South African cabinet rules that public hospitals should provide ARVs

The South African government has instructed its health minister, Manto Tshabalala-Msimang, to draw up, within one month, a plan to make antiretroviral therapy available in public hospitals. There have been false dawns and apparent u-turns by the South African government in the past, but this move does seem to bring to an end four years of inactivity by President Thabo Mbeki’s government.

Domestic and international anger has been aroused over the years by Mr Mbeki’s questioning of the causal link between HIV and AIDS and the refusal of his government to provide ARVs. There have been several announcements that official policy had changed – promises that were never fulfilled.

This change of heart appears to be different because it was taken by the full cabinet, arises from a joint report by the health ministry and the treasury, and because it has resulted in an instruction that an operational plan be drawn up within a month.

The Treatment Action Campaign (TAC) issued a statement welcoming the cabinet’s endorsement of the report, which found that between 500,000 and 1,7 million South African lives could be prolonged with ART and that the country could afford to provide the treatment in public hospitals. TAC said: “There is cause for celebration and optimism.”

Shortly before the cabinet’s decision, the TAC learnt that the announcement was imminent and members persuaded Zackie Achmat, one of the organisation’s leading figures, to start treatment. He had refused treatment while the government refused to treat other people.

The announcement was accompanied by other related and significant moves. It was announced that some of the money and expertise for providing the treatment would be supplied by the Bill Clinton Foundation. The Global Fund to Fight AIDS, TB and Malaria announced that a $27 million grant it has been waiting to give to organisations in South Africa for work including ARV treatment – but which was held up by the government – had finally been accepted.

A statement issued by the special cabinet meeting said: “Cabinet decided that the Department of Health should, as matter of urgency, develop a detailed operational plan on an antiretroviral treatment programme. The Department will be assisted in this work by South African experts as well as specialists from the Clinton Foundation AIDS Initiative who have not only offered to contribute to this effort, but have also been of great assistance in commenting on the work done thus far. It is expected that this detailed work would be completed by the end of September 2003.”

The TAC statement said: “This is a critical step to develop a more comprehensive treatment and prevention plan for managing the HIV/AIDS epidemic. Properly implemented, this will restore hope, dignity and life for millions of people in our country, and, hope throughout the continent.

“The TAC National Executive will formally suspend the civil disobedience campaign and reconsider pending litigation early next week. We welcome Cabinet’s bold step today but we also remember the anguish, pain and unnecessary loss of lives over the last four years.”

The government statement on the special cabinet meeting can be read at, and a pdf of the full Report of the Joint Health and Treasury Task Team can be downloaded from (click on full report):
http://www.gov.za/speeches/8aug03.htm