Nelson Mandela at the launch of a new MSF clinic in Lusikisiki

A Worldwide Revolt for Access

Photograph by Eric Miller
Nelson Mandela at the launch of a new MSF clinic in Lusikisiki Photograph by Eric Miller

Getting Lifesaving Medicines to People With HIV/AIDS

In South Africa in the early 2000s, an unprecedented mix of events and developments was happening: the first decade of post-apartheid rule; alarming numbers of people dying from HIV/AIDS, despite lifesaving antiretroviral (ARV) treatment being available in wealthy countries; government denialism about the crisis and even that HIV causes AIDS; MSF’s beginning to treat people in the face of unaffordable ARV drugs; the start of MSF’s Access Campaign; the International AIDS Conference in Durban in 2000; and a lawsuit brought by the pharmaceutical industry against Nelson Mandela’s governmental attempt to override patents and obtain affordable generic ARVs.

"Together, these elements triggered international outrage and action among health activists everywhere. This is the remarkable story of how widespread revolt of public opinion led to lifesaving access to medicines for people living with HIV/AIDS – told through the words of those who were there."
Pan-African HIV/AIDS Treatment Access Movement Declaration of Action, representing activists and organisations from 21 African countries, August 2002.

Ellen 't Hoen of MSF at a press conference held by MSF, Oxfam, Cosatu, and the Treatment Action Campaign in Pretoria
Ellen 't Hoen of MSF spoke at a press conference held by MSF, Oxfam, Cosatu, and the Treatment Action Campaign in Pretoria. Photograph by Lori Waselchuk

Early days

"Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not."
Dr Peter Mugyenyi, HIV/AIDS researcher and physician, and director of Uganda’s Joint Clinical Research Centre, July 2000, International AIDS Conference, Durban.

"[There] was an internal resistance. People were not ready to launch an HIV programme to treat patients in MSF. Treatment was too expensive at the time. We’re talking US$12,000 per treatment per year [for lifelong treatment]. Patient groups…were very vocal during this bit of time. Activists influenced us a lot. We started to build some alliances with them."
Dr Bernard Pécoul, director of MSF Access Campaign, 1999-2002.

MSF intervention

"We opened the first clinic in February 2000. People literally came in masses. [A] few months after we opened, we had registered several hundred people as HIV-positive. People were coming from all over the place."
Dr Eric Goemaere, coordinator of MSF’s HIV and TB programme in Khayelitsha, a township of Cape Town, where the team was struggling to cope with the high number of people coming to the clinic for treatment given the high prices pharmaceutical corporations were charging for the drugs.

Dr Eric Goemaere gives a blown up glove to a young HIV patient.
Dr Eric Goemaere gives a blown up glove to a young HIV patient. Photograph by Francesco Zizola

Speaking out, taking action

"The only reason we are dying is because we are poor."
Zackie Achmat, founder of Treatment Action Campaign (TAC).

"Due to government denialism and pharmaceutical greed, the poor were sent home to die while those who could afford to buy antiretrovirals in the private sector were able to live. The size of your pocket determined whether you lived or died."
Vuyiseka Dubula, former nurse in MSF’s Khayelitsha programme and former Secretary-General of TAC.

"HIV causes AIDS"

Durban Declaration, International AIDS Conference, 2000, signed by 5,000 scientists and physicians in response to government denialism.

Drop the case!

"We don’t have the intention of breaking the law. What we will be doing is breaking Pfizer’s patent. We will be showing that Pfizer and other companies are abusing their patents. We have no criminal intention. Our only intention is to defend people’s lives."
Zackie Achmat, on bringing generic fluconazole, a drug for treating an AIDS complication, from Thailand where it cost 5 cents per capsule, to South Africa, where it cost US$30.

Nelson Mandela and Zackie Achmat (TAC) during his visit in the Khayelitsha township. Khayelitsha, Cape Town. 12/12/2002
Nelson Mandela and Zackie Achmat (TAC) during his visit in the Khayelitsha township. Photograph by Eric Miller

"The court was filled with people and…they started to sing. Every hair on my body was standing on end. It was in the air that they were going to drop the case, that we had won. And when it did, the whole thing  just broke out in one big dancing party."
Ellen ’t Hoen, former policy advocacy director of the Access Campaign, when in April 2001 the Pharmaceutical Manufacturers’ Association, representing 39 corporations, withdrew their lawsuit against the South African government for circumventing patents to make low-cost medicines more available.

"When lifesaving medicines are unaffordable because of high prices resulting from exclusive marketing rights (patents), intellectual property protection threatens people’s health."
Carmen Perez-Casas, Pierre Chirac, Daniel Berman and Nathan Ford,  MSF Access Campaign, Lancet correspondence, December 2000.

Treatment to the people

"It was a losing proposition at the time. But we thought, ‘Why should one make money on things that we know people can’t afford?' Let’s go ahead, and do this on a humanitarian basis."
Yusuf Hamied, chairman of Indian generic drug manufacturer Cipla, on their 2001 announcement offering the main ARV drug cocktail for US$350 per treatment per year – about $1 a day.

"The HIV-positive people we see here today are alive, they are healthy, and they are happy. What we see is proof that there is live after HIV/AIDS."

Nelson Mandela, former President of South Africa, December 2003, at the launch of a new MSF clinic in Lusikisiki, a few months after the South African government announced universal rollout of ARVs.

Adapted from: “No Valley Without Shadows”, 2014 book; “Fire in the Blood”, 2014 film; individual interviews and statements.