less and from July we will institute a massive INH prophylaxis for certain categories of HIV positive people
* All pregnant women who are HIV positive with CD4 count of 350 have started receiving treatment at 14 weeks
* Lastly, all children who are HIV positive have started receiving treatment regardless of CD4 status.
The history of HIV and AIDS response has been one of demanding action. It has changed the frontiers of public health. It is for this reason that the effectiveness and success of our response is underpinned by the deployment of the South African society itself, led by President Jacob Zuma and leadership from all sectors, political, social and economic.
This is bold and ambitious but it has public health safeguards. This way of responding by South Africa is a sign our commitment to improve the lives of our people, it is also an expression of the respect we attach to each life affected by the disease and our resolve to give every child a better life and every woman decent care.
Mr President, I am pleased to inform you that this has been precisely the launch of the biggest campaign ever by South Africa. Launched on 25 April, it involves testing 15 million South Africans for HIV by June 2011.
We have decided to include as part of this campaign a focus on non-communicable diseases and diseases of lifestyles. Hence all the 15 million South Africans who presented at testing stations, apart from being counselled and tested for HIV, will also have their blood pressure and haemoglobin checked, random blood sugar level determined, and TB oral screening undertaken. Any woman who tests positive is also being offered a pap smear. We hope this offer will be extended to all women as a matter of routine in due course.
Another major campaign which has also been launched recently is the massive male medical circumcision. To this end, in the province of KwaZulu-Natal alone, where the practice of circumcision was stopped more than 200 years ago, this decision has been reversed by the king of the Zulu nation himself, and a massive male medical circumcision is currently underway there.
The implication of the above initiatives means that resources will have to be increased. The South African government has recognised this and has committed additional funding whereby the antiretroviral budget alone increased by 33 percent over the allocation of the previous financial year.
The approach we have taken and the change of policy we have adopted are a tall order for any country, especially a developing country. But we are determined and we will wage this war to the bitter end. With your support and encouragement, we are beginning to make small positive gains, which are making significant strides. One day these will incrementally contribute to a quantum leap that will take South Africa out of its current situation.
It is on this basis that I sincerely believe we can turn the tide and that by 2015, where the WHO report of 2005 has recorded “No progress/worsening”, it will record “progress, 20 to 40 percent decrease in measles, mumps and rubella (MMR)” or better still, it will record “on track”. With political will, technical and financial support, collaboration and joint effort, I am convinced it can be done.
In conclusion Mr President, permit me to thank the WHO Director-General and other United Nations agencies and our development partners for their support in the past year. We will work in partnership with other countries in the African Region and beyond to improve the lives of our people.
OBAMA ADMINISTRATION RESPONSE
“At Front Lines, Global War on AIDS Is Falling Apart” (front page, May 10) conveyed an unjustifiably negative picture of the global AIDS fight and America’s role in it.
Our country’s vigorous response to the H.I.V./AIDS epidemic has been one of the great public health success stories of all time. The United States government provides more than half of all donor support for the global H.I.V. response, through our own programs and contributions to the Global Fund to Fight AIDS, Malaria and Tuberculosis.
The United States now supports more than 2.5 million people on antiretroviral treatment. In Uganda, our budget is now about $280 million per year — well over 70 percent of all H.I.V. funding in that country.
The United States is expanding treatment in Uganda and throughout the Pepfar (President’s Emergency Plan for AIDS Relief) countries. By 2014, we will be supporting treatment for more than four million people with H.I.V., and we recognize the role others must play in meeting the global need.
While challenges remain, we are building on and expanding our successes, not walking away from them. This is a global responsibility, and we are using this success story to invite other governments and donors to join us in meeting it.
U.S. Global AIDS Coordinator
Department of State
Washington, May 12, 2010
Obama Pictures500 hundred mainly working class and poor African-American people came to express solidarity.
PROTEST OBAMA’S CUTS TO AIDS TREATMENT FOR AFRICA! Thursday 13th May 2010 — outside St. Regis Hotel 55th Street at 5th Avenue
Encourage all your friends, family, co-workers and strangers to join this protest — Save Lives — Build, HIV and Development Programmes NOT War and Ban
AIDS Activists Announce Plans to Protest Obama’s Broken AIDS Promises
at DCCC Fundraiser
When/Where: 5:00 PM, Thurs, May 13th, outside the St Regis Hotel, 55th
St. at 5th Ave, NYC
Outraged at President Obama’s about-face on AIDS, hundreds of angry
AIDS activists will demonstrate outside of his appearance at the
DCCC’s $15,000-to-$50,000-a-ticket fundraiser. Activists will come
from New York, New England, Philadelphia, Baltimore, and Washington,
DC to demand that Obama meet his promises to fight global AIDS and
stop turning people who were promised life-saving medication away from
AIDS clinics around the globe.
They include people living with HIV and their allies from the US and
immigrants from countries affected by Obama’s broken AIDS promises,
including members of ACT UP Philadelphia, ACT UP/New York, Africa
Action, African Services Committee, Community HIV/AIDS Mobilization
Project (CHAMP), NYC AIDS Housing Network, VOCAL-NY Users Union,
Housing Works, Health GAP, AMSA, and Philadelphia Global AIDS
On the campaign trail, President Obama pledged “to provide at least
$50 billion by 2013 for the global fight against HIV/AIDS, including
our fair share of the Global Fund, in order to at least double the
number of HIV-positive people on treatment and continue to provide
treatments to one-third of all those who desperately need them.”
The reality is that since taking office, President Obama’s budgets
have shifted funding away from AIDS programs, and his commitments to
fighting AIDS have not even kept pace with inflation, let alone
increased to the level he promised. As has been highlighted by recent
stories in the Boston Globe and Newsweek, a flat-funded budget means
that people who were tested under US-sponsored programs and promised
treatment when they got sick are now being turned away. Clinics
receiving money from the US government are being instructed to enroll
no new patients in life-saving treatment programs. Doctors are being
instructed to ration drugs and face choices between giving their
dwindling supplies to young mothers or children. People who are turned
away often have nowhere else to go, and will die.
“Obama’s broken promise is killing people with AIDS around the world.
We cannot backtrack on our commitment to saving lives,” said ACT UP
Philadelphia member Jose de Marco.
Special note: Are you a doctor or researcher? Contact reps from the
American Medical Student Association to join the Doc Bloc at the
action: Farheen Qurashi – JRLD@amsa.org, 703-881-6458 or Karen Wong -
What is President Barack Obama, Rahm Emmanuel and his brother Zeke Emanuel up to in Africa and South Africa? When people in the United States elected Barack Obama their President, it symbolised historic change in the US and elsewhere. The most important global expectations placed on the Obama administration included starting to mend the imperial legacy of George W. Bush and Dick Cheney and to help save lives. Obama inherited a destroyed local and global economy, an environmental crisis, the deepest social inequalities in US society, the largest recorded budget deficit, global disgust and fear based on the Bush wars in Afghanistan and Iraq. He cannot fix these in a day or a decade.
These wars were not simply neo-conservative over-reach that destroyed the US image abroad; increased its public debt to hasten the collapse of banks; lined the pockets of the Bush-Cheney war and oil companies; undermined international law; they were all these and more. The Bush Wars attacked the most fundamental right of all — the right to a dignified life. Foremost among its victims are the countless households in Iraq and Afghanistan that were destroyed through bullets, disease, sectarian strife, bombs, torture, imprisonment and neglect. He also blighted the lives of US soldiers and their families.
George Bush did one good thing during his terms as President. He established the Presidential Emergency Program for AIDS Relief. Together with the Global Fund for AIDS, TB and Malaria (GFATM), the Bush initiative PEPFAR helped save at least four million lives across the world. The programs were the result of local and global activism based on the right to a dignified life. While blighting the lives of millions of people in Iraq, Afghanistan and the soldiers of the US, PEPFAR helped save lives. Now, this programme is under threat. Winstone Zulu, a courageous Zambian man who lives with HIV sent this message:
“Today I met my sister-in-law who was tested under Pepfar programs and used to get drugs three months up-front and was only given for a month last Friday. When she asked why, she was told that she should be grateful she got anything at all. She was told that next month she may not get anything.”
This testimony is the tip of the iceberg. PEPFAR and the Global Fund are indispensable to millions of people whose lives depend on sharing the responsibility for health across the world. The Obama administration advised by Dr. Zeke Emannuel (brother of Rahm Emmanuel) has decided to flatline read PEPFAR funding. Zeke Emmanuel loudly proclaims that these countries must “take care of themselves” and specifically names South Africa in this regard. This intervention is not begging for special treatment for Africa, South Africa or even HIV — it unequivocally condemns the $700 billion spent on war while cutting social programs in the US and abroad. HIV, global public health and development spending is a necessary investment for global freedom, peace and security.
I continue to support President Barack Obama but as a supporter, I believe that if he follows the path of Zeke Emmanuel his administration will entrench the practice that the right to life is meaningless and that US administration remains a cruel, fading empire that cannot be trusted. President Obama will you help save the life of Winstone Zulu’s sister-in-law and countless other people living with HIV. We demand an answer.
Minister Aaron Motsoaledi delivers — 15 million people to be tested. Get tested. Prevent HIV. Get treated. Always use a condom!
On 15 April 2010, for the first time in the history of the South African epidemic, a real properly resourced HIV testing campaign will be launched.
Minister of Health Dr. Aaaron Motsoaledi is leading the largest every HIV testing drive on the continent with a target to test 15 million people by June 2011. (see statement below)
Over that period, he also aims to increase condom distribution from 450 million to 2.5 billion.
This is serious delivery. I urge everyone to become an advocate for HIV testing. Organise five friends to get tested for HIV, diabetes, hypertension and TB.
This is a tribute to all the members, activists and supporters of the Treatment Action Campaign. Our comrades in Khayelitsha have shown the way. In 2004, the City of Cape Town distributed 2.7 million condoms in Khayelitsha. The township accounts for 11% of the population but 31% of sexually transmitted infections.
TAC joined the active condom distribution drive. Every month TAC distributes about a million male condoms in Khayelitsha. In 2008, 12 million condoms were distributed at taxi ranks, shebeens, public libraries, schools and through other organisations. Between 2006 and 2008 a 50% drop in HIV incidence has occurred. This demonstrates that when men get condoms we use them.It also shows that joint work between government and civil society has a mjor impact on public health.
Please read and distribute this statement. Let us get to work!
25th March 2010
Media Statement: Outline of the national HIV Counselling and Testing
Dr. Aaron Motsoaledi, Minister of Health
I wish to begin by taking this opportunity to remind the nation that in August 2009
the distinguished medical journal The Lancet revealed that South Africa is
apparently facing a quadruple pandemic, meaning we are going through four
HIV/AIDS and TB; South Africa is only 0.7% of the world population, but we
are carrying 17% of the global HIV burden, and 1 out of every 100 South
Africans has TB.
The second pandemic is that of maternal, infant and under 5 mortality.
The third pandemic is violence and injury, and
The fourth pandemic is that of non‐communicable diseases – high blood
pressure, heart diseases, diabetes mellitus, and cancer.
As a result of this and other research reports, on the 11th of March 2010, the Cabinet announced that the country intends to launch a massive HCT campaign. This was a decision taken at the Cabinet fortnightly meeting.
This groundbreaking decision was part of a process to take forward the 2009 World AIDS Day announcements by the President and to try to help us achieve the targets of the National Strategic Plan on HIV, AIDS and STIs. To remind those of us who might have forgotten, on that day last year, the President announced a new
approach to HIV and AIDS, in terms of a massive prevention and HIV testing
promotion strategy, as well as new treatment protocols.
We are Ready Today we have gathered here from all walks of life to announce to South Africa that we are absolutely united and ready the take the bull by its horns. We have gathered here under the banner of the South African National AIDS Council (SANAC) and government.
We are from all the 19 sectors of SANAC, which include the religious sector, labour, business, youth, women, children, disability, men’s sector, traditional leaders, NGOs, clinicians, researchers, sports and entertainment, and many other South Africans, who in their own right, declare that we are ready to launch this campaign.
We need to stand up and confront our challenge as South Africans.
On the 15th of April, the President and Deputy President will officially launch the
biggest HCT campaign South Africa has ever undertaken. The launch will take place at Natalspruit Hospital in Ekurhuleni district in Gauteng. While the national launch is on 15 April as mentioned earlier, provinces will launch simultaneously on 19 April. National Ministers, Deputy Ministers and provincial leaders as well as SANAC leaders will take the lead and test first.
This campaign will be run under the theme:
I am responsible
We are responsible
South Africa is taking responsibility
A Plan is in Place
We as South Africans should confront the scourge of HIV and AIDS through this
prevention and HIV testing promotion campaign, and we shall be engaged in the following activities:
Information, education and mass mobilisation
Detection and management of sexually transmitted infections
Massive voluntary HIV counselling and testing
Widespread provision of condoms – male and female
Embarking on a plan to introduce medical male circumcision on a large scale
Prevention of mother to child transmission aimed at totally eradicating the prospects of being children born with HIV
Safe blood transfusions
Post‐exposure prophylaxis for rape survivors at all health facilities
Life skills education for learners
The counselling and testing shall take place at the following facilities:
All government hospitals and clinics
All universities and FET campuses, subject to confirmation by the various
university principals and CEOs of colleges
Mobile units mainly from clinics into villages, rural areas, and other remote
areas of the country
Over the last month I have met with many leaders, and as a result, I am happy to announce the following major commitments for the campaign:
The Clicks and Link Pharmacy Group has pledged to make available 470
pharmacy clinics to provide free tests throughout the whole campaign. These
are available as testing sites. The government will provide them with testing kits and condoms, and they will provide staff and expertise. I would like to
take this opportunity to heartily welcome the CEO of the Clicks Group who is
here amongst us.
The Life Care private hospital group has pledged R500,000, and to support
training of health workers. They say the full scope of their contribution is still
Last night, I have met with approximately 500 general practitioners from around Gauteng province, who pledged that all their practices will be
available as free testing sites. Government will provide them with testing kits and condoms, and they will provide the rest. Details of these GPs will be
The independent pharmacies have also agreed to make their facilities
SAPPA, the South African Progressive Pharmacy Association, have proposed to
their 2,000 community pharmacists to offer testing services. A proposal is
being finalised with them.
We encourage all organisations in South Africa to consider how they can contribute to this campaign, and to inform the nerve centre of their pledges. Contact the nerve centre at (012) 338‐9300 or firstname.lastname@example.org.
Improving all aspects of care
This campaign is not just about HIV counselling and testing. Our intention is that anybody who enters a testing station anywhere in the country, shall also have the following services:
Blood pressure to check for hypertension
Blood sugar measurement to check for diabetes mellitus
Haemoglobin measurement to check anaemia
Symptomatic TB screening – 5 questions asked, and if one answers positively to any, then screen for TB using sputum, and x‐ray.
HIV testing is confidential. People need not disclose their status publically, but are encouraged to disclose their status to friends and family. Part of this campaign is to fight stigma.
We are targeting people from the age of 12 years and older, and hope to reach 15 million people by June 2011. We are appealing to the media to take this campaign forward positively, through radio, television, newspapers etc.
The SANAC website (www.sanac.org.za) shall also be the source of information.
In our endeavour to run a very smooth campaign, we have set up a nerve centre in Pretoria, at the Sol Plaatjie building. The SANAC Chief Operating Officers and a Chief Director from the Department of Health will operate the nerve centre on a full‐time basis.
Each hospital CEO is being instructed to establish a nerve centre in every health
facility. Other operations like pharmacy stores, general practitioners, universities, and any other site, shall be attached to each hospital nerve centre. CEOs of hospital have further been instructed to select one person to be dedicated full‐time to the campaign in each and every hospital, and every clinic attached to it.
I have met hospital CEOs from six provinces, and still have to meet those from Northern, Eastern and Western Cape, but they are all busy with preparations.
Provinces shall soon also establish nerve centres.
Due to the size of the campaign, a lot of human resources are going to be needed:
The NGO sector has pledged to mobilise 9,000 lay counsellors
The SANDF has pledged their medical personnel
We have asked medical universities to release all their final year medical
students for at least 5 days in the first week of the campaign. Medunsa and
the University of the Free State have already obliged. I am waiting for a
response from the other medical universities.
I have written letters to all retired nurses, doctors, pharmacists and social
workers, and I am hoping for a favourable response. Over 4000 retired health workers have already offered to assist.
Condoms and Test kits
In terms of test kits for the campaign, 2.1 million kits are already available in all nine provinces, and an additional 1.9 million test kits have been ordered. The rest shall be ordered as the campaign progresses.
In terms of condoms, the government is distributing 450 million male condoms
currently. In this campaign, we will increase this drastically. Each person receiving
HIV counselling and testing will receive 100 condoms. Hence we need 1.5 billion
condoms for 15 million people tested. Furthermore, we wish to distribute another 1 billion condoms to public facilities, especially FIFA‐accredited hotels, hospital and clinics.
We shall then need 2.5 billion male condoms over the next year.
For this purpose, 177 million condoms have been purchased for the initial phase of the campaign, and of this, 91 million were distributed last week – ready to be handed over to 910,000 people.
In terms of laboratory capacity, we have met with the NHLS and they are busy
establishing the necessary capacity.
I wish to take this opportunity to recap and clarify the World AIDS Day
announcements pertaining to treatment.
There were four major announcements:
Pregnant women with a CD4 count of 350 or below will receive treatment.
Alternatively, if they show symptoms of advanced HIV infection, regardless of
the CD4 count;
Infants, that is children below one year who are HIV positive will start
treatment, regardless of their CD4 count;
All pregnant women whose CD4 count is above 350 will start PMTCT at 14
weeks, instead of 28 weeks as is the practice now;
All TB and HIV co‐infected people will start treatment at CD4 count of 350 or
In addition to all four announcements, we wish to state that we took a decision as a country to scale up INH prophylaxis for people who are HIV positive, but who don’t have active TB. This is to protect them from acquiring TB. We regard this as a very serious intervention that will help us to control the TB epidemic.
I wish to take this opportunity to thank our development partners:
The US government with its various agencies, USAID, CDC and the US Embassy
The United Kingdom through DFID
The Swedish government, through SIDA
The German government, through its various agencies – GTZ, KfW, DED and
The European Union
The Bill and Melinda Gates Foundation
The Clinton Foundation
The role played by other UN agencies like WHO, UNICEF, UNFPA, UNHCR, ILO
The role they have played is immense.
The contribution of the World Bank and the Global Fund to fight AIDS, TB and
Malaria, is also difficult to express in words.
Ladies and gentlemen, as you can notice from attendance at this meeting, you as
South Africans have really shown your commitment to this campaign. Each one of you did not come here as spectators.
Over the past two weeks, I met with several of you as representatives of
organisations and sectors, but also in your individual capacities. You agreed to come here to pledge your support and be part of the campaign.
I met you as:
Human rights sector
Lesbian, Gay, Bisexual and Trans‐Sexual Sector
Sport and entertainment sectors
Celebrities, and many others
I am overwhelmed by your support.
I regard what we are about to embark on as attempting to climb Mount Everest.
But I am confident that working together in this enthusiastic manner, Mount Everest is possible to conquer.
I thank you.