Inter Press Service - December 21, 2001
Farah Khan

It has been the year in which the technical medical terminology of terms like "anti-retrovirals" that do not slip easily off the tongue have become commonplace.

Placards like "Mr. Mbeki, give us Nevirapine" and "AZT for pregnant women and babies now" spoke of a new consciousness about the life-saving abilities of these drugs.

Thabo Mbeki is the president of South Africa.

Ordinary people first took on the multinational pharmaceutical companies and later the state in an effort to secure treatment that has transformed AIDS in the West from a death sentence to a manageable disease. The drugs offer a medium-term solution, while a vaccine is still the coveted prize.

As the disease starts to peak, the debate is increasingly shifting in sub-Saharan Africa toward securing drug treatment. And it is a battle often waged by women.

One soldier in the new fight is Sindiswa Godwana. She was in the frontlines of the court battle in March, when the South African government was taken to court by 40 pharmaceutical companies to prevent it from putting in place laws that would make it possible to import the cheaper generic versions of anti- retroviral drugs.

The drugs are manufactured in developing countries like Brazil, India and Cuba. Godwana, 31, is an AIDS activist from Cape Town who made the 1,100-kilometre road trip to Pretoria where the case took place. When she is not on the streets lobbying for AIDS drugs, she is a counsellor to other young women bewildered by the energy-sapping, life-taking immune deficiency disease.

"Ginger is excellent for flu. Garlic also strengthens the immune system," she says.

But it is not as effective as the tongue-twister patent drugs and their generic equivalents that activists like Godwana have come to say so easily. "Diflucan's very expensive and flucanazol is cheap. If you've got thrush, these drugs can help."

She reels off the names of friends who have died of AIDS when ginger and garlic became ineffective and drugs were too expensive.

The pharmaceutical companies caved in under the eloquent pressure of activists like Godwana and the case was proclaimed a victory for developing countries like South Africa.

The settlement paved the way for other countries to also pass legislation that could override the draconian intellectual property rights regime of the World Trade Organisation (WTO) and Kenya, for example, has taken the gap.

What the court victory also did was win the hearts and minds of developing countries. Reading the writing on the wall, pharmaceutical companies reduced the price of life-saving drugs drastically so that some drugs are now 85 percent of their initial cost. In countries like Botswana and Lesotho, companies are giving the drug free for a stipulated period.

Their attempts to make the drugs affordable have been cautiously welcomed, but activists say these can be piecemeal. What is needed is a global tiered pricing system that introduces greater certainty and standards.

"They seem more willing to countenance limited, ad hoc arrangements that are easier to control and less likely to lead to profit-reducing, parallel importing," according to an HIV/AIDS dossier in the ACP-EU Courier magazine. ACP is the African, Caribbean and Pacific group that has a special trade arrangement with the European Union (EU).

In addition to such a pricing policy, more funding is also necessary to extend treatment. A report on the United Nations IRIN service said Stephen Lewis, the UN special envoy for AIDS in Africa, said 2002 should be a breakthrough year for access to treatment.

"Africa is now mobilised and ready to take advantage of all the plans that are in place, but it needs a dramatic infusion of donor dollars and that money is not there," he said.

Currently only 30,000 Africans living with AIDS get anti- retrovirals - against an infected population of 25.3 million people, according to UNAIDS.

In November, the World Trade Organisation members agreed to a declaration which clarifies that the Trade Related Aspects of Intellectual Property agreement (TRIPS) should not prevent developing countries acting in the interests of public health.

In addition to the judgement, this declaration also creates the context for poor countries to secure cheaper drugs, either through price reduction or through parallel imports.

But as the epicentre of the pandemic has moved into Southern Africa, attention is increasingly falling on the South African government's prevarication on AIDS.

President Mbeki's government has failed to take the gap opened up by the March court victory - no efforts have been made to import generic drugs. Instead, government has repeatedly questioned their efficacy and raised queries about toxicity.

By the end of the year, it had arguably lost the moral high ground when activists won a court case ordering the state to introduce a drug treatment programme to prevent the transmission of HIV from pregnant mothers to about 70,000 babies a year.

Health Minister, Manto Tshabalala-Msimang, has decided to appeal the judgement, opening the way for another fractious year in 2002.

Lawyers are taking on HIV-positive babies as their clients, and suing the state on the infants behalf. It is likely to be the pattern next year as government digs in its heels and insists it will not extend a treatment programme until it has the necessary infrastructure and safety insurance.

Yet, poorer countries like Senegal and Uganda, as well as wealthy Botswana, are introducing treatment programmes, while Kenya is likely to import generic drugs.

These countries have realised that prevention and treatment are both vital weapons in the AIDS fight.

In the 21st century, African leadership is increasingly being forced in the HIV/AIDS arena. "The President himself speaks out on AIDS," says Senegal's Health Minister Dr Awa Marie Coll-Seck to explain the countries' success in curbing the spread of AIDS.

South Africa, unfortunately, is suffering a lack of leadership in its battle. And its one factor that has seen the country eclipse all other African nations, except Botswana, in the rate of HIV infection.

Sub-Saharan Africa is by far the worst affected region in the world. The estimated 3.4 million new infections in sub-Saharan Africa in 2001 mean that 28.1 million Africans now live with the virus, according to UNAIDS.

It estimates that 2.3 million Africans died of AIDS in 2001.
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