Chronology of HIV/AIDS treatment access row

Following a meeting with South African Deputy-President Jacob Zuma last week, AIDS lobby group, Treatment Action Campaign (TAC), announced it would suspend its civil disobedience action aimed at forcing the government to introduce a national HIV/AIDS treatment programme. TAC said they would meet with the government next month to try to iron out disagreements on the treatment plan. The suspension of the campaign comes after months of a bitter stand-off between the South Africa's AIDS activists and the department of health, over its refusal to implement a treatment policy. The following is a chronology of events during 2002 and 2003 over South Africa's controversial HIV/AIDS treatment access programme. 2001: December - The Pretoria High Court orders the South African government to provide antiretrovirals (ARVs) to all HIV-positive pregnant women after a court case brought against the government by TAC. In their application TAC argued that the government had a duty to offer Nevirapine under the constitutional right to health care. In handing down his judgement, Justice Chris Botha said the government should provide a programme on how they will extend their mother-to-child transmission (MTCT) prevention scheme by the end of March 2002. The government's MTCT programme was initially restricted to 18 national pilot sites. Doctors at state hospitals which were not part of the pilot sites were not allowed to prescribe Nevirapine. 2002: 21 January - The KwaZulu-Natal provincial government announces that HIV-positive pregnant women in state hospitals will receive Nevirapine. KwaZulu-Natal becomes the second province, after the Western Cape, to defy government policy by making the drug available. February - Finance Minister Trevor Manuel announces that in addition to an estimated R4 billion (US $348 million) spent by provincial health departments on AIDS-related illnesses, funding for "prevention programmes, hospital treatment and community-care programmes will amount to R1 billion (US $87 million), rising to R1.8 billion (US $156 million) in 2004/5." This amount includes a "progressive roll-out of a programme to prevent mother-to-child transmission at the conclusion of the current trials." 1 February - International humanitarian organisation, Medecins Sans Frontieres (MSF) and TAC announce they are importing generic drugs from Brazil for their pilot ARV programmes. March - When asked during an interview on national television if government would be prepared to follow the court order to roll out its Nevirapine programme, minister of health Tshabalala-Msimang was quoted as saying: "No, I think the courts and the judiciary must also listen to the authorities — regulatory authorities — both from this country and the United States." 28 March - The government announces it will appeal the Pretoria High Court judgement, ordering them to provide Nevirapine to HIV-positive pregnant women, in the Constitutional Court. 5 April - The 2001 High Court decision ordering the state to roll out Nevirapine is upheld by the Constitutional Court, which points out that by restricting Nevirapine to 18 pilot sites, government is violating the constitutional rights of women and their babies. 17 April - In a cabinet briefing, government announces that survivors of sexual assault and rape can finally receive ARVs. A hospital superintendent had earlier been discharged for insubordination because he had accommodated the Greater Nelspruit Rape Intervention Project (GRIP) in his facility. GRIP was the first NGO to provide antiretroviral prophylaxis for rape survivors in cooperation with doctors. 26 April - The Global Fund to Fight AIDS, TB and Malaria awards the country a US $165.2 million grant. But Tshabalala-Msimang blocks the US $72-million grant awarded to KwaZulu-Natal, saying the province should not have approached the fund directly. June - The release of the 2001 antenatal survey showed a minimal increase of 0.3 percent in the national HIV prevalence rate, taking the overall figure for people aged between 15 to 49 to 20.4 percent. July - Findings from the 14th international AIDS conference in Barcelona, Spain, demonstrate that AIDS treatment campaigns are possible in poor communities. July - Tshabalala-Msimang, attending the international conference, is quoted as saying ARVs are "poisons" killing "our people". August - Mining giant Anglo American says it will pay for ARVs for its workers, as part of its expanded HIV/AIDS strategy. October - During the launch of its "Campaign of Hope" on AIDS, cabinet issues a statement acknowledging that ARVs could "improve the condition of people living with HIV/AIDS" and says government is addressing challenges such as drug prices "to make it feasible and effective to use antiretrovirals in the public health sector". 14 October - Deputy-President Zuma meets with representatives from TAC for the first time, indicating a thaw in relations between the groups. 17 December - In an interview with the Guardian newspaper, Tshabalala-Msimang is reported as saying budgetary priorities meant her department could not provide ARVs to HIV-positive South Africans. "South Africa cannot afford drugs to fight HIV and AIDS, partly because it needs submarines to deter attacks from nations such as the US," the newspaper quoted her as saying. 25 December - The National Association of People Living with HIV/AIDS launch a fasting protest outside the offices of GlaxoSmithKline as part of its 'Black Christmas' campaign to demand free ARVs. 14 February 2003 - AIDS activists march on the opening of parliament to call for a national treatment plan to provide free ARVs to all those who need them. AIDS advocacy groups say they have been left with no choice but protest action after the government failed to sign a National Economic Development and Labour Council (NEDLAC) agreement for a treatment and prevention plan last year. 21 February - The government will not elevate HIV/AIDS above other diseases by giving it priority attention, Tshabalala-Msimang is reported as saying. She had seen the draft treatment plan drawn up by NEDLAC, but no one would compel her to sign as the state had many pressing issues to deal with. 27 February - Finance minister Manuel announces plans to almost double the amount spent on HIV/AIDS. Over the next three years, R3.3 billion (US $400 million) will go towards extending preventative programmes and finance "medically appropriate" treatment for HIV/AIDS. 28 February - Government misses the TAC deadline for signing the NEDLAC framework agreement for a national HIV/AIDS treatment and prevention plan. March - The health minister comes under fire again for appointing AIDS dissident Roberto Giraldo as her nutritional adviser. 18 March - Tshabalala-Msimang denies undermining the importance of ARVs but maintains the need for adequate infrastructure before rolling out a treatment plan. "I want to put the infrastructure in place before freely distributing it. However, it appears the Constitutional Court is forcing me to do it. In my heart, I believe it is not right to hand them [ARVs] out to my people." 19 March - In an update on the national HIV/AIDS plan, government says the work of a joint technical team tasked to look into the resource implications of an expanded response to HIV/AIDS, including antiretroviral treatment, is nearing completion and cabinet will be considering the findings. But Manuel slams calls for ARVs, saying claims about the effectiveness of the drugs in the treatment of HIV/AIDS are "a lot of voodoo" and spending government money on them was "a waste of very limited resources". 20 March - TAC launches its civil disobedience "Dying for Treatment" campaign. Activists lay charges of culpable homicide against Tshabalala-Msimang, and Minister for Trade and Industry Alec Erwin, for failing to prevent an estimated 600 AIDS-related deaths every day. April - Global Fund executive director Richard Feachem flies into the country expecting to sign an agreement allowing the grant money to be released. The government blames last minute hitches and there is no signing. "This is very disappointing. The work is urgent and the money needs to flow - the delay in money means a loss of human lives. These are life and death issues," Feacham was quoted as saying. 23 April - South Africa's AIDS policies are failing and the government urgently needs to make drugs freely available, a report by the South African Human Rights Commission (SAHRC) shows. Despite the creation of one of the most comprehensive policies and enabling legislation in the world, the country had not succeeded in implementing these plans sufficiently to make an impact on reducing the prevalence of HIV/AIDS, the SAHRC report said.