The struggle for anti-AIDS drugs in South Africa

FRFI 165 February / March 2002

The leading killer in South Africa (SA) is the pandemic AIDS which, according to a 2001 government study, accounts for 40% of deaths. At a rate of 4,800 deaths a week, many people in the country are demanding that HIV/AIDS be declared a national emergency. But the ruling African National Congress (ANC) government of President Thabo Mbeki continues to dither while people die. Mbeki is more concerned with reducing social and healthcare expenditure and keeping company taxes down. He does not want to seem to be attacking the interests of the capitalist class.

No single issue has lost the ANC government more credibility than the AIDS crisis. Mbeki became the laughing stock of the world when a few years ago he claimed that HIV did not cause AIDS and that the disease was possibly a fabrication by Africa’s enemies. The president’s ridiculous views stopped being a laughing matter when the South African government refused to take vigorous steps to fight the pandemic because of the ‘unproven’ nature of its existence and hence the efficacy of measures to combat it. Under pressure from public opinion to retract his unfounded statements, Mbeki appointed an expensive but dubious advisory panel to ‘investigate’ the link between HIV and AIDS.

Meanwhile 70,000 babies a year are born infected because of the failure of the government to provide drugs to stop mother-to-child transmission (MTCT) of HIV. Most die before they are five despite research showing that infection could be reduced by up to 50% if an anti-viral drug, Zidovudine (AZT), is administered at birth and the baby is not breastfed. The then Minister of Health, Nkosazana Zuma, refused to provide this drug on the grounds that it had harmful side effects and its efficacy had not been scientifically proven. It was left to Mbeki’s spokesperson, Parks Mankahlana, to give the real reason for the government’s refusal to provide AZT. He said that if the government gave AZT, the babies would be saved but then it would be left to the government to raise the orphans and this would be a strain on the budget. In a macabre twist Mankahlana himself then died from an AIDS-related illness.

On 10 December 1998, International Human Rights Day, the HIV/AIDS Treatment Action Campaign (TAC) was launched to fight for greater access to drug treatment for all South Africans. Its leader is Zackie Achmat, himself living with AIDS. TAC has waged an effective campaign involving raising public awareness, mass action and legal action which has received widespread support in the country and exposed the government’s failures. Significantly it works closely with COSATU, the biggest trade union federation in SA which is also in a formal alliance with the ANC and the South African Communist Party. It was as part of such a ‘united front’ with COSATU and other national and international organisations that the TAC tackled the pharmaceutical giants and won.
In 1997, the ANC government had passed the Medicines Control Act which allows the parallel importation of cheaper patented medicine into the country. The act, which was not implemented, would have obliged pharmacists to prescribe cheaper generic versions of unpatented medicines and to set up a pricing committee to introduce a transparent pricing system for all medicines.

The first attack on the Medicines Act came from US Vice-President Al Gore who, on behalf of the pharmaceutical corporations which funded his campaign, tried to bully South Africa from enacting a law which threatened profits. Gore withdrew after protesters turned up at a Democratic Party convention to choose the party’s presidential candidate for the next election. The Pharmaceutical Manufacturers Association, representing 39 companies, was left with no choice but to do its own dirty work, launching a legal action against the South African government. The TAC, COSATU and many organisations inside and outside SA backed the South African government and came out firing on both barrels. The case grabbed the world’s attention and the TAC campaign in the streets and inside the court left the pharmaceutical giants no choice but to withdraw. The message was clear: the medicine companies wanted to make profit at the expense of millions of people’s lives. South Africa’s victory was a victory for the working class and all the sick and penniless of the world.

However, vacillating between the interests of big capital which it serves and paying lip service to the black working class in whose name it rules, the ANC did not capitalise on its victory by immediately importing cheaper drugs. Instead the new minister of health, Manto Tshabalala-Msimang announced that the government would still not provide anti-retrovirals to HIV-positive pregnant mothers but instead would set up ‘pilot studies’ in selected parts of the country. She also argued against AZT saying it was expensive and had dangerous side effects. Her department also resisted pressure to provide anti-retrovirals to rape victims, many of whom were getting infected due to the high prevalence of gang-rape amongst the 1.6 million rapes in South Africa per year.

The ANC government’s stubborn refusal to provide treatment to HIV/AIDS patients was recently struck a further blow. In December 2001 TAC took the government to court demanding that it provide anti-retrovirals to pregnant women to prevent MTCT. The case was based on Section 27 of the country’s constitution which guarantees every citizen a right to health care, including reproductive health care, so long as this is ‘within the state’s available resources’. The judge ruled that the government is obliged to provide anti-retroviral treatment, in particular, the cheaper nevirapine syrup which costs R10 (less than 50 British pence) per dose. The government is appealing against the decision on the grounds that it will create ‘budget distortions’, throw the health system into chaos and set a bad precedent where ‘judges make policy’. The ANC is refusing to implement the provisions of a rights-based constitution it drew up itself.

Recent research has shown that rape victims who receive anti-retroviral drugs within 72 hours of their ordeal have a 100% chance of not being infected. This totally exposes the government’s claims that such treatment does not work as an excuse to keep state health expenditure down at the expense of the people. Only a few weeks ago an ANC provincial minister of health refused to provide such treatment to a nine-month-old baby who had been gang-raped. It is becoming increasingly clear to many South Africans that the ANC government is incapable of addressing the HIV/AIDS crisis just as it is unable to solve any of the numerous problems faced by the working class: unemployment, homelessness, low wages, illiteracy, etc. Mbeki and his party have chosen to manage capitalism rather than struggle against it. Workers in COSATU and activists of the TAC fought against the pharmaceutical companies when it became clear that the medicine bosses were prepared to let people die in order to make profits. Many workers in South Africa are beginning to see that it is not only pharmaceutical profits that kill, but that all bosses are murderers because their system kills workers.

Trevor Ngwane


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