A group of South African public health doctors have written an open letter to senior figures in the country’s government saying that they can no longer continue to work with “integrity” when so many of their terminally ill HIV-positive patients do not have access to anti-HIV medication.
The open letter was published the same day that the South African cabinet claimed that it was increasing funding for HIV treatment, prevention and education.
However, the doctors’ letter, which is addressed to the deputy prime minister, health minister and trade minister, takes apart the government’s objections to the provision of antiretroviral (ARV) drugs and exposes the human cost of current policies.
Highlighting the success of ARVs at restoring the health of the few rich enough to afford them or lucky enough to be on state sponsored pilots which make the drugs available, the doctors contrast this with “the devastating effects of the disease on families and communities.”
The doctors say that it is no longer possible to accept any of the arguments which the South African government has deployed against providing anti-HIV drugs. These have included the experimental nature of ARV therapy; the large numbers of pills which need to be taken; and, the cost of the drugs. “An affordable WHO-approved generic, well tolerated by most patients, can make a dramatic difference between life and death” emphasise the doctors, undermining arguments about adherence and cost by pointing out that this treatment “consists of one combination tablet twice daily…for around R400 a month. It can be carefully monitored clinically and with simple, cheap blood tests.”
Arguing that they are unable to discharge their most basic duties as doctors, to relieve suffering and prevent death, the doctors say “we find ourselves standing by and watching the survival of those who can afford drugs while the poor suffer and die and their families spiral deeper into poverty and social dislocation.”
A moral and professional dilemma is making it necessary for the doctors to ask if they can continue to practice medicine; or break patent laws and illegally import generic ARVs; or join the civil disobedience activities, such as that recently launched by TAC.
”We can no longer in good conscience simply continue providing palliative and terminal care for our patients with AIDS, when we know life-saving treatment is available”, say the doctors, calling for HIV to be declared a national emergency and a national HIV plan to be put in place, which includes access to ARVs from the state.
The HIV package announced the same day falls far short of this, even though funding on HIV will increase from R320 million in the last financial year to R3.6 billion by 2005.
The government trumpets its expanded provision of nevirapine for the prevention of mother-to-baby transmission of HIV and offering of ARVs to women who have been raped, and the efforts it has been making to improve treatment for HIV-related opportunistic infections.
However, regarding the universal provision of ARVs to people who would benefit from them, all the government statement offers is promises that task forces on resource implications and costs will report “soon.”
The government does however make efforts to distance itself from so called” AIDS dissidents” by saying that their policy is “based on the premise that HIV causes AIDS.”
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Further information on this website
South African HIV treatment activists start civil disobedience programme - news story
About the epidemic – Africa - overview
Use of generic antiretrovirals - overview