Why We Cannot Abandon South Africa's Treatment Action Campaign (TAC)

TAC demonstrators

Since the Treatment Action Campaign (TAC) was founded on Human Rights Day in December 1998, it has been among the leading groups of people living with HIV/AIDS (PLWHA) organizing for power and social change worldwide. Today, the group's work and the work of so many of us has brought us to the precipice of turning the tide against the HIV/AIDS crisis. But now, the TAC is under a major threat.

Major development agencies have become enamored of the idea that South Africa, as a middle income country, should largely take care of its "own" epidemic -- and that includes helping fund one of the world's most important civil society organizations. As has so often been the case, it is falling to the HIV community -- activists, academics, clinicians, PLWHA and affected communities, and all of us -- to remind the international community what solidarity looks like.

One in six people living with HIV in the world is living in South Africa -- totaling over 6 million people. Today, nearly half have access to treatment through the world's largest HIV treatment program -- nearly all of them because of victories won by the TAC. Life expectancy in South Africa is finally recovering -- from a low of just 54 years in 2005 to 61 years in 2012. Yet, it is still nearly 20 fewer years than most people in wealthy countries can expect.

This success is incredibly fragile. Seventeen percent of South Africans ages 15 to 49 are living with HIV, and transmission rates are still far too high while millions more people are waiting for treatment. Meanwhile, there are signs that the HIV/AIDS response is beginning to unravel, leading to a recent New York Times headline: "AIDS Progress in South Africa Is in Peril." The South African Health Minister recently revealed that 37% of patients starting HIV treatment are lost to follow up. With the biggest burden of HIV in the world, the global response against HIV is inexplicably tangled with the South African response.

More than ever, the world needs the TAC and we need to rally to its support.

"The World's Most Effective AIDS Group"

The TAC was founded in 1998 when only a handful of the richest South Africans had access to antiretrovirals. By 2006, The New York Times called the TAC "the world's most effective AIDS group." It began with a simple concept: organize people living with HIV into a powerful political force to fight back against the neglect and avarice of pharmaceutical companies, the South African government and the world community. Just a few of their many successes include:

Securing affordable drugs: When multinational pharmaceutical companies sued Nelson Mandela's government for even considering generic production of HIV/AIDS treatment, it was the TAC that mobilized world attention and helped to birth the global HIV/AIDS treatment movement, ensuring that today's high quality antiretrovirals are available at affordable prices for many.

Winning a constitutional court case: TAC fought to open the door to a nationwide program to prevent mother-to-child-transmission of HIV (MTCT) when the Mbeki government opposed the rollout of treatment to pregnant women. MTCT is now less than 3% in South Africa.

Breaking AIDS denialism: For years, South Africa's president and minister of health questioned the connection between HIV and AIDS and portrayed treatment as toxic -- suggesting lemons and beets as HIV therapy instead of antiretrovirals. In the face of huge pressure, the TAC changed the game and led the movement to marginalize AIDS denialism, winning the National Strategic Plan in 2007 that forced science into policies that are succeeding in the country.

Mobilizing literate communities: The TAC has led the push to empower PLWHA to know their own virus, control their own treatment and to promote take-up of antiretroviral treatment while meticulously monitoring the rollout, pointing out every problem, stock-out and shortage.

TAC demonstrators

South Africa Today

Today the TAC continues to represent public health care system users in South Africa. It campaigns and litigates on critical issues related to HIV/AIDS treatment and broader rights to health care. The organization has over 8,000 members and a network of 182 branches and provincial offices in seven of South Africa's nine provinces. Members elect the leadership, which ensures that the TAC's policies are accountable and reflect the realities on the ground. Through its branches and members, the TAC monitors thousands of clinics and hospitals. Its members are the people who need the public health system to work -- so they are the first to notice when it doesn't. In addition to the large national campaigns, the local activism of the TAC's members is the true lifeblood of the organization.

Because of the TAC's success, South Africa has actually assumed an HIV/AIDS leadership role -- making huge progress and dramatically expanding the country's own budget to cover the vast majority of the response to the epidemic. Yet that system is stretched to the breaking point -- and it is still smart activism that is keeping the system accountable at this juncture. In several regions of the country the health care system itself is collapsing -- it has been the TAC that is leading the monitoring of health facilities and communities' access to HIV and TB services in particular. It has built coalitions, identified malfeasance, and pushed for the removal of politicians who fail in their responsibilities.

TAC demonstrators

We Cannot Pull Back When the Work Is So Far From Done

Many of the major global foundations and rich governments are taking a look at South Africa, declaring success and preparing to pack up and end their help. South Africa is a middle-income country, they say, there's no need for aid. As a result the TAC is facing a massive budget deficit, created by funders who are dropping their support.

As the HIV/AIDS community, we urgently must reject this cynicism and show the TAC that solidarity does not stop when the mainstream media stops paying attention.

We need the TAC. And we can help the TAC. Please spread the word.

Matthew Kavanagh is a senior policy analyst at Health GAP (Global Access Project) and fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.