The South African cabinet on 8 August 2003 finally approved the provision of anti-AIDS drugs for HIV-positive people through the public health system and instructed the health ministry to act "with urgency".
The announcement came after months of acrimony between AIDS activists and the department of health over the delay in implementing a treatment policy.
The following is a chronology of events in the treatment access debate, from August 2003 through to the rollout of free antiretroviral (ARV) drugs on 1 April 2004 at five major hospitals in Gauteng Province.
8 August - Cabinet issues a statement instructing the health department to develop a "detailed operational plan" for the ARV rollout. The lobby group Treatment Action Campaign (TAC) welcomes the decision.
12 August - Rural Doctors Association of South Africa (RuDASA) appeals to the government for the political will and resources to manage HIV in the public sector. RuDASA expresses frustration at the circumstances under which they have to provide care to HIV-positive people.
20 August - HIV/AIDS doctors express anger at the Medicines Control Council's (MCC) "unacceptably slow" registration of a 600mg dose of the anti-AIDS drug, Efavirenz. The doctors point out that a 600mg pill had two important advantages over the 200mg version currently being used by patients: it is cheaper, and reduces the number of pills that need to be taken daily.
9 September - The results of the latest ante-natal survey are released, five months later than expected. In October 2002, the Department of Health conducted the 13th national HIV sero-prevalence study among pregnant women. The survey demonstrates that the HIV/AIDS epidemic remains the most serious health challenge with more than 600,000 new infections in 2002.
14 September - MCC affirms that the drug Nevirapine is safe and effective for the prevention of mother-to-child transmission of HIV. This follows a decision by the MCC 90 days earlier to deregister Nevirapine.
26 September - The Generic Antiretroviral Procurement Project and the TAC Treatment Project asks pharmaceutical giant Boehringer Ingelheim for permission to import generic Nevirapine for use in combination anti-AIDS therapy, failing which they would seek compulsory licenses in court. The drug company relents and the two NGOs are granted permission.
16 October - The Competition Commission finds pharmaceutical giants GlaxoSmithKline and Boehringer Ingelheim in contravention of the Competition Act. The previous year AIDS activists had lodged a complaint at the Competition Commission against the two manufacturers for excessive pricing of their antiretroviral medicines. People who suffered loss as a result of past excessive pricing can now sue the companies for damages.
23 October - The Clinton Foundation announces that it has made a deal with generic manufacturers Aspen, Cipla, Ranbaxy and Matrix on the prices of their antiretrovirals. These companies agreed to sell generic versions of triple-drug therapy at a cost of just under US $13 per monthly dose.
12 November - Minister of Finance Trevor Manuel allocates approximately US $2 billion towards HIV/AIDS over the next three years and clarifies that over $3 million of the total amount is earmarked for antiretroviral treatment. TAC says this is sufficient to rollout a comprehensive treatment programme with the potential to meet a target of at least 200,000 people by March 2005.
13 November - Government Communication and Information Services (GCIS) announces that the release of the operational treatment plan has been delayed yet again. Although an earlier GCIS statement promised that cabinet would finalise matters before the end of November, this becomes the third delay in the release of the report. AIDS activists charge that every delay results in more "unnecessary lives lost".
19 November - Cabinet finally approves the Operational Plan for Comprehensive Treatment and Care for HIV/AIDS. The plan envisages that "within a year, there will be at least one [antiretroviral] service point in every health district across the country, and within five years, one service point in every local municipality." It aims to have 1.4 million people on treatment within five years.
2 December - Nearly five years after TAC's launch, the American Friends Service Committee nominates the group and its chairperson Zackie Achmat for the 2004 Nobel Peace Prize.
10 December - A settlement is reached between AIDS activists and GlaxoSmithKline and Boehringer Ingelheim, which goes well beyond what could have been won by pursuing the initial prosecution of the complaint under the Competition Act. The two companies have agreed to grant TAC licenses to import generic versions of some of their patented drugs.
20 February - Health minister Manto Tshabalala-Msimang denies that the government promised to begin its treatment programme by March. Spokesman Sibani Mngadi says the ministry was still checking clinics where drugs would be dispensed, setting up a system to track patients and writing training manuals.
10 March - Tshabalala-Msimang is given until 17 March to respond to a TAC letter demanding the purchase of "an urgent interim supply of antiretrovirals pending the finalisation of the tender process" or face litigation.
15 March - Gauteng Province's health department announces that the roll out of antiretroviral drugs would begin on 1 April. The province hopes to treat about 100 new cases a week, expanding to 10,000 people within a year.
25 March - The health department says it will procure an emergency supply of anti-AIDS drugs as an interim measure until the formal tender process is completed.
1 April - South Africa's public HIV/AIDS treatment programme takes a step forward as patients in five hospitals in Gauteng begin receiving free antiretrovirals.