| IF NOT
NOW, WHEN? IF NOT YOU, WHO?
Helen Keller
In this edition of share we invite you to look
back at the year 2003 to the context within which
war was waged to increase political commitment
to stem the HIV/AIDS epidemic. In a January trip
to Iraq, Health Minister Tshabalala-Msimang pledged
South Africa's support to Iraq's health care system.
Health care facilities in Iraq were severely challenged
by an inefficient procurement system attributed
to sanctions impacting on the country’s
access to medicines and health technology. The
South African Minister of Health and her counterpart,
Dr Umaid Mubarak, agreed to strengthen their bilateral
relationship in three areas including preventative
medicine. In the same month, US President George
Bush declared a US $15 billion emergency AIDS
pledge for "a work of mercy" where the
US would "lead the world in sparing innocent
people from a plague of nature".
Andisha
Maharaj manning the HIVAN stand at the first national
AIDS
Conference held in Durban (03 - 06 August 2003)
The month of February witnessed President Bush’s
release of an emergency AIDS budget proposal for
allocating the US $15 billion over a 5-year period.
The budget, which triples US commitments to HIV/AIDS
care, treatment and prevention for 2004 through
2008, witnessed cuts in various other programs,
such as a US $9 billion cut in transportation
and cuts of almost US $1 billion in US Labour
Department training programs.
On 19 March, the eve of the U S invasion of Iraq,
South African Finance Minister Trevor Manuel dismissed
the use of antiretrovirals in the treatment of
HIV/AIDS as "voodoo", commenting that
such spending was "a waste of very limited
resources." At this time, Health Minister
Manto Tshabalala-Msimang, absent from both meetings
of the South African National AIDS Council (SANAC)
in February and March, reportedly proposed "garlic,
lemon, olive oil and African potatoes" as
superior options to antiretrovirals.
While the world focused on the US-led war in
Iraq in April, the battle for the HIV/AIDS Authorization
Bill, H.R. 1298 was waged quietly within the walls
of the U S Congress, with conservatives advancing
amendments that supported an 'abstinence-only'
approach to prevention. In the same month, GlaxoSmithKline,
one of the biggest manufacturers of AIDS drugs
in the world, halved the price of its leading
AIDS drug, Combivur, in sixty-three countries,
including South Africa.
In the wake of President Bush's declaration of
closure on the major combat phase in the Iraqi
War on 1 May, US Congresswoman Nancy Pelosi strongly
resisted the proposed allocation of at least thirty-three
percent of prevention funds to abstinence-only
programs. She urged: "H.R. 1298 is a bipartisan
Bill that we can all proudly support. It’s
a Bill that President Bush supports. Why sacrifice
that broad support in the name of politics, especially
when so many lives are at stake?” The U.S.
Leadership Against HIV/AIDS, Malaria and Tuberculosis
Act of 2003, with the proposed abstinence-promotion
amendment applied to one third of proposed prevention
expenditure, was passed on 16 May 2003 by the
United States Senate.
In June, South Africans cheered as Bill Clinton
pledged his foundation to the treatment of 700
000 HIV/AIDS patients over a five year period
(2004-2008). In the same month, the Medicines
Control Council approved the first vaccine trials
for South Africa. The research trials are taking
place in Johannesburg and Durban. July witnessed
a historic trip by President Bush to South Africa.
At a press conference held on 10 July, Mr Bush
and Mr Mbeki avoided debate on their disagreements
over the war in Iraq, dwelling constructively
on bilateral economic treaties and the emergency
AIDS pledge. The quiet diplomacy of their interaction
was contrasted by protesting activists wielding
slogans.
 Major
victories were achieved in August 2003. South
Africa's first National AIDS Conference in Durban
was convened and chaired by Professor
Hoosen Coovadia, one of HIVAN's widely-published
and acclaimed directors, and Victor Daitz Chair
of HIV/AIDS Research at the Nelson R Mandela School
of Medicine, University of KwaZulu-Natal. Intensive lobbying
at the conference was followed shortly by Cabinet's
request to the Ministry of Health for the delivery
of an operational plan for the roll-out of antiretrovirals
as a matter of urgency. The Minister of Health
appointed a National HIV and AIDS Treatment Task
Team, to co-ordinate the drafting of the operational
plan which was delivered timeously end-September.
A further milestone for 2003 was an agreement
signed in early September to allow developing
countries improved access to generic drugs for
HIV/AIDS. The 13th International Conference on
AIDS and STI's in Africa (ICASA), hosted by the
Swiss Tropical Institute, was convened in Nairobi
in late September. Entitled "Access to care:
challenges", the conference was attended
by 7 200 official delegates from 109 countries.
This was followed in October by Bill Clinton's
deal with four generic drug companies to provide
low-cost drugs to developing countries and a visit
by President Mbeki to India. Here, agreement was
reached on India’s provision of registered
low-cost generics to South Africa. October also
witnessed announcements of plans to pilot finger-prick
testing to monitor blood cell counts or HIV viral
levels by disease researchers in African countries.
The signing of a crucial agreement between KZN
traditional healers and medical doctors representing
the Nelson R Mandela School of Medicine, University of KwaZulu-Natal, was a further highlight for October.
Also significant in October was the Minister of
Social Development, Dr Zola Skweyiya's, call to
all NGOs, particularly those from the faith-based
sector, to collaborate with the public sector
in government grant application and delivery processes.
A significant issue compromising such collaboration,
reiterated by organisations present at the first
Shellcross Community Forum in Durban, is the capacity
of grassroots organisations to secure and account
for government funding.
November witnessed the first meeting of the reconstituted
SANAC and the first HIV vaccinations in Johannesburg
and Durban. Rumours of government imperatives
to medical schemes to offer antiretroviral therapy
in 2004 circulated after schemes announced cuts
in provision of cover to patients with chronic
psychological disorders.
Following the delivery of the operational plan
for roll out of antiretrovirals to cabinet end-September,
in camera government discussions in the last quarter
of 2003 focused: on eliciting critical support
to the roll-out from traditional healers, and
on the identification of district-level service
points to encourage integration of services in
the roll-out plan. In-principle cabinet approval
of the operational plan was forthcoming in this
quarter.
A further coup for the last quarter occured when
Finance Minister Manuel committed R 12 billion
to a medium-term budget for HIV/AIDS. The challenge
to both government and activists for 2004 onwards
is to ensure that this budget is wisely spent.
A further challenge is to ensure donar commitment
to funding and the fair distribution of available
funds. This will be particularly important if,
as maintained by activists, Bush's 5-year pledge
of US $15 billion will shrink to US $12,862 billion,
once all non-AIDS and research spending has been
subtracted.
MRC
Vaccine Trials Unit CAB members undergoing a values
training exercise
The impetus to spend available funds wisely is
also compelled by Washington’s cut in contributions
to the UN's global fund to fight AIDS from US
$350 million to US $200 million. South Africans
are compelled to address the prospect of diminished
long-term funding, more so if valuable U S funds,
equating to US $4 billion a month, are spent on
maintaining occupation of Iraq in the medium-
to long-term.
It is almost two years since 19 February 2002
when Health Minister Tshabalala-Msimang declared:
"South Africa cannot afford drugs to fight
HIV/AIDS partly because it needs submarines to
deter attacks from nations such as the US."
The high-tech weapons referred to cost South Africa
US $5 billion. Trevor Manuel's commitment of the
R 12 billion medium-term budget to HIV/AIDS in
November tells us that government is, in part,
committed to the HIV/AIDS epidemic. Effective
planning is important to give weight to this observation.
In view of the impetus towards effectiveness
in the context of limited funding, academic, government,
NGO and corporate sectors have a responsibility
to ask: How can we work together to implement
HIV/AIDS interventions that reduce the impact
of the disease and save financial resources in
the process? To address this question we look
further, in this edition of share, to the concept
of cost-effectiveness, with a particular emphasis
on HIV/AIDS prevention interventions. We further
highlight grants that are available to persons
infected with HIV/AIDS with a view to emphasizing
points of access to these grants. HIV/AIDS, the
law and dismissal is a further focus, as is a
case highlight to demonstrate good practice with
regards planning in the private sector. We hope
you enjoy this issue of share and we look forward
to your comments.
The following sources have been used
in this article:
On-line news: Associated Press, BBC online, Mail
& Guardian, Business Report
Other websites: Government Communication and Information
System (GCIS)
Journalists Against AIDS
Cabinet Reports: “State of the Union”
address by President Bush on 28 January 2003
Statement to Congress entitled “HIV/AIDS
Prevention is too important to be undermined by
politics: We must support what works” by
Nancy Pelosi on 01 May 2003
<<Back |
