BY PATRICK BOND
JOHANNESBURG — On November 19, the African National Congress (ANC) government finally conceded that it must begin providing anti-retroviral (ARV) medicines to hundreds of thousands of people who are HIV-positive. Activists hope that the 5 million infected South Africans, who account for more than a quarter of the country's adult population, will eventually get the desperately needed medicines.
Victory was declared by South Africa's Treatment Action Campaign (TAC) and its international allies, including US-based activist group ACTUP, British-based charity Oxfam and France's Medicins Sans Frontiers (Doctors Without Borders).
South Africa's President Thabo Mbeki, the pharmaceutical corporations and South African big business have resisted the TAC's demands for universal access to ARVs for years. They remain responsible for hundreds of thousands of unnecessary premature deaths.
Even though shopfloor cost of HIV/AIDS — absenteeism, declining productivity, payouts for early death — has soared to as high as 25% of the South African payroll, according to the September Financial Times, most employers are still hesitant to provide ARVs.
South Africa's huge pool of unemployed labour — more than 40% of the potential work force — has meant that local capitalists can readily replace unskilled workers who develop AIDS symptoms with desperate, jobless people. This is less expensive than providing medicines.
Last year, the most respected of South Africa's business journalists, Ken Owen, predicted that until 2010 or even later, "the lost workers will be quite readily replaceable from the millions of unemployed, and society will adjust in a myriad of ways to labour shortages". Some firms' cost-benefit analyses showed that it was only "worthwhile" for a company's "bottom line" to provide ARVs to the highest-paid 12% or so of employees, because of the cost of recruiting and training replacements.
The government's statement announcing the provision of ARVs cited these factors for its change of policy:
- a fall in the prices of drugs over the past two years;
- new medicines, and international and local experience in managing the utilisation of ARVs;
- sufficient health workers and scientists with skills and understanding to implement the program; and
- the availability of fiscal resources to expand social expenditure in general, as a consequence of the "prudent macro-economic policies pursued by government".
However, the ANC government did not dare mention the key reason for its "back flip" — the massive political pressure generated by the campaign waged by the TAC — lest it encourage further protests.
The TAC's victory statement was explicit: "The combination of the Constitutional Court decision on mother-to-child transmission prevention, the Stand Up for Our Lives march [which attracted 15,000 people] in February, the civil disobedience campaign and the international protests around the world have convinced cabinet to develop and implement an ARV rollout plan."
Another factor, of course, is the 2004 presidential election, which Mbeki is expected to win easily, but which will be characterised by high levels of apathy and a no-vote campaign by the Landless Peoples Movement. (Other groups, such as the Anti-Privatisation Forum have not announced their election strategies, which may include a call for a spoiled ballot as a protest against continuing water and electricity disconnections, and evictions.)
A high-visibility roll-out of ARVs may be an important antidote to this. Pretoria has promised that "within a year there will be at least one service point in every health district across the country and, within five years, one service point in every local municipality".
South Africa's health system is massively overextended, with far too few essential medicines available in underfunded rural clinics. The program's resources — US$40 million through to next March, rising to $680 million per year in 2007 — are also meant to build the health system's capacity.
There are other factors that have allowed the Mbeki government to reassess its hardline opposition to the general provision of ARVs. The national budget deficit will climb this year to nearly 3% of GDP, up from just over 1%, allowing extra leeway for AIDS spending.
Also, the giant pharmaceutical corporations — in an effort to rebuild their battered image as cold-hearted Scrooges — are cooperating with the World Health Organisation, the Clinton Foundation and governments to lower AIDS-medicine prices for Africa, in an effort to defuse the growing demands that generic versions of the drugs be widely produced in, or for export to, poor countries.
Pretoria's Competition Commission also recently ruled that pharmaceutical corporations are pricing ARVs so as to acquire monopolistic profits, and a cut-price compromise deal is anticipated.
And finally, South African employers are paying for a dramatic rise of AIDS-related disability claims, up from 18% of all disability claims in 2001 to 31% last year.
Will ARV availability generate unintended negative consequences, such as the emergence of drug-resistant HIV strains due to poor people failing to comply with treatment regimes? The MSF has been running successful treatment pilot projects in Cape Town township clinics, where compliance with treatment regimes is higher than 90%.
Another problem could be the black-market smuggling of the cheaper drugs to Europe and North America, which would reduce access in Africa. Another is that, although stigmatisation will decline given the availability of hope-giving drugs, so too might the practice of safe sex. These are all major challenges for TAC and other health-sector groups.
Gender inequity, which is a major contributing factor to the spread of HIV/AIDS in South Africa, will have to be confronted as part of the country's attempt to make ARVs widely available, including combating patriarchal power relations in the home, men practising unsafe sex with multiple partners and the scandalous levels of rape.
The TAC's win is a victory for the politics of "decommodification" and "deglobalisation" that are so crucial to social progress across the world today. To decommodify is to take that which is life-giving — our medicines and health care, access to water and a decent environment, clean energy, education and child care, support for the elderly, even food and culture, as well as employment — and remove them from the tyranny of the market.
Such socioeconomic human rights can be won only through deglobalisation, namely the delinking of countries and regions of the world from the bureaucratic straightjackets designed in Washington and Geneva — such as neoliberal structural adjustment programs and Trade Related Intellectual Property rights protection of medicines monopolies — on behalf of corporate interests.
For the 500,000 South Africans who have AIDS symptoms, there is now immediate hope of survival. Across the world, for the 3 million people who died this year of AIDS, this breakthrough has come too late. But for 40 million others who are infected, the TAC activists and their local and international allies deserve a standing ovation.
[The second edition of Patrick Bond's book, Against Global Apartheid, which has two chapters on the AIDS medicine campaign, has just been published by Zed Books.]
From 91×ÔÅÄÂÛ̳ Weekly, December 10, 2003.
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