Some victories, but not the end

Some victories, but not the end
30th November 2014 | Spotlight

A number of people have over the years played a role in the development of the TAC and our battle for antiretrovirals. There are too many to mention. In the following pages a small group of people who played a role in one way or another and represent various constituencies, share their recollections of the past and their dreams for the future.

Dr Eric Goemaere is the medical coordinator of Médecins Sans Frontières in South Africa. This activist doctor has been a key ally of the TAC since his arrival in 1999. He serves on the TAC Board of Directors.
Dr Eric Goemaere is the medical coordinator of Médecins Sans Frontières in South Africa. This activist doctor has been a key ally of the TAC since his arrival in 1999. He serves on the TAC Board of Directors.

Looking back, I realise I was naïve when I landed at Johannesburg Airport from Brussels in August 1999, convinced Médecins Sans Frontières would trigger a Prevention of Mother-to-Child Transmission (PMTCT) breakthrough, at the time considered to be the first step of a large-scale public HIV treatment programme. It was to be a quick reality check for me. There was to be no soft landing: The then health minister Dr Nkosazana Zuma had forbidden AZT use and nurses in Khayelitsha went out of their way to prevent us from starting as this would “attract lots of HIV infected people”. Denial was everywhere, fuelled by non-scientific propaganda, while science and human dignity “bodyguards” from the Treatment Action Campaign to the University of Cape Town, from The Aids coalition to the Congress of South African Trade Unions, rallied to form a human shield between criminal policies and activists doctors. Dissidents were on both sides of the fence. We found allies in government via for example then Western Cape government official Dr Fareed Abdullah and even Madiba himself who came to our rescue in late 2002 while denial and repression was rife.
Our early candidates (patients) all presented in what health workers term the terminal clinical stage, with a median baseline CD4 count of 40 (people with health immune systems have a CD4 count of between 500 and 1 500). The candidates with these low CD4 measures required urgent treatment, however we could at the time really only offer treatment to one out of three people we saw as we had severely restricted resources. It was an unbearable ethical dilemma for doctors desperate to save lives.

In today’s era where antiretrovirals are freely available for all eligible candidates with some of the best regimens including fixed dose combinations on offer and accessible in most public primary health care clinics across the country, this can be called “a dream come true”.

What would have sounded like total Utopia at the end of the 90s is now the norm rather than the exception in most sub-Saharan countries.

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Looking back we have no doubt scored a victory, but let us not forget the struggle lessons we can learn from a very dark time in our history: The best of science joined forces with the best of civil society, a grassroots struggle involving people fighting for their rights and dignity and ultimately for their lives.

Despite major progress, the end of the epidemic is unfortunately not yet in sight – keeping people initiated on antiretrovirals, on long term treatment is not easy. We still face unacceptable incidence (new infection) rates in adolescent and young adult women, another epidemic within an epidemic.

Can we treat ourselves out of the epidemic? I think we are one third of the way, but we simply do not have available funding, including international funding, for the remaining two-thirds.

We urgently need new bio-medical tools to cut on HIV incidence as much as we need massive community support to keep the people on treatment alive and fighting. Ten years is worth remembering, but the struggle goes on!