Saving TAC is vital for the next phase of the struggle to fix the public healthcare system, argues Anele Yawa
I joined the Treatment Action Campaign two decades ago in 2002. The organisation was four years old at the time. Back then there were no branches in Uitenhage. Perhaps as a result, it may be more accurate to say that I was one of the co-founders in the area. I joined the organisation because the HIV pandemic was ravaging my community. KwaNobuhle, in this sense, was no different from many other communities across the country. According to official statistics, more than 800,000 people died in South Africa from 1997 until 2002 from AIDS related illnesses, and 13% of these AIDS deaths happened in communities in the Eastern Cape province.
Since then the TAC has had many highs and lows that coincide with the country’s quest to fulfil the Constitutional promise of quality healthcare for all. Like other social and political movements that have shaped post-Apartheid South Africa, it may be argued that the TAC is a victim of its own success. In galvanising a groundswell of support across the world in one of our key campaigns, we have suffered from the ignominy of having our place in history cemented in a time and place, when the truth is much rather that our work has continued and continues at incredible levels.
In our context, people rightfully acknowledge the role of the organisation as well as that of our vital partners in fighting against AIDS denialism as well as for access to ARVs. Today South Africa has the largest treatment programme in the world with 5,5 million people currently on ARV treatment across the country. Countless lives have been prolonged, and research has shown us that people living with HIV live long healthy lives, with a similar life expectancy as HIV negative people provided they are diagnosed early and have consistent access to HIV treatment. This is in distinction to the Mbeki years, where Havard University estimated that over 330,000 lives were lost to AIDS-related illnesses.
While our fight, which culminated in crucial Constitutional Court victories largely extinguished the fire of denialism, it still simmers today. Just in September this year, Thabo Mbeki, the country’s second democratically elected President and Denialist-in-Chief reiterated his denialist views in a lecture at UNISA. This has rightly been criticised by many actors, including the South African Medical Research Council, us as the Treatment Action Campaign, SECTION27 and the Progressive Health Forum (PHF).
Similarly, while less visible than the days of Matthius Rath and others, quacks still exist today, with misinformation and disinformation as their weapons of choice. They claim they can cure HIV, COVID-19, Cancer and other illnesses, among other things. While peripheral, this is why the battle to align complementary medicines between the Minister of Health, SAHPRA and the Alliance of Natural Health Products in South Africa is so important and why we keep actively following it.
The TAC today
Since I became General Secretary of TAC in 2014 we have continued to experience these highs and lows. For instance, TAC is currently going through a period of financial difficulty. We currently have a deficit of R3 million for the 2022/23 financial year, which amounts to 10 percent of our budget.
This is happening despite us having distinguished ourselves as the eyes and ears of public healthcare users and holding duty bearers to account on multiple health issues. Sadly, we are not alone in facing these constraints in civil society. Other organisations that also do crucial work are going through similar circumstances. One which fights for broader human rights and against important violations based on nationality and belonging is suffering the same fate. Their work highlighting statelessness and the rights of asylum seekers and refugees is world leading. Another working on issues of access to basic education has also suffered from funding constraints. Their work on access to quality infrastructure and healthy and adequate food for learners is stellar. This is as a result of an exodus of traditional funders from the country. We are under no illusions that this will continue and a new way of raising funds and ensuring sustainable organisations is necessary for the future because without the work of organisations such as ours there will be a major setback to our democracy and to our fight for fundamental human rights.
Admittedly this is not the first time we have asked the public to #saveTAC. Through public efforts in 2014, including the interventions of key people such as Graca Machel and Desmond Tutu, TAC was saved. We were adamant then, as we are now, that AIDS is not over and TAC still had (and has) a pivotal role to play in our four key campaigns. These are monitoring the HIV and TB response; on health systems strengthening; on the fight for access to quality and affordable medicines and building local, national and international activism.
Given space constraints, I will only focus on one current campaign per work area.
Health systems strengthening
TAC has repaid the faith and the mandate handed to it by individual and organisational donors since the #SaveTAC campaign. Ritshidze, a TAC administered project, for instance, systematically and continuously monitors over 400 health care facilities across 8 of the country’s 9 provinces. These sites, which account for almost half of all people living with HIV on treatment, are almost exclusively PEPFAR supported sites. It is the largest community-led monitoring project in the world. Affected communities of people living with HIV, TB survivors and Key Populations, among others own it and importantly advocate for change regularly and directly to duty bearers. Since its launch in 2019, there have been marked improvements on multiple indicators, including but not limited to patient waiting times, facility staff numbers and staff attitudes. While these cannot be solely attributable to the work of Ritshidze and TAC, we are certain that we have played a significant role in doing so.
Over the past two years Key Populations, that is people who use drugs (PWUDs); sex workers; gay, bisexual and men who have sex with men (GBMSM) and trans people have monitored key population services in clinics, drop-in centres and communities. Over 8,000 KPs have been engaged using a snowball effect. Importantly, most of our monitoring is occuring in massively underserved areas in order to improve access to healthcare for all.
Significant plans have been underway to radically increase the number of sites monitored to well over 600 facilities by early next year. This ambitious project to protect the gains of the past 24 years cannot be possible without significant resources, both human and financial.
A partially resourced TAC would not be able to achieve this.
HIV and TB response
TAC’s financial woes occur at a time when the HIV/AIDS response needs to be increased. In fact, UNAIDS recently re-evaluated the country’s targets, lowering the targets of those initiated and still on treatment to 5,7 million. As is, the country is nowhere near the 95-95-95 targets. It has been argued, quite rightly, that this is largely because COVID-19 and the scale of the response inimically affected the response to the other four major pandemics, namely HIV, TB and Gender-Based Violence and Femicide (GBVF). Financial and human resources were redirected in the case of HIV and TB, as a result, TB testing and diagnosis declined by 50% and 33% respectively. According to former DDG Yogan Pillay et al, HIV testing decreased by 22,3%. We continue to see significant patients being lost to care because of bad staff attitudes, stockouts and shortages of medicines and other systemic issues and not enough being welcomed back to care.
TAC is needed more than ever in this fight!
It is because of this that we decided to take part in the World AIDS Day commemorations this year. While I have individually criticised past events as a ‘jamboree’, echoing our co-founder Mark Heywood’s sentiments in 2016, where politicians kiss babies and shake hands and others try and get closer to power, this World AIDS Day needs all actors to come together. TAC and other members of the National PLHIV Sector have been on the ground in the Free State. Our message is a simple one: to make everyday World AIDS Day. Through our partnership with the Free State Department of Health and the provincial AIDS Council, we have placed emphasis on bringing healthcare services to the people. Mobile clinics with services ranging from HIV testing, TB screening and testing, pap smears and access to sexual and reproductive health rights (SRHR) and treatment literacy have been made available to marginalised communities. Through our build up activities and other engagements, we will advocate for lasting and quality services in these communities.
Building local, national and international activism
TAC prides itself on being rooted in the community. We currently have over 6,000 members in 8 of the country’s 9 provinces. Almost all our members are poor, black and infected and/or affected by HIV. We unashamedly want to build a social movement that is reflective of our society and hope to ensure that many, many more people join the organisation and are part of a groundswell of comrades advocating for change.
This can not happen without a strong TAC. The next phase is to FIX THE BROKEN HEALTHCARE SYSTEM. But TAC must be fully resourced to effect real change. Help us save TAC and continue advocating for access to quality healthcare services by donating here!
Anele Yawa is the current General Secretary of the Treatment Action Campaign. He has previously served as a PR Councillor in Nelson Mandela Metro in the Eastern Cape.
