A Decade of Fighting for our Lives

A group of South African activists founded the Treatment Action Campaign (TAC) on 10 December 1998, International Human Rights Day. It was no accident that TAC was formed exactly fifty years after the adoption of the Universal Declaration of Human Rights. The backbone of TAC is its use of advocacy to fight for the realisation of the right to health, which is enshrined both in international treaties and in the South African Constitution.
At the time when TAC was formed, South Africa was falling into a health crisis. Today, more than 5 million South Africans are infected with HIV, and 1500 are newly infected each day. Approximately 2.5 million deaths occurred between 1990 and 2008. South Africa also faced an escalating tuberculosis (TB) epidemic, as well as growing epidemics of multi- and extremely-drug resistant TB. During this time, maternal and child mortality also reached a crisis point.
During its first decade, TAC focused on challenging government health policies that were not evidence-based and were putting multinational profits above people. In the beginning, TAC struggled to secure access to particular medicines for poor people who could not afford them. Its members saw that while many poor people in developing countries were not able to access lifesaving treatment, people living with HIV in richer countries were benefiting from these medications. TAC tried to engage with pharmaceutical
companies, encouraging them to be transparent in how they came up with the prices they were charging. However, few companies were willing to disclose this information, because it would have revealed how they made millions of dollars in profits in countries like South Africa at the expense of the poor, who continued to die from treatable and manageable diseases.
TAC forged solidarity partnership with activists in Brazil, India, Thailand, the United States, the United Kingdom, and other countries. Together, it created a global movement to fight drug company profiteering by challenging the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, and its application in developing countries with significant HIV, TB, or malaria epidemics. TAC went to court to challenge the patents of multinationals such as Pfizer in South Africa for their exorbitant price of essential drugs like Fluconazole.
TAC challenged patents that allowed drug companies to sell essential medicines without competition and earning enormous profits, while many poor people were unable to afford crucial treatments. It exposed this conduct by gathering affidavits of people living with HIV and health care workers, together with evidence of prices from the generic drug industry. This information was provided to South Africa's Competition Commission to demonstrate that the market must be opened to allow more companies to compete. Subsequently, this led to a more competitive market in South Africa and the price of HIV triple therapy fell from about R4500 per month, to just below R200. Once prices had fallen to this level, TAC activists were able to push the government to dramatically expand access to HIV treatment.
During this time, TAC faced an extremely hostile political environment. Under the leadership of former President Thabo Mbeki, the Health Ministry focused on making excuses for why government was unable to provide HIV treatment. It eventually became clear that we were dealing with a denialist government that went so far as to publicly refute the crisis in the health system. The government flatly denied that many women and children were dying in our public health system, and promoted alternative therapies, such as traditional medicines, with much more passion than they promoted HIV treatment. TAC had little choice but to respond to these abuses of power by mobilizing communities, creating active citizens to challenge the government's denial and lack of will to fight HIV effectively. TAC volunteers created grassroots branches across South Africa to educate, organize, and mobilize our communities, teaching them about human rights and the science behind HIV. Over time, this activism, combined with the frustration of many poor people, gave rise to a social movement. TAC fought to give meaning to the words in South Africa's Constitution that guarantee the rights to health and life, using many strategies, including litigation, to empower poor communities and hold the government accountable for policies that resulted in unnecessary deaths. TAC forged strategic partnerships with key movements in South Africa, including the faith-based organizations, labour and unions, children's organizations, Médicins Sans Frontières, and prominent legal organizations, including SECTION 27 (incorporating the AIDS Law Project) and the Legal Resources Centre. This movement inspired many activists in Africa to take similar actions in their own countries under the leadership of a new movement called the Pan-African Treatment Access Movement.
Collectively, we were able to achieve significant changes in South Africa. In 2004, treatment of HIV using antiretroviral drugs in the public sector became official government policy. In 2007, TAC became an important partner in the drafting of a new comprehensive National Strategic Plan to Fight HIV/TB and Sexually-Transmitted Infections from 2007-2011. This marked the beginning of a new chapter in South Africa, where civil society and government united in the fight against HIV/AIDS. Rather than fighting unjust policies, TAC shifted towards ensuring that the government carried out the policies it had committed to implement. We knew that this new plan required political leadership to make it a success. In 2008, Barbara Hogan replaced the former Minister of Health, MantoTshabalala-Msimangwas. For many people living with HIV, this was a welcome sign of change. A year later, Dr. Aaron Motsaoledi took over the ministry, and TAC welcomed another strong leader and mainstream health professional. These changes have led to 1.2 million people receiving treatment in 2011, and the government plans to double that number by 2014. Today, government and civil society have very few disagreements on policy matters. The remaining challenge is to ensure implementation of the HIV/AIDS plan.
South Africa has the largest HIV epidemic in the world and the largest HIV programme in terms of the number of people receiving treatment. Sustaining the government's commitment to providing HIV/AIDS treatment remains a critical area of focus. Additionally, we think our country now has an opportunity to help explore creative ways to finance its health system to serve as many people as possible. South Africa is on the right track, but it needs to increase its efforts on prevention interventions, as well as working to close the leaking prevention "tap."
South Africa's performance toward reaching the Millennium Development Goals on reduction of child and maternal mortality and stopping HIV and TB are dependent on ensuring robust investments in training, deploying more healthcare workers, finding innovative ways to deliver primary health care, continuing efforts to reduce the prices of HIV treatment, and ensuring that existing financial resources can be stretched further.