August 2002


Ken Davis (Australia)


1. The example of Treatments Action Campaign (TAC) in South Africa has been a fantastic inspiration around the world, in both advanced capitalist countries as well as in Asia, Africa, E Europe and Latin America. The global campaign that TAC has led, with allies in Europe, Asia (in particular Thailand and Philippines) and the Americas, has featured distinct anti-capitalist and anti-imperialist axes, and has targeted one of the highest profit-making sectors: big pharma. TAC has been a model of mass action, of organising people with HIV, of coalition politics -- particularly with COSATU, the engine of the anti-apartheid struggle. TAC has taken the lead in what Edwin Cameron sees as creating viable post-Apartheid grassroots activism.


But since the court victory in April 2001, TAC has focused on South African domestic priorities: still fighting denialist tendencies in the national cabinet, and seemingly endless court cases around nevirapine to limit mother-child transmission, but also fighting to implement a rounded national treatment plan drafted by PWAs, civil society, the trade unions and medical sector. To its credit, TAC's last conference assembled key activists from the southern Africa region to push the campaign in the less industrialised countries.


In late July, Mandela met with TAC chair Zackie Achmat (former CWI leader and gay activist, now refusing ARV til it's publicly available in RSA): "we know that there are treatments available that support the immune system, that fight opportunistic infections such as tuberculosis. Is it acceptable that these dying parents have no access to treatment? The simple answer is no. We must find the means to take life saving treatment to all who need it, regardless of whether they can pay for it, or where they live or whatever reason."


2. At the international conference in Barcelona, there were some pilot projects in Haiti and Western Cape proving antiretroviral therapies can work in "resource-poor" settings, without high tech lab work and with community support for "compliance". This is a good argument against defeatism: against the idea that throughout the Third World, primary health care is so decimated that HIV treatment is impossible.


3. Some of the lessons of the global HIV treatments access movement have been not to counter-pose access to ARVs to treatments for other opportunistic infections, to prevention, to STD/reproductive health, to restoring primary health care structures (or health worker wages), to TB services, to microbicide or vaccines development.


4. The struggle for HIV treatments access has been located alongside the wider struggle for essential medicines, against "patent" abuse", against debt and structural adjustment, against retrograde "terms of trade" and for democratic rights and women's rights. It has taken it's place alongside key international solidarity campaigns in "the North".


5. There appeared to be a victory at the Doha WTO meeting, with the imperialist push to extend USA-style patenting slowed by the explicit exemption for public health after broad international coalition campaigning. Also some big companies were offering what looked like good deals. But still few Africans or Asians are getting generic ARVs (maybe 30,000 in all of Africa). The key issue now seems to be that the producers of generics, such as Brazil and India, are being blocked from exporting to less industrialised countries that need to purchase.


6. The Global Fund Against AIDS TB and Malaria has almost $2 billion (instead of the $10 billion planned, primarily due to hostility of Bush administration, which prioritises short-term capitalist interests over longer term interests). USA is blocking promised distribution of first grants, distrustful of the "mechanisms", and fearful that GFATM could purchase generic ARVs. USA is routing $500 million via a new initiative, so that they can ensure purchase  of patent holder drugs. This is after GlaxoSmithKline ran a $30 million fundraiser for the Republicans. In assessing the GFATM, it's also important to remember that most official aid allocations from imperialist countries are filtered through high profit donor country companies, before recipient country kleptocracies can get their "take". So how much of these disappointingly meagre funds can actually make a difference in terms of how many people will get life-saving drugs soon?


7. One new access of struggle is around international employers, such as AngloAmerican or Coca Cola, ensuring their workers and families can access ARVs in all countries. This has already taken off in USA, and could be easily picked up by labour movement allied groups in many countries. AngloAmerican seems to have finally done a deal with NUM in RSA for treatment of mine-workers. Can this be extended within mining industry world-wide via ICEM?


8. There have been some very successful coalition campaigns around this issue, involving trade unions, anti-globalisation and/or "fair trade" activists, religious structures, PWA orgs, Greens, women's and LGT movements, international solidarity movements (eg remaining anti-apartheid and pro-Zimbabwe democracy campaigns), and international development NGOs. Health GAP and ACT UP Paris have been fantastic. Oxfam and MSF have played great roles in many countries, but in some instances are classically sectarian, putting their own promotion and fundraising ahead of broadening the coalition and mass action. Other mainstream LGBT and HIV community sector organisations have dodged the global treatments issue as "too shrill" perhaps due to worries about funding from governments and drug companies. It is important that left activists around the world take actions to maintain the trajectory of an open mass action coalition campaign with clear anti-capitalist demands, labour movement involvement, and visible PWA leadership.