There are still many hills to climb and many obstacles to overcome. The role of civil society organisations like the Treatment Action Campaign (TAC) in making the National Strategic Plan work cannot be overstated. Organisations like the TAC have a major role in particular in influencing the provincial plans which are funded and led by provincial councils. They must challenge provinces to set bold targets and to lead inclusive responses.
Since its formation, the TAC has been on the right side of history. It has been on the side of ordinary South Africans from all walks of life. For nearly two decades, it has been at the forefront of the struggle for social justice, human rights and universal health care. It has played an outstanding role in mobilising South Africans to defend their right to life, to health and to dignity.
Our accomplishments, as a country, in expanding HIV treatment and improving life expectancy is an inspiring story of civil society activism and vigilance. It is a story of life, hope and possibility – where collaboration and united action overcomes untruths and mistrust.
Despite the progress we have made, our journey towards an Aids-free generation is far from over.
There are still many hills to climb and many obstacles to overcome. The co-infections of HIV and TB remain a real and immediate threat. Many people are trapped in fear of knowing their HIV status. Many still die needlessly because they have to travel long distances to reach a clinic to access treatment.
Many people become infected because they do not have condoms or because they are not able to make informed decisions about their sexual behaviour. We live in a society that continues to discriminate against people living with HIV or those infected with a curable disease like TB.
Ours remains a society that stigmatises patients. It ostracises vulnerable groups like sex workers and the LGBTI community.
The advances we have made in turning the tide against HIV and TB are daily undermined by poverty, inequality and lack of economic opportunities.
We must confront the high rates of HIV infection among adolescent girls and young women. We must all be alarmed about the challenges posed by the emergence of the “blue tooth” phenomenon among nyaope drug users.
We must acknowledge that our health system is under great strain and that it is struggling to meet the needs of our people.
As the South African National Aids Council (Sanac), we expect this crucial TAC Congress to provide direction on what we need to do, together, to address these challenges. The TAC is not a protest movement. We know it to be a movement of activists committed to effecting meaningful change in the lives of our people.
We therefore have high expectations of this congress. The people of this country are urging us to forge trust, build consensus and inspire hope.
Together we have crafted the new National Strategic Plan to arrest the spread of new infections and to expand treatment. We must acknowledge that concerns have been raised about certain elements of the plan. We must engage on these concerns and find agreement on how to address them.
However, we should be careful not to allow whatever gaps there may be in the plan to undermine its tremendous value as an instrument to unite South Africans in the struggle against HIV, TB and STIs.
Considering where we have come from as a country, considering the disagreements that for too long thwarted our response to HIV, it would be unwise for any of us to turn our backs on a plan that has the potential to make a real and lasting impact.
Through the NSP, we are prioritising vulnerable communities that are at a high risk of contracting HIV and being infected with TB.
In addition to expanding treatment, the NSP aims to galvanise our nation to protect ourselves from preventable infections. It aims to empower women through skills development, access to health services and economic opportunities.
The role of civil society organisations like the TAC in making the NSP work cannot be overstated. Organisations like the TAC have a major role in particular in influencing the provincial plans which are funded and led by provincial councils. They must challenge provinces to set bold targets and to lead inclusive responses.
The TAC needs to use its grass roots organisational capacity to make sure that its achievements at a national level are replicated in the provinces and districts. It is at that level of the health system that the challenges are greatest. It is at that level where our people’s experience of access and quality is most keenly felt. It is at that level that social mobilisation has its greatest impact.
Despite the difficulties, despite our weaknesses and shortcomings, we are making progress.
It is significant that, since September 2016, we have removed CD4 count as a condition for ARV treatment.
In June 2016, we began providing pre-exposure prophylaxis to sex workers in several programmes. We remain committed to expand the provision of PrEP to all vulnerable young women.
Last year, we launched the “She Conquers” campaign to address HIV infections and unwanted pregnancies and ensure girl children stay in school. The campaign is also aimed at reducing the shameful scourge of sexual and gender-based violence.
Already, we are receiving positive feedback on how social partners are succeeding in creating employment and economic opportunities for young girls and women.
Minister Aaron Motsoaledi (Minister of Health) has reported that in the 22 priority sub-districts where we have rolled out the campaign, more than 230,000 adolescent girls and young women have taken the HIV test.
Of those tested, 18,000 were positive and were immediately linked to care.
We are working hard to achieve quality universal health coverage for all South Africans. We are investing strategically to build an adequate national health infrastructure. We are working to improve the quality of care and achieve greater efficiency at our primary health care facilities.
Through ideal clinics, we have seen greater collaboration between government, the private sector and NGOs in addressing the social determinants of health.
Just like drug-resistant TB, we face the risk of developing drug-resistant HIV if patients do not adhere to ARV treatment. Such a prospect would reverse the many gains we have made to date in finding a cure or vaccine for HIV.
When clinics and hospitals run out of ARVs, we expose our nation to this risk.
We are thus innovating and exploring ways to exploit technology to ensure efficient and timeous access to life saving medication.
Work is underway to set up the institutional mechanisms that will drive the implementation of the NHI.
Civil society organisations like the TAC have been valuable partners in placing the goal of universal health care firmly on the national agenda. We look to the TAC to intensify its support for the implementation of the NHI so that no South African is excluded from quality health care.
Speaking in Paris last month, your Deputy General Secretary, Sibongile Tshabalala, cautioned that we must resist the temptation of being complacent in the fight to end the HIV and TB pandemics.
“Aids is not over!” she warned. “If the party starts now the end will never come.” She noted, correctly, that Aids budgets are falling and investments in the health system are lagging behind.
She called on the world to feel the urgency to act to stop deaths. She said: “We have to go faster and we can.”
As South Africa, we do indeed need to go faster. This requires that we do not shut the doors of engagement. It requires that we work together to strengthen Sanac and sharpen its strategies. We have a common, genuine interest to save the lives of South Africans and end the pandemics.
Sanac remains an achievement of social partnerships. The voice of the TAC must continue to be heard loudly and clearly within Sanac and across society.
It is a must that we work together.
We must choose collaboration over antagonism.
We must choose progress over complacency.
We must choose the needs of the people over the interests of a few.
If we fail to do so, future generations will judge us harshly. DM
Remarks by Deputy-President Cyril Ramaphosa during the TAC’s Sixth National Congress
Riding a Black Unicorn Down the Side of an Erupting Volcano While Drinking from a Chalice Filled with the Laughter of Small Children is the title of a dark cabaret album by 'Voltaire'