Mail & Guardian (Johannesburg) - August 15, 2003

The Treatment Action Campaign (TAC) said that while it welcomes the nnouncement, it is also "cautious". "[The announcement] came out of a very long period of contest within the government ... [and] out of a long period of denial at the highest level of the government that does not evaporate overnight. So it is not as if suddenly on Friday August 8 all the old problems fell away," said TAC secretary Mark Heywood.

But "the fact that they put the joint treasury and health report [on the costing of ARV treatment] on the Web and distributed it is very important," he said.

"It is a recognition of an intention to move forward ... [The government] knows this report would be the centrepiece of any litigation if there was not an intention to move forward."

Among health-care practitioners there remains doubt about the government's ability to deliver. "I'll be waiting with anticipation. Very often announcements are made, there are high expectations - then delays," said Sue Roberts, chief nurse of Helen Joseph hospital's HIV clinic.

She said the announcement has resulted in patients expecting ARV treatment immediately. "We do have the capacity to roll out, but the hospital budgets are seriously strained."

Roberts said the ARV treatment must have a separate budget, and all public health-care services need to be strengthened for the successful roll-out of ARVs.

She said the roll-out could boost staff numbers. Many health-care workers have left the public sector, feeling "useless" because they could not treat people with Aids. They might now be tempted to return, she said.

It is business as usual at the Cotlands Baby Sanctuary in Johannesburg, which is not taking any chances: it will not drop its fundraising efforts to sponsor ARV treatment for children.

"Until we can walk into a clinic and get the drugs, we are operating as normal," said Jackie Schoeman, director of Cotlands. The sanctuary has 11 children on lifelong ARV treatment, but another 14 also need it. "If treatment is provided, these children stand a chance of being adopted and integrated into society."

Currently children remain institutionalised at places such as Cotlands because their ARV treatment is sponsored by corporations. "We do not need three years to workshop the issue. There are projects that can be used to scale up this national treatment," Schoeman said.

Heywood said the TAC will not redefine its role because of the announcement. It has never been a protest organisation and its primary objective is to save lives and make sure people with HIV/Aids have access to affordable treatment. "Our focus will now be at local and community level around the lack of training, stigma and bad drug procurement supplies."

The TAC is still involved in putting pressure on the pharmaceutical industry to reduce the price of ARVs. This is one of the aims of the Generic Anti-Retroviral Procurement Project (Garpp), a wholesaler consisting of 19 projects that consolidated their efforts in response to the crisis in access to affordable ARV drugs. In the light of the announcement, Garpp's role is to promote access to low-cost ARVs of good quality for its members, says Marta Darder, spokesperson for Garpp and coordinator of M d cins Sans Fronti res in the Western Cape."A lot of this experience has been generated by projects that are Garpp members." Darder said it will advocate that the government benefit from experience already accumulated. There are 24 projects providing treatment to 1 454 candidates nationally.

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