In the time honored TAGline tradition, we will be dedicating this as well as the October issue to sorting through and processing the goings-on at the 13th International Conference on AIDS which, if you hadn't heard, was held on the African subcontinent this year, in Durban, South Africa, from July 9-14. As we did on the heels of the head-spinning Vancouver conference four years ago, TAGline sat down with those who attended the meeting (Mark Harrington, Gregg Gonsalves, Michael Marco, Yvette Delph) and tried to get a handle on the mini revolution Durban has firmly set into motion. The second half of the roundtable discussion will appear in next month's issue along with additional items from the conference.

Harrington: Mike Barr is interviewing us.

Marco: Barbara Walters, eat your heart out!

TAGline: Okay. Where to start? I guess I'd like to know what made the biggest impression on you in Durban. And what do you think the media back here in the states might have overlooked. Yvette?

Delph: I think it was a huge conference. Politically, I think this was groundbreaking. It was wonderful to see the level of organization and enthusiasm of the South African treatment activists and the participation of TAC [NB: Treatment Action Campaign, a growing activist movement based in South Africa; see accompanying article]. And to see the participation in the march that they organized. And to see the cooperation among the AIDS activists internationally and the participation by U.S. and other treatment activists from around the world in the TAC march. It was very, very invigorating to hear people like Winnie Mandela, Edwin Cameron and Nelson Mandela speak.

I think, like everyone else, I was disappointed over Mbeki's speech and his apparent dodging of the HIV issue and trying to put everything at the door of poverty. I think poverty and debt relief are important–and crucial in solving the problem–but I also think that those are very long-term strategies and there is lots of stuff that can be done to address the HIV/AIDS situation in the short-term which he does not seem to be willing, at least overtly, to talk about.

Marco: It was also really amazing to just be there and have so much interest, attention and media on AIDS which, while it is a huge problem in South Africa, it's not often addressed by everybody. For instance, I had amazing talks with cab drivers wanting to talk about AIDS and, you know, asking questions like, Should someone with HIV still be able to cook them dinner. And just basic questions we used to ask in the '80s and that some people still ask today in the U.S. But just doing some basic outreach and education, talking to them about Mbeki and what they thought. And I think also, I'll agree with Yvette, that the activism was great: seeing TAC grow and flourish at the meeting. Also, big time AIDS researchers, everybody from Judy Currier to Trip Gulick to Julio Montaner, getting passionate and fired up and talking like an activist. You could see the fire in their eyes. And they really thought that something needs to be done and that this is going to galvanize them to start working on international issues. There were some absences from activists and from leading AIDS researchers that were disappointing. The data and scientific presentations and some of the oral presentations, you know, were mediocre.

Harrington: Not all of them.

Marco: Not all of them, but the politics and the fever that happened there totally outweighs a good or bad accepted oral presentation.

Delph: Some of the debates that occurred were particularly helpful and interesting. To mention a couple of them: whether HIV-infected women in the developing world could breastfeed; is anything less than HAART acceptable in countries with few resources? Julio Montaner was really good in that debate.

TAGline: My TAG cynicism–skepticism–would lead me to question whether a few months from now all these people having this Third World lovefest in Durban... I mean it just seems like it will all dissipate and the local people will be left with a little, maybe, encouragement and maybe a few extra resources, but is there really going to be anything long-term?

Harrington: Mike, are you suggesting that the Durban feeling was just a mass hysteria that's going to wear off when people go back home to their lives?

TAGline: Well, yes, I think that's human nature.

Delph: Mike, I think it is human nature, but those of us who feel that strongly about making sure that it does not die down also have a responsibility to keep the fires burning here.

TAGline: What is Julio Montaner or Trip Gulick or Judith Currier, for example, going to do back in New York or Vancouver, you know, two months from now?

Gonsalves: Mike, I share your cynicism...

Harrington: Skepticism, Gregg, skepticism.

Gonsalves: Skepticism and cynicism. I think the whole meeting was a challenge to people, to researchers and activists alike, to actually look at an epidemic of a proportion they've never seen before in the face–to see the reality of AIDS in the developing world. Different people are going to rise to the challenge in different ways–and not rise to it. The challenges are enormous. Before we went to Durban, nobody could have predicted that the issue of treatment access in the developing world would have blown up to be such the hot button political issue of the meeting. Everyone said, "Vaccines, vaccines!" The vaccine advocates say that's the only answer to stopping–helping–the epidemic in the developing world.

TAGline: I think that might just be your bias, Gregg. The people I talked to, which admittedly could be counted on the fingers of one hand, all said, "Oh, it's all going to be about access, it's all going to be about access." And dismissed it. A lot of the reason people didn't go to Durban was because they were worried it was going to be about access and pricing policies and politics. So I don't know. Was it really that big of a surprise? I mean, yes, it was surprising to see a full page spread in The New York Times about compulsory licensing and parallel import–and some of Mike Waldholz's stuff–but other than that, wasn't this all pretty much expected?

Harrington: I actually think the way the meeting was covered in the U.S. was very different from the way the meeting was experienced by the people who were there. And one of the things I noticed when I got home was that people didn't have a sense of the real exhilaration and inspiration that people got who were there. And when you would read the articles by Larry Altman, they might talk about some of these issues, but it was in a very removed way. Clearly, Larry and Mike W. didn't go to the march, didn't see the workshops the Treatment Action Campaign gave before the march, and they didn't really see the way that Edwin Cameron related to the Zulus in the audience, who were from the most hard-hit area in South Africa who clearly were responding on a political level to the need to mobilize their own government around treatment issues. That was really a mass movement, and was not something that was covered in the press here.

And so it's not just a matter of what people who went to the meeting and came back do, it's also the fact that there is this mass movement. There is incredible pressure on the drug companies. They've made a lot of promises now, but they haven't really started delivering on any of them. And there is the possibility that the pressure will be lessened, but I think that having made some of these promises they're going to now have to start figuring out how to deliver on some of them–and so are other agencies that are going to have to start thinking about the infrastructure. In the meantime, there are people in parts of South Africa that are already moving ahead to implement programs like short-course AZT in mother-to-child transmission–in the teeth of opposition from the government. And they're already getting substantial results, and it will be pretty interesting if in a year or two... as more people become aware of their HIV infection in South Africa (which is a middling resource setting compared to some of the other poor countries) and Brazil making the offer to help other developing countries with access to the generic antivirals that Brazil is making... is really putting unprecedented pressure on the global pharmaceutical industry. So things are going to happen. I don't think they'll happen fast enough.

Delph: I think you also need to include in that the kind of pressure that is being put on UNAIDS and the various member organizations like WHO and the World Bank. I think a lot of pressure was put at Durban. Many of the agencies came to say basically, "Look at what we've done. We've done a whole lot." And we basically said "You've not done enough."

Gonsalves: There are also research challenges, Mike, that we have focused on that took on a new twist in Durban. We've talked about long-term effectiveness research over the past 18 months, about when to start, when to switch. There are questions about: How are things being implemented in mother-to-child transmission protocols and how have they been evaluated? How do you tell what works on the "ground" in resource poor settings? Which hasn't been part of our effectiveness agenda, but it is–it's definitely post-marketing research–but it's not the kind of post-marketing work researchers are used to thinking about.

Delph: Even the long-term effectiveness research and its relevance to the developed world also has major implications for the cost effectiveness in developing countries. Because if we find, in fact, that we don't need to start... that it's better to start antiviral therapy when the CD4 count is 250 or 300, that translates into major cost savings not only for the developed world but for the developing world.

Gonsalves: On the skeptical side of things, Mike, there are a lot of Saul-on-the-road-to-Damascus conversions happening in Durban to people for whom [access and equity] haven't necessarily been issues, but then all of a sudden you get there and you decide that that's where the world should be focusing its fight.

TAGline: I mean, out of all these...

Delph: Mike, Mike, before you go on, I would also like to draw the analogy between, for me, attending Durban this year and attending the Beijing Women's Conference in 1995.

TAGline: Okay.

Delph: Because there was a lot of the same kinds of criticism: "We spent so many millions of dollars to bring women and governments from all over the world. What is it really going to mean?" What did the Cairo Conference in 1994 mean?

TAGline: Cairo?

Delph: The women's conference is an international conference on population and development.

TAGline: Okay, Cairo '94. Beijing '96?

Delph: '95. And I think that five years later we've seen that what it has meant is that grassroots women and organizations have come together, that they have proliferated, that they have meant greater understanding by the people of their basic rights–whether as women or rights in terms of reproduction. It has meant that there is pressure on governments to ensure that people know these rights, that these rights are enshrined in legislation and in practice. There has been a tremendous pressure, for example, to address issues of bride burning, of female genital mutilation, all kinds of things. And it has brought both to the fore as issues and the pressure has been maintained, and I think that progress has been made. I don't think enough progress has been made, I think that [the governments] are nevertheless at this late date trying to back out of certain commitments. And funding for these programs is still a big issue. But at the same time, I would not want to minimize the impact that those conferences have had.

TAGline: I don't mean to minimize the impact of the meeting. We [Aid for AIDS] had a conference in Venezuela a couple of years ago. Maybe it's apples and oranges, but the one thing that did come out of that weekend after the feel-good wore off was the networking that goes on, the transfer of experience and "technical assistance," whatever you want to call it. And there are two or three activist groups there in Venezuela today that either didn't exist before or are much stronger now. So I think that's something that conceivably could be a lasting legacy of the meeting.

Delph: And the knowledge at the end of the day that you are not alone out there. And that there are others out there who are interested in helping–who you now know and have contacts with and can maintain that contact. I think together we can do so much more than each of us can do individually.

Gonsalves: Mike, I think it's also about witnessing, about being a witness. It's not so much about what we did there but what we witnessed. We saw a Supreme Court justice get up who is gay and HIV-positive in a country where people get murdered because they are HIV-positive. We saw poor people who probably go home…

TAGline: But isn't it relatively easy for a well-to-do white man to stand up and come out as HIV-infected? It seems a little…

Gonsalves: But it wasn't easy for the black African men and women we saw, who probably go home to fairly squalid living conditions, to come out and to protest and to demand treatment and to wear T-shirts that said they were HIV-positive. They identified themselves publicly as positive in a country where people get killed for that.

Harrington: And I'm not sure it is that easy for white gay men to come out in certain countries, and I wouldn't make that assumption right off the bat.

Delph: And I also think…

Harrington: Wait, wait, wait. I want to make this point. It might be easier for judge Cameron to make that point than for someone in KwaZula Natal who's going to go back to a township and might get beaten, but it's also... when somebody takes on their government like that, it's a very brave thing. And I don't think we should just discount it and say, "Oh, it's just another white man coming out with HIV." We know a lot of activists who are relatively privileged, and they haven't come out in certain settings in their own countries in the North.

Marco: Look at Elizabeth Glaser or Mary Fisher in some ways. You also saw, just recently, some very prominent family, I don't know the name...

Harrington and Delph in unison: Sisulu. [NB: Walter Sisulu was an ANC colleague and prison-mate of Nelson Mandela.]

Marco: They admitted that a death in their family was due to AIDS. That would have never happened if it weren't for Cameron and this conference. I mean, those are wild steps.

Delph: I think you also need to remember South Africa had its history of apartheid. It also has its history of whites who have fought apartheid, but you're also seeing here a white gay man who, yes is in a privileged position, but he's also fighting now for access to HIV drugs for a majority black population.

TAGline: Uh-huh.

Gonsalves: The more moving thing to me was seeing people... The AIDS activist movement in the U.S. largely started from, yes, privileged white gay men who were either dying or saw their friends... [But here you have] people without alot of social privilege doing something in a fledgling democracy with a huge burden of HIV stigma... black men and women from townships coming out to the cities and doing this and saying, "I'm HIV-positive and I want treatment..."

Harrington: And getting help from their labor unions and... There are a lot of aspects of their mass movement that are impressive in ways that we were never able to achieve here [in the U.S.]. The fact that the unions were there, several political parties that are in opposition to the ANC were involved. There really was a mass feeling to the demo that I think was maybe only comparable to when... Mike, do you remember when the Haitians took over Brooklyn Bridge?

TAGline: '90? '91?

Harrington: There was a truly mass kind of demonstration about... I think it had something to do a government proposal for mandatory testing.

Marco: Also, Mike, to hear Nelson Mandela speak...

Gonsalves: It's weird, Mike, because I heard Edwin Cameron speak, and Fauci said it was the best speech he had ever heard at an AIDS conference, and I thought it was great. And then on the last day of the conference, to hear this guy whom everyone has admired and is probably one of the greatest men of the twentieth century speak... but also make this extremely skillful, powerful speech where he was able to tell the West to get off Mbeki's back about the etiology of HIV and to say that the debate was irrelevant in the face of the suffering of millions of his countrymen and women and that he did have to face the challenge of treating opportunistic infection and preventing mother-to-child transmission with AZT or nevirapine.

Marco: The fact that Mandela used the words "safe sex" and "condoms" and used the term "opportunistic infection." I mean, he got press worldwide. I don't think we understand how huge that was, even though Mandela might have bloody hands for not doing enough under his reign.

Gonsalves: And also, Mike... We heard George W. Bush last night give this flaccid stump speech...

Harrington: You did. I didn't.

Gonsalves: ...to give this really flaccid stump speech filled with every political platitude in the book. Then to hear Mandela talk about compassion and dying and invoke his own death... You know, he's 82 years old and he talked about his own mortality and the need to approach people with AIDS with compassion and love. For him to say that to his country was really moving to watch. It was definitely the best international conference I've ever been at. ¤

Sanibonani! Ninjani? Nami ngiyaphila. Ladies and gentlemen, I have greeted you all in the language of my Zulu-speaking compatriots. I told them that I saw them. Their response was initially passive: they acknowledged my statement. Then I asked them how they were. They told me that they are well and living. I was able to reply the same. That to me was significant. It wasn't merely a formality. It was an important part of my reality here today. I'm here, I'm able to be talking to you, I'm able to engage with you, I'm able to speak with you about this important topic, because I am on antiretroviral treatment.

Three years ago in October 1997 I fell very ill. Is there anyone here today who's feeling ill? Yes, I see you. Is there anyone who's feeling ill from AIDS? Who wants to speak about it? Well, I can tell you that you taste death in your mouth when you have AIDS. Your body stops absorbing food. Your body stops producing energy for you to work and think and to enjoy life. Your body starts breaking down against its own will, and you feel terrible.

When I fell ill, I had good medical care. I had a good doctor. He gave me medicines to deal with the things that were making me so ill. And then he gave me the medicines that treated the underlying cause, which was this virus that was stopping my body's ability to defend itself against the things that were making me ill. That was nearly three years ago. The average survival time for someone like me–a well cared for, medically attended, well nourished male in his mid-40s–after the onset of full blown AIDS is 30-36 months. I fell ill 33 months ago–so I should be dead by now. Instead of which, I'm here, ngikhona, ngiyaphila, I'm still living.

I'm still living when there are people here on the street outside, people in Kwa Mashu, in Dundee, in Nongoma, on the South Coast, who are terribly ill, who are dying. There are people throughout Africa, 24 or 25 million people in Africa and nearly 34 million people in our whole world, who are this moment dying. And they are dying because they don't have the privilege that I have, of purchasing my health and life.

I'm a judge. As a judge, I have many privileges and benefits. And I exercise them; I don't claim not to. I have the privilege of a secure position. I cannot be sacked by an employer that discriminates against me because the Constitution says that I cannot be sacked. I also have a loving family who are here today. And I have colleagues and friends who support me. And most importantly, on the salary of a judge I have the privilege to purchase my life. I can afford my medication that costs me $400 (2,550 rand) every month. Who here is working? Who earns 2,550 rand a month? How many of you are not working at all? Too many–too, too many people–are not even working. Now, why should I have the privilege of purchasing my life and health when 34 million people in the resource poor world are falling ill and dying? That to me, ladies and gentlemen, seems a moral inequity of such fundamental proportions that no one can look at it and fail to be spurred to be thought and action. That is something which we in Africa cannot accept. It is something that the developed world also cannot accept.

A century ago in the trenches of the first World War, 18 million white Europeans died because of corporate greed, governmental ineptitude, and human folly. In Africa we face death and dying and misery and loss and mourning on the same scale. Except that this does not have to happen. Our history teaches us South Africans. I'm proud to be a South African, and I'm proud to be an African. I'm white and I'm an African and I'm proud of that, and our history has taught us a great deal.

Our history has taught us that we don't have to accept "inevitabilities." We don't have to accept what one woman from the United States in the seminar I attended yesterday called "a sad reality," that these medications are not accessible to Africa and the resource-poor world. We don't accept "sad realities" in South Africa. If we accepted what others told us were sad realities, we would still have a racist oligarchy oppressing our people. We would have indescribable chaos and bloodshed.

We have shown through our history that we will confront those "sad realities," and we will change them. Our country is not perfect. But we have a democracy and a Constitution and national aspirations that we can be proud of. You are here today because you want to be proud of our country in every respect. You want us to be proud of the way that we can make health and life available to everyone.

At the seminar where I was yesterday and again this morning, Dr. William Makgoba released figures, which are published today in the Sunday Times. These figures come from our own Department of Home Affairs. They show that the natural order of things–that people die late in life and women die later than men–has been reversed in our country. It has been reversed particularly in Kwa-Zulu Natal. Women are dying in their early 20s and mid-30s. And women are dying before men. These are figures that show that something dramatically and terribly wrong is happening to our people. And what is it? We know what it is. It's not TB. It's not malaria. And it's not malnutrition. It is a virus. It's a virus called HIV. It causes AIDS. And if AIDS is not treated, it leads to terrible sickness and death.

But there is a greater fact even than that. The greater fact is that medications are available. They exist and can be cheaply produced, but the drug companies are keeping them unaffordable and inaccessible to the people who most urgently need them. We need to change the facts of our world. We need to change the facts that are going to lead to the deaths of 25 million people in Africa. And we do plan to change them. That is our role as Africans, as proud Africans, as proud South Africans. We will confront that fact and we will change it by changing the conditions that create it, through principled political action, through legal action, through principled commitment to what is right. We will challenge the future by intervening in the present. Thank you, very much. ¤

In May 1998 Ms. Gugu Dlamini was stoned to death in Durban for revealing that she was HIV-positive. A few days ago 5,000 people, many wearing "HIV Positive" T-shirts, gathered at the Durban City Hall to demand equitable access to HIV/AIDS treatment. The excited group of nuns, drag queens, sangomas, doctors, communists, teenage punks on skate boards, Pan-Africanists, gay activists, unionists, students and nurses had come from all over Durban, South Africa and the world to join the Global March for Access to HIV/AIDS treatment. The official posters castigated the drug companies for making huge profits from the AIDS crisis while the homemade posters said things like, "AIDS is as real as cANCer" and, "Mbeki, forget your R3 million jet and buy us medicine."

The march was organized by the Treatment Action Campaign (TAC), a rapidly growing organization with strong support in the trade union movement. It was lead by people of the stature of leading Muslim theologian Dr. Farid Essack, Anglican Archbishop Njongonkulu Ndungane and Catholic Archbishop Denis Hurley. The streets of Durban were full of singing, dancing, laughter, warm solidarity and hope. Gugu Dlamini had been vindicated and the demand for equitable access to HIV/AIDS treatment had been turned into the single biggest issue confronting the 13th International Conference on AIDS. Previous conferences had focused on prevention but now treatment–and equitable access to treatment–were topping the agenda.

But there was another major issue: Mbeki's reluctance to make AIDS drugs available and his perceived support for the right wing American AIDS "dissidents." Before the conference he had been "trashed" on the influential U.S. news program 60 Minutes, and the leading intellectual Dr. Mamphele Ramphele had accused him of "irresponsibility bordering on criminality." Mbeki's credibility was further compromised by his government's casual dismissal of the Durban Declaration, the international outrage at his conference speech and the viciousness of his government's response to criticism. Professor Thomas Coates of the University of California went so far as to call the government's stance "genocidal."

There was a danger that Mbeki, rather than the AIDS pandemic, would be the big news story coming out of the conference. But the extent of the crisis was certainly made apparent. (No one had to tell South Africans that they were spending their weekends at funerals.) The world learned that there will be 44 million African orphans by 2010, that South Africa has the highest number of HIV infections on the planet, that 5,000 HIV-positive babies are born in South Africa each month, that 4.2 million South Africans are living with HIV/AIDS and that by 2010 life expectancy in South Africa will drop to 36 years.

Moreover, the government's claim that AIDS drugs are ineffective and toxic was conclusively refuted. South Africans learned that the drugs do work and that those who can afford them can live a long and healthy life with HIV. Scientists presented rigorous research showing that women who were given AZT and 3TC after being raped by HIV-positive men did not become infected with HIV. And although the South African government had repeatedly claimed that nevirapine is ineffective and toxic, research showed that the worst side-effect of nevirapine is that a few patients develop a mild rash on the day after treatment and that nevirapine does prevent mother-to-child transmission. "The position," Jerry Coovadia insisted, "is now absolutely clear."

The Executive Director of UNAids, Peter Pilot concluded that, "This conference has made it irreversible–prevention and care are combined." But, according to Time magazine, only 20,000 of the millions of Africans living with AIDS are receiving treatment. The rest will probably be dead within 2-3 years. High Court Judge Edwin Cameron made the point with headline-grabbing eloquence: "My presence here embodies the injustices of AIDS in Africa. Amidst the poverty of Africa, I stand before you because I am able to purchase health and vigour. I am here because I can afford to pay for life itself."

Influential American economist Professor Jeffery Sachs agreed that, "Talking about prevention without treatment has been ended decisively at this meeting" and added that, "It (treatment) can be afforded." Jerry Coovadia insisted that, "It is too expensive not to intervene," and experts estimate that the cost of non-intervention will be a 17% decline in South Africa's GDP by 2010. The South African Department of Health estimates that it would cost $6 billion a year, at current prices, to provide antiretroviral therapy to all people living with HIV. That would be less than 3% of the national budget–less than a fifth of the $32 billion which the government recently spent on arms–and less than a sixth of the $40 billion which is spent on paying off the apartheid debt each year.

But South Africans are still drinking bleach in a desperate attempt to self medicate and wandering from hospital to hospital in a fruitless search for help from the state. Nevirapine, which costs R24 a dose, could prevent 5,000 babies a month from being infected with HIV, but there is no treatment for the one in four 15-24 year old South African women who are HIV-positive. Nevirapine has been approved for use in Uganda and Senegal, but the Medicines Control Council has still not approved the use of nevirapine in South Africa.

The assault on the drug companies began at the march and was carried forward by Edwin Cameron's widely reported comment that, "The drug companies and the African governments seem to have become involved in a kind of collusive paralysis." And with the World Health Organization (WHO) and the highly respected Nobel prize-winning organization Médécins sans Frontières/Doctors Without Borders (MSF) joining the attack, the drug companies were forced into a defensive position. It was clear that there is a critical mass of people who simply refuse to accept that the Brazilian government can treat a thousand people with dual therapy for the same price that the Ugandan government can treat 228 people. Or that 100 mg of AZT costs $2.00 in South Africa and $0.30 in Thailand.

In response to the pressure, a group of 5 drug companies offered to cut prices by 85%, but Medecins sans Frontieres likened the gesture to "an elephant giving birth to a mouse." MSF believes that the answer does not lie with donations or price cuts from drug companies but rather with the Brazilian approach of mass-producing quality generics. Countries which can't afford high prices can either manufacture their own generics or import them from producing countries. This could result in the cost of a year's anti-retroviral treatment being cut from the $2,250 (which it would cost with the 85% discount) to a mere $200 a year. This is not a pipe dream. The polio vaccine is sold for several dollars in the U.S. and just a few cents in the developing world.

Pfizer manufactures fluconazole, which is used to treat the opportunist fungal infections suffered by people with HIV. Pfizer, who made a profit of $800 million last year from fluconazole alone (their total income was $3.35 billion), offered to provide free fluconazole to HIV patients with cryptococcal meningitis. But only about 14% of South Africans with HIV develop cryptococcal meningitis. Pfizer is not, however, making fluconazole available to people with candida–the most common opportunistic infection plaguing people with HIV. Candida leads to severe discomfort, but one or two fluconazole pills a day can restore quality of life, dignity and hope. So unless they are prepared to smuggle a fluconazole generic in from Thailand (where it costs R3.72 a pill) or India (where it costs R7.81 a pill), South Africans with candida will only be able to get fluconazole if they can pay R86 per pill–that's over R6,000 a year. Pfizer's offer expires at the end of 2002–six months after its fluconazole patent expires–and many people, including an expert from the World Health Organization, suspect that the offer has been designed precisely to prevent the South African government from buying generics for those six months.

It was no surprise to see left leaning newspapers like England's Guardian and Australia's Green Left Weekly come out against the drug companies and the governments which support them. But it was highly unusual and noteworthy to see conservative newspapers like The Washington Post and The New York Times making similar arguments. The Washington Post said that the fact that effective treatment is available but priced beyond the means of the poor "constitutes an outrage against the most basic conceptions of international justice, of human dignity, against the very idea of human solidarity."

This would have slotted in perfectly to Winnie Madikizela-Mandela's rousing speech at the TAC march, and it seems that the enormity of the AIDS epidemic has mounted a serious challenge to the orthodox view that the market's thirst for profit must be put before the needs of people. It has been widely recognized, even in conservative circles, that there is simply no way that the AIDS pandemic can be countered until governments insist that people's needs be considered before the profit needs of the multinationals.

The demand to make the market serve the needs of people has passionate and growing global support. What's more, the TAC is prepared to take the South African government and the drug companies to court if there is no immediate progress. And they'll have the support of people around the world–including many of those for whom the autonomy of the market was previously non-negotiable.

But what about Mbeki? Will he continue to equivocate in the face of the avalanche of international condemnation which has even united Winnie and Nelson Mandela and the DP and the PAC in their criticism of the President? Coovadia has acknowledged that, "There is strong disapproval of the government" and expressed his concern that the gap between the government and its critics is widening." This raises important questions of strategy for AIDS activists. Should they challenge the government directly–or should they, rather, give Mbeki the space to back down gracefully?

The charismatic chairperson of the TAC, Zachie Achmat, has taken a principled decision not to take any antiretroviral drugs himself until the government makes the medication available to all people living with HIV. He describes himself as "an ANC member in good standing–I attend all my branch meetings!" Moreover, the bulk of the rapidly growing TAC membership comes from ANC-aligned unions and are probably ANC supporters. Achmat explains that, "Our approach is to take a firm, principled stand on the issues. But if it becomes clear that they won't compromise, then we will issue a challenge." He confirmed that if the Minister of Health fails to provide nevirapine to pregnant women, the TAC will launch an urgent High Court application demanding the constitutional right to treatment. TAC has also served notice that it will take legal action against Pfizer to seek a compulsory license to allow South African companies to produce cheaper copies of fluconazole. TAC members have also committed themselves to a defiance campaign: they will import fluconazole and distribute the drug through a number of doctors and nurses who have already indicated their support for the project. Achmat explained that, "We are taking this action because we have been in negotiations with the government for two years. They promised to act as soon as they got the S.A.I.N.T. report on the nevirapine trial. They got it two weeks before the conference, but there has been no announcement."

Mbeki's likely response to this action is still a matter of conjecture, but it is clear that the Treatment Action Campaign and other AIDS activists have major support in South Africa and around the world. If Mbeki treats AIDS activists, rather than AIDS, as the enemy, he runs a serious risk of losing all credibility. Indeed, it seems clear that if Mbeki fails this test, a significant sector of his own electorate will judge him unfit to govern.

Please feel free to visit or support the Treatment Action Campaign via their website at www.tac.org.za. You may also subscribe to their electronic newsletter by sending an e-mail request to list@tac.org.za. ¤

• May 12, 1999
  Bristol-Myers announces 5-year donation of $100 million to fight AIDS in Botswana, Namibia, Lesotho and Swaziland and South Africa.

  April 4, 2000

  Pfizer offers free fluconazole to South Africans with AIDS suffering from Cryptococcal meningitis.

  May 11

  Five pharmaceutical companies (Boehringer Ingelheim, Bristol-Myers, Merck, Glaxo and Roche) offer steep cuts (up to 80%-90%) in price of AIDS drugs for Africa.

  June 16

  Doctors Without Borders/MSF releases report of country drug price differentials.

  July 7

  "Bristol-Myers Finds Pledging AIDS Aid Is Easier Than Giving It" (Wall Street Journal headline)
  "Mr. Baralengwa soon learned that the gift came with many strings attached... A close look at Bristol-Myers's project shows the pitfalls that ensue when a big-pocketed foreign corporation, well-meaning but with little or no experience in Africa, brings its money and management style to Africa's AIDS epidemic."

  July 8

  Boehringer Ingelheim announces it will give nevirapine to Africa free for 5 years for use in blocking vertical transmission of HIV from infected pregnant women to their unborn children.

  World Bank officials say they will make available $500 million in form of 40-year loans to African countries setting up national AIDS programs.

  July 9

  "Africans Fear Costs of Free AIDS Drug" (Washington Post headline)

  "At roughly $4 a dose, nevirapine is within the budget of many developing countries. However, those who might find its cost a burden are likely to be those without sufficient clinical laboratories and other medical infrastructure to make full use of the offer to get it free."

  July 10

  Merck and Gates Foundation will provide Botswana $100 million over 5 years to fight AIDS.

  Abbott Labs plans charitable program for Tanzania, Burkina Faso, Romania and India.

  "Southern African Governments Criticize Motives"

  Health Ministers from the 14-member Southern African Development Community (SADC) lash out at drug companies for making drug offers public without first informing governments.

  July 17

  The South African based Treatment Action Campaign (TAC) announces it will take legal action against Pfizer to seek compulsory license to allow South African companies to produce cheaper copies of fluconazole. The group also announced plans to import the drug from other countries where it is less costly.

  July 18

  U.S. offers African nations $1 billion a year in loans to finance the purchase of AIDS drugs.

  August 21

  South African nations (to date, South African and Namibia) reject U.S. loan offer to buy AIDS drugs, politely explaining that the last thing they need at this time is more debt.