Key resolutions from the TAC National Council (NC)  April 2-3 2012, Cape Town

The TAC National Council (NC) took place from April 2-3 2012 at TAC House in Muizenberg. The NC was attended by all TAC Provinces as well as key TAC partners who are members of the NC.

The meeting was dedicated to the memory of Jason Wessenaar, an activist who was murdered in Pretoria on December 18^th 2011. His murder remains unsolved. TAC calls on the police to urgently speed up the investigation into his killing, a killing that has the hallmark of a hate crime and may be linked to the murder of at least eight other gay men in Gauteng.

Below are resolutions adopted at the NC. Resolutions on organisational and internal matters will be published separately.

On Politics and the State of the response to HIV in South Africa:

The NC recognises that progress has been made in the fight against HIV/AIDS, and particularly:

• The leadership of the Minister of Health, Dr Aaron Motsoaledi.
• 1.5 million people on treatment and over 15 million testing for HIV.
• The launch of the new NSP 2012-2016.
• The restructuring of the South African National AIDS Council (SANAC).
• Recent announcement on the NHI pilot sites in 10 districts and the direct impact this will have in improved health care delivery and HIV specifically.

We are heartened to note that the death rate due to HIV/AIDS has begun to decline as a result of access to ARVs. Significantly too, the rate of mother-to-child HIV transmission has also drastically reduced.

However, the NC believes that serious threats exist to the progress that has been made, and is conscious that the response to HIV and health is also influenced by local, national and international politics and economics. Particularly that:

• The world is currently in a very unstable and dangerous political position with the EU and USA economies possibly facing recession, leading to political instability and cuts in funding for health care and HIV in particular.
• Between 2008 and 2010 South Africa lost a million jobs because of the global financial crisis. This left more people vulnerable to health problems, more women ending up in sex work, less money available for government to spend on health and social grants.
• Over the last few years the budget for health has grown at twice the rate of inflation, nearly 13% per year. Yet, we still have shortages of health care workers, shortages and inadequate supply of medicines and bad health facilities. Over the next few years health expenditure is going to decrease - but the need for health care will grow. This lends urgency to health reform, NHI and the control of prices in the private health sector.
• People in communities are frustrated and very impatient with their living conditions. 18 years of political freedom has not put bread on the table for millions. Basic education is in crisis. Youth unemployment is extremely high. People are getting tired and angry. It is expected that more conflicts will arise as a result of this. The need for ‘economic liberation' and social liberation is going to get stronger in people's minds. This is why TAC needs to link its campaigns with other social movements that aim to create social justice.

In particular:

On Education:

The TAC NC received reports from Equal Education (EE) and SECTION27, both members of the NC, about aspects of the crisis in basic education. It supports the call for binding Minimum Norms and Standards for schools and resolved to support the litigation that has been launched by Equal Education to demand the development of norms and standards. TAC will seek the support of EE to educate our members on the litigation and the issues it raises.

TAC NC also responded with horror to reports by SECTION27 about sexual abuse of girl learners by teachers, and the failure of the education system to both stop and punish this. Sexual abuse in schools is linked to HIV infection and teenage pregnancy among girl learners. TAC branches in Ekurhuleni are assisting SECTION27 with this issue.

The NC also noted a report by SECTION27 about the terrible state of toilets in many schools, particularly Limpopo. It welcomed the work of TAC activists in Limpopo to assist SECTION27 in demanding proper and decent toilets in all schools.

On Traditional Courts Bill:

The TAC NC received a report about the problems with the process and content of the Traditional Courts Bill (TCB) currently before Parliament. The NC expressed its concerns about the Bill and resolved to be part of a civil society alliance that has been formed to educate rural communities about the Bill and to challenge it in parliament.

TAC also resolved to work with Sonke Gender Justice and others in educating communities where there are TAC branches about the Bill.

On the NSP:

The NC noted the agreement on a New national Strategic Plan, 2012-2016 and congratulated SANAC and the Government on its adoption.

It noted the dispute that arose over Strategic Objective 4, key parts of which were withdrawn on the instruction of the Cabinet and mandated its representatives at SANAC to assure that the original programmes and activities of SO4 of the NSP are reinstated.

Although the new NSP is ambitious we are concerned about continued stock-out of essential ARVs, most recently Tenofovir. A letter will be written to the Minister of Health to communicate this concern. We also call for the SA HIV Clinicians Society, MSF and SAMAto urgently assist in developing guidelines for clinicians on drug substitution in the event of stock-outs. But more importantly we call:

• For the MCC to urgently register Fixed Dose Combinations of Tenofovir/lamivudine (3TC)/efavirenz; and Tenofovir/emtracitibine (FTC)/efavirenz. TAC is informed that these FDCs were submitted to the MCC for registration in December 2010. That is more than 15 months ago. TAC believes this will go a long way in addressing issues of adherence and minimising pill burden.
• For the introduction of a national IT system for monitoring drug stock at facility level.

On SANAC:

TAC noted slow progress with the strengthening and restructuring of SANAC and commended the growing involvement of TAC members in Provincial and District AIDS Councils. In this respect the NC,

• Commended the moves to set up a functioning PAC in Limpopo and resolved to request a meeting with the new MEC for Health, Dr Norman Mabasa.
• Commended the leadership of the Premiere of KZN in establishing a strong PAC and noted TAC's active role in the PAC.
• Expressed concern at the dysfunction of the PAC in Mpumalanga and the apparent contempt of the Premier for the PAC and for civil society. TAC calls for intervention by the national AIDS Council to ensure a functioning PAC in this province, WC and other like it.
• Resolved to request that the chairperson of SANAC, and leaders of all political parties, write to Mayors instructing them to take leadership in establishing Local AIDS Councils and ensuring their functionality.

The NC also supported the continued production of the SECTION27/TAC NSP Review and agreed to develop an easy-to-use activists manual on ‘How to make a Local AIDS Council work'.

On TB:

TAC resolved to organise a one day activist pre-conference before the National TB conference in Durban which is taking place from June 12-16 2012.

TAC NC resolved to support and be part of a call to the Medicines Control Council (MCC) to permit the compassionate use of TMC207 (Bedaquiline) for named TB patients who have failed other TB drugs. Although Bedaquiline is still an experimental medicine and not yet registered, the NC noted that there is significant evidence of its efficacy and safety and that for this class of patients the benefits outweigh the risks. Its use for compassionate treatment is also endorsed by clinical experts.

If necessary, TAC will organise a demonstration at the MCC to support and publicise this demand in May. The NC also noted the need for treatment literacy among TB patients about Bedaquiline and to put human faces and stories behind the campaign for its compassionate use.

TAC noted the extensive roll-out of the Gene Xpert in South Africa and commended the Department of Health on making this revolutionary new TB diagnosis available. However the NC expressed serious concern about the price of cartridges for the Gene Xpert which is limiting its use and accessibility, especially in other high burden TB countries like Kenya and many others.

The NC resolved to challenge to Cepheid, the manufacturer of the cartridges, and demand a price reduction from $17 per cartridge currently to $7 per cartridge. A letter making this demand will be written to Cepheid, pointing out that if this does not happen a resolution to challenge Cepheid, if necessary through litigation, will be tabled at the National TB conference in June 2012.

Finally, TAC NC noted a recent judgment of the Supreme Court of Appeal overturning a judgment of the Western Cape High Court that found that an awaiting trial prisoner, Mr Dudley Lee, had been infected with TB in prison as a result of negligence and the failure to implement proper TB programmes by the Department of Correctional Services in Pollsmoor prison.  The SCA ruled that because causation could not be definitely proved (even though they admitted it was most probable) the prisoner was not entitled to damages.

The NC resolved to appoint SECTION27 as its attorneys and to seek admission as amicus curiae (friend of the court) in an appeal against this case; alternatively to work with the prisoner's legal team to assist the appeal. In this regard TAC noted a shocking recent article in the South African Medical Journal that scientifically proves that there is an extremely high risk of TB infection in South African prisons because of the absence of proper policies for infection control.

On Continued Use of the TaraKlamp for male circumcision in KwaZulu Natal:

TAC wholeheartedly supports the voluntary male circumcision programme of the Department of Health. However, we have publicly and privately raised concerns with the Minister of Health Dr Aaron Motsoaledi and KwaZulu Natal Premier Dr Zweli Mkhize about the use of the TaraKlamp for MC.

The TaraKlamp is an unsafe medical device that was withdrawn from use in a clinical trial because of a high rate of adverse events. Despite this it is being used in KZN in suspicious circumstances. TAC has recently received further incontrovertible evidence that it is causing serious harm to men's penises.

We have tried hard to engage the KZN government and SANAC on this issue but to no avail. The NC therefore resolved to:

1. Submit a dossier of evidence regarding questionable procurement practices to Corruption Watch for further investigation.

2. To write to the Chairperson of SANAC, the Deputy President, drawing to his attention evidence of the dangers of the TK and requesting his urgent intervention.

3. To ask SECTION27 to investigate whether a complaint can be made to the Public Protector about the TK.

4. To consider litigation if either of the two steps above are unsuccessful in bringing about the withdrawal of use of the TK.

On National Health Insurance:

TAC supports National Health Insurance (NHI). However, the Green Paper published last year contains many gaps, and much still needs to be done to finalise a reasonable policy on NHI.

In the meantime we note the list of 10 pilot districts for NHI services and that these districts include districts where TAC has branches and  model districts, such as Gert Sibande, Umgungundlovu and OR Tambo. The NC resolved:

• To play an active role in NHI pilot districts, participating in NHI structures that are established, monitoring the districts and assisting with civil society mobilisation to ensure that NHI is successful and understood.
• To investigate setting up an NHI monitoring forum.
• To conduct activists' dialogue on both the NHI and NSP in association with SECTION27 in May/June 2012, starting in Lusikisiki.

International Issues:

Global Health Assembly:

The NC took a resolution to participate in the Global Health Assembly in Cape Town and to work with the People's Health Movement (PHM) and others in organising a National Health Assembly in early July 2012.

The Medicines Patent Pool voluntary license with Gilead:

The NC took note of the dispute between AIDS activists and the Medicines Patent Pool (MPP) over the voluntary license negotiated with the pharmaceutical company Gilead in 2011.

This issue was extensively discussed at a meeting held by SECTION27 in March 2012 and attended by TAC, the Executive Director of the MPP as well as treatment activists from India.

The NC believes that some of the criticisms of the license are justified and noted that they have led to attempts to amend/improve the license as well as to a broader awareness of the MPP among activists globally.

The TAC NC resolved to continue to support the principles underlying the Medicines Patent Pool. TAC supports any genuine initiative that is aimed at expanding access to affordable medicines, and the MPP originated from our struggles.

However, TAC stressed that any voluntary licenses that are agreed to by the MPP should not contain terms and clauses that in any way undermine national activist efforts to expand access to affordable medicines both internationally and respective countries

We therefore:

• Call on the MPP to convene a meeting as soon as possible to consult with activists to discuss normative terms and conditions that should form the starting point for voluntary license negotiations - as well as against which future voluntary licenses can be measured.
• Demand that all other relevant pharmaceutical companies - including companies such as Johnson and Johnson that have refused to negotiate with the MPP - place essential HIV medicines in the Medicines Patent Pool, and
• That existing negotiations are speeded up and that licenses are agreed on terms that will genuinely expand (and not limit) access to treatment.
• Call on the MPP to ensure proper representation of the community of people living with HIV in their structures.

We call on the Board of the MPP to henceforth guarantee greater transparency of all its process and for civil society vigilance and monitoring of the MPP so that no licenses are negotiated that in any way undermine activists' struggles for access to treatment.

Statement issued by Nonkosi Khumalo, TAC Chairperson, and Vuyiseka Dubula, TAC General Secretary, April 16 2012

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