Address by COSATU President,Willie Madisha, at Sparrow's Nest Aids Village - Defeating HIV: Now is the time, 14 February, 2002

Address by COSATU President, Willy Madisha, at

Sparrow's Nest Aids Village, Gauteng

14 February, 2002

Defeating HIV: Now is the time!

The Congress of South African Trade Unions (COSATU) has welcomed President Mbeki's comments in relation to HIV made in his state of the Nation address recently. COSATU further made an "appeal to everyone concerned to get out of entrenched positions and public posturing on this grave national crisis and put the needs of the our people first."

(Batho Pele is a watchword of our government- and truly we are trying as a public service to do this). In tackling HIV "we must put people first" because - the evidence in the hospitals and our cemeteries confirm that people are dying and that where anti- retrovirals are applied life is clearly extended, and where they are denied, as day follows night, so a premature death follows such denial.
Last year, two separate reports confirmed that large numbers of people are now dying of AIDS-related illnesses. The first report by the Medical Research Council (MRC) was contested by the government, particularly because it drew the conclusion that AIDS was now the main cause of death amongst adults and would lead to millions of deaths within the next few years.
The second report produced by Statistics South Africa (SSA), the government's "official" analysts, repeated that there have been dramatic changes in (a) the numbers of people dying, which has increased greatly and (b) The patterns of death in South Africa - with large numbers of people now dying...in their 20's and 30's. This report resisted drawing the conclusion that AIDS was the major factor behind this. We on the ground know that there can be no other explanation.
What both reports confirm is being felt on the ground and is being reported anecdotally by doctors, nurses, church leaders, community activists and trade unionists. This pattern of increasing sickness and death among young and poor people in SA will continue for many years to come unless there is a deliberate and united intervention to prevent it.
When our President talks about a holistic approach, it cannot be faulted; however, two key points need to be stressed.
First of all, new HIV infections can be prevented by more effective communication strategies but also by targeting the social conditions that put people at a greater risk of infection. Here we are talking about the urban and rural poor who are the systematic victims of capitalism's ruthless pursuit of profits over all other social and moral considerations.
We in COSATU believe that targets must be set - to both reduce the number of infections - currently 1500 per day - as well as having it as a measuring tool to test effectiveness of our strategies.
The second point is that there is absolutely no doubt, in my mind, that anti-retroviral medicines lead to a reversal of many of the consequences of HIV infection and, in most instances, dramatically improve and prolong lives.
There is ample evidence that anti retroviral therapy is highly effective in reducing a person's level of infection with HIV. That leads to a substantial improvement in the immune system and a longer life. Since the most effective treatment, which combines three of the anti-retrovirals (so called coctails or combination therapy) was only introduced in 1996, it is not known for how long treatment can be used.
A seminal study by Palella and others have shown a decrease of deaths in the USA by more than 70% since the combination therapy was used. A study in a Chilean public hospital between 1997 and 2000 demonstrated an equally remarkable success.
Patients getting anti-retrovirals experienced a 60 to 73% fall in Aids - related deaths, whilst Aids related illnesses dropped 65 to 76%. Oesophageal candidiasis dropped 84%, TB75%; cryptococcosis and toxoplasmosis, 66 %, PCP 55%; and bacterial pneumonia, 46%. Overall, hospitalisations were 73% lower for patients getting anti-retrovirals than for patients who did not.
Brazil has been cited by UNAIDS as a best practice for its response to HIV - Aids epidemic. The country has about 500 000 people with HIV, substantially less than South Africa. Its government introduced an anti-retroviral programme in the early 1990's. It now ensures universal access to the therapy, including mother-to-child prevention programmes. As a result, mortality rates for people with HIV dropped by 50%.
The above facts is the reason for all our focus on Anti Retroviral's (ARVs), but it should not be read as excluding or denying the importance of other interventions. However, the bottom line is that for ą 200 000 people a year access to these medicines is their only hope.
The key priorities then for 2002 are:
A) Now is the Time / Sekunjalo! The issue of mother-to-child transmission (MTCT) needs to be put to bed and put beyond further controversy, and we - as nation - cannot wait. Despite its opposition to the court case, in 2001, senior government figures viz (Zweli Mkhize, KZN Minister of Health, Eddie Mahlanga, Director of Maternal and Child Health, Ayanda Ntsaluba - Director General of Health), have repeatedly accepted that Nevirapine works and that it is safe and that the sole challenges are around implementation.
Most recently, our President Thabo Mbeki said that provinces with capacity should be allowed to use this capacity whilst focus should be on improving capacity of the poorest provinces, particularly the Northern province. The essential and yet-not-in-place ingredients of patient counseling have often been raised in the media and public debate. This must be urgently addressed by us all especially those in the service unions (health, education etc) and community organisations.
When President Mbeki quoted the case of the teacher from Inkonjane Senior Secondary School in Soweto I was doubly pleased. The teacher, Bathabile Serei, is a member of SADTU and together with the Sunday Times did really good work in supporting learners in the KZN area who are less privileged and suffering from HIV. The other reason for being pleased is that the president underscored the importance of solidarity and the need to rebuild community spirit.
Research has it that KZN is at the epicentre of the virus in our country. The impact of the epidemic on students, teachers and institutions is extremely severe as University of Natal's researcher Peter Badcock-Walters argue, that SA is witnessing a decline in the quality of education which negatively impacts on the potential and the productivity. His study estimates that: * 275,000 school-age children in KwaZulu-Natal Province are not attending school. * First grade enrolment has dropped 60 percent since 1998.
My union, SADTU has shown that teachers in the province are dying very young - presumably from AIDS.
With this in mind, I am calling on COSATU leaders - shop- stewards and activist members - as well as the Labour Movement at large, together with all civil society organisations, to join in the spirit of Matsema / Letsema and volunteer their time to become counselors. A number of NGOs are willing to do this training and I am going to take up the course myself. I know there are many who are able and willing to do likewise. Every workplace and community must have at least one counselor.
B) One giant step towards a holistic health strategy will be to put into place a National Treatment Plan for tackling HIV. This will deal in a comprehensive manner on prevention of HIV. We are fully aware that other illnesses and diseases such as Malaria and TB are widespread.
But, by preventing HIV we will go a long way towards freeing the public health system - so that it can deal with other illnesses as well as providing meaningful treatment to those people who are already infected. For this to happen means proper and adequate funding for the public health system, must be forthcoming.
C) For the plan to succeed, the political will as well as the resources must be put in. We have all along called for HIV to be declared a national emergency, since it is not one equal health issue amongst many, but the determinant of many other epidemics as well as the general ability of health workers and health services to promote and improve health in South Africa.
Since the COSATU / TAC /MSF "operation" to bring ARVs back from Brazil and challenge the patent holders, the TAC and COSATU have again been directly approached by the local pharmaceutical industry with proposals for local production of these medicines.
This would create jobs, create investment and the possibility of sustaining access to these essential medicines. However, the generic companies cannot produce unless there is political support and political pressure to issue compulsory licenses for local production.
Finally, I have spoken above about solidarity and rebuilding community spirit and organisation but it will require a massive injection of urgent treatment to ensure that the hope and resilience of our people is nourished and sustained. This calls for governments - our public sector - to be centrally involved in rolling out the treatment since only it has the leverage and capacity to reach all our people.
When I voted for this government I did so with the express understanding that as a government - like all governments it has an obligation to look after the most vulnerable of its people. The case of people living with HIV has become the litmus test of our revolution, since it touches on illnesses, and the impact poverty and other factors has on it. Whilst a rich or relatively well off person living with HIV may truly live, because they can afford to buy all the anti retroviral cocktails, poor people, cannot afford these.
Here I am reminded of my good comrade Judge Edwin Cameron, who has been living with the virus for years, and has been eating healthily, going to gym and keeps on taking his cocktail. A poor person, on the other hand, living in an informal settlement without a job and without access to treatment will surely die.
Our government will surely, and I sincerely believe, rise to this challenge. Then we as a people -united- civil society, unions and our government will shoulder to shoulder, do what we did to Apartheid: relegate it to the dustbin of history.
Our presence here - at the Sparrow Rainbow Village, which we believe will not only be a place to die, but to resist the virus and win. COSATU commits itself to working with all people in our country working to overcome the devastation caused by the virus and poverty. We shall overcome! Venceremos - Victory is certain!

Š COSATU