Since 1976, I have been involved in anti-apartheid and human-rights work. By the time I reached my 18th birthday, I had been detained and imprisoned by the apartheid government on five occasions. Over the years, I have enjoyed writing, reading, human-rights work and producing videos. I am a gay man and I have been active in the struggle for lesbian, gay, bisexual and transgender equality in southern Africa, campaigning for the clause that guarantees equality on the grounds of sexual orientation.
I also have HIV. Currently, I am in good health. I suffer occasional HIV/AIDS-related opportunistic infections. In December 1998 and January 1999, I became quite ill. My doctors diagnosed systemic thrush–a condition associated with HIV/AIDS progression. At the time, I was not on medical aid, and my friends assisted me with the costs of medication. Over a period of three weeks I paid more than a month’s salary for a medicine known as Diflucan (generic name, fluconazole), made by Pfizer–a United States-based multinational corporation. I recovered and realized that without the financial assistance of my friends I could have died. Later I learned that a generic equivalent of the same medicine cost less than 450 rand (about $76 at the time) in Thailand, where fluconazole is not patented.
Since that bout of illness, my friends have insisted that I use anti-retrovirals, the medicines that stop HIV from replicating and can reduce the virus to undetectable levels in the bloodstream. For many people in Europe, North America and Brazil (for different reasons) as well as small minorities in poor countries, anti-retroviral combination therapy has transformed HIV/AIDS from a fatal condition to a chronic and manageable disease. Currently, combination therapy costs between 1,800 and 3,500 rand in South Africa, about $200 to $400 per person per month. (In 1998, before the global campaign to lower the prices of HIV drugs, these medicines cost more than 4,000 rand.) In 2000, my personal income was about 3,500 rand per month. I cannot afford anti-retroviral medicines. My friends have said they will provide the money. But in December 1998, I made the decision not to take anti-retroviral therapy unless it becomes available in public hospitals and clinics. This decision is based on the principle that everyone has the right to life and dignity.
More than a month ago Justice Bernard Ngoepe ruled that TAC could join the case of the Pharmaceutical Manufacturers Association and 39 drug companies suing the South African government. I have been integrally involved in TAC, an organization fighting for affordable HIV/AIDS medicine and a better health-care system for all people. I submitted an affidavit in the Pretoria case. My account was a small part of the picture represented in affidavits by many of my friends and comrades to the court. Unlike many of them, I have a job. Many of them face a ravaged public health-care sector. I have a good doctor. I have no child who has HIV. I am not a doctor in a township clinic who cares singly for 700 patients with HIV/AIDS and has no medicines to give to them. The drug companies fought hard to keep these stories out of the court record. But we gave a face to this epidemic that has claimed millions of lives and will continue to take millions of nameless and faceless others without medicines made by these companies.
Now that the drug companies have given up the fight, our challenge is to transform our victory into effective treatment for millions of poor Africans. A conference of AIDS experts in Kampala last week debated exactly how to do that. What TAC would like to see is a development program that would help poor countries pay for drug treatment, counseling and preventive education. (South Africa has the resources to do it on its own.) The proposal announced by Harvard scholars this month to get rich nations to donate billions to an international agency like the United Nations that would buy anti-retrovirals in bulk at a sharp discount is a start. But the way forward has to include not just governments and brand-name drug companies, but also generics manufacturers and civil society. It’s a question of sustainability; even with lower prices this problem will not go away for generations. Governments, international agencies, civic groups and generics and brand-name manufacturers must all work together. Groups like TAC must concentrate on educating health-care workers and patients on how to follow the complicated drug regimes–and on getting money for research on microbicides and a vaccine.
I want to take anti-retroviral medicines. I want to study and become a lawyer. I want to write a novel and continue making videos. I want to be healthy and productive. I want to enjoy life, the company of my friends. But I won’t take anti-retrovirals until we have a plan that makes them available to everyone who needs them.
