It is not the end of AIDS and therefore not the end of the TAC

AIDS is not over. Over six million people in South Africa are HIV-positive.Our country has the world’s largest AIDS treatment programme withover 2 .4 million people on antiretroviral therapy. At least another two

millionpeople will require treatment inthe next five years. In parallel withthe scale-up in the provision of AIDS treatment, life expectancy at birthhas recovered from a low of 54 years in 2005 to 61 years in 2012.This isstill 20 years fewer than most inhabitants of industrialised countries canexpect to live, but demonstrates the importance of ensuring that theantiretroviral treatment programme continues to work and improve.

Some are talking up an ‘end to AIDS’ by 2030. There is nothing we would want more than to end AIDS. But while some models have shown that this may be possible, this is by no means the trajectory that we are on. As this issue of the NSP Review reveals behind the triumphant sets of top-line statistics there is another much bleaker picture emerging. There are worrying indications that the AIDS response is stalling – and perhaps beginning to unravel in parts and places.

In his June 2014 budget vote speech Health Minister Dr Aaron Motsoaledi stated that 37% of patients starting antiretroviral treatment are lost to follow-up three years after initiating treatment. Even if this number is an overestimate, we are still in trouble. An independent survey published by the Stop Stock Outs Project in late in 2013 found that one in fi e healthcare facilities had experienced a stock out of key HIV or TB medicines at least once in the preceding three months.

While South Africa has generally good health policies under Dr Motsoaledi, we are witnessing growing evidence that the implementation of these policies is now failing. Our report on the crisis in the NHLS should be of huge concern to all readers because the NHLS is the backbone of the HIV programme.

In many respects the healthcare system suffers from the same mismanagement, corruption, cadre-deployment and politisation that plagues much of the public service. Our reports on the Free State show how the problem is exacerbated by bad governance in most provinces, which provide the bulk of health services Provincial administrations suffer from poor capacity and weak management systems, while Health MECs like Benny Malakoane are appointed on the basis of political loyalties, rather than commitment or competence.

In this context, the TAC’s work to campaign for quality healthcare for all has by necessity become intertwined with the struggle for good and accountable governance and management of the public health system. This is likely to be the most signifi t challenge facing South Africa in coming years. Civil society monitoring and reporting is crucial. Well- informed, human-rights-based, politically astute civil society organisations like the TAC have a crucial contribution to make in this struggle. Strong activism by TAC has driven the AIDS response for 15 years. Only strong activism can sustain it.

On November 4, Archbishop Desmond Mpilo Tutu, a man who embodies the best of activism, made a plea to save the TAC. These are his words:

“HIV/AIDS brought out the worst and best in us. Political paralysis caused delay and confusion. Death blighted the land. But citizen activism led by the Treatment ACTION Campaign in particular restored hope and dignity. The actions of the TAC were a vindication of our wonderful constitution.

But my message to you is that AIDS is not over. Thousands still die and are newly infected. AIDS is not over while one person still needs ARV medicines or dies of Tuberculosis. It is not over until the last new HIV infection. It is not over until the evils that drive HIV, like rape and violence against women and children, are defeated.

There is still a long road ahead.

So this is a time for rededication and new commitment. It is a time to find our fire again.

There was a time when the campaigns of ordinary people, rallying together with T-shirts that said “HIV positive”, taking to the streets as the TAC, rescued our country from a disastrous response. Now I ask you to come to the support of the TAC. Please show solidarity and prove your belief in others’ humanity by donating to the TAC in the organisation’s time of need. Let us show that we will invest in our own quest for social justice Let’s keep activism and accountability alive.

Please support the TAC.”