Treatment Action Campaign(TAC) Strategies
TAC’s strategy was successful because they invested their efforts in four critical areas: understanding and using the law, doing high-quality accurate research, mobilising people in communities, and dealing effectively with the media.
With leaders from labour, from medical and legal backgrounds, from the churches, and with a history of activism in communities and nationally, TAC set out to build a mass base in the worst affected communities. ‘TAC created a new generation of post-1994 political and civil society leaders,’ says former TAC chairperson Zackie Achmat.
Building a grassroots movement
‘TAC didn’t begin as a grassroots movement,’ says Sipho Mthathi, TAC’s General Secretary from 2005 to 2008. ‘It started with a few middle-class people [who] had working-class roots. We knew we had to become a movement based in communities to have any integrity or we’d be just another NGO.’
The Campaign set up its first offices in Johannesburg, Cape Town and Durban in 1999 and was able to mobilise and operate at a community level by establishing branches across the country. This model of social mobilisation and organisation was adopted from the struggle against apartheid. Branch members operated in their own communities, educating others on HIV science and establishing adherence clubs and support groups.
‘Most importantly for many of us in TAC, this organisation became a centre of learning and leading,’ says Nonkosi Khumalo, former TAC Chairperson. ‘It became a home where we learned about politics, leadership, democracy, law and social mobilisation. It became more than just about HIV, but also about access to health care and what section 27 of the Constitution means. We have combined different tactics such as community mobilisation, the South African Constitution and law, education, research and use of the media to achieve our ends. This is why TAC has transformed many of us in ways we never thought would ever be possible.’
As the HIV epidemic spread and death rates rose throughout sub-Saharan Africa, the head of the United States Agency for International Development argued that the regimen involved in taking antiretroviral treatment was too complex for Africans to adhere to. TAC contended that access to medicine is a fundamental human right for all people, not to be reserved solely for the rich.
Understanding and sharing the science of treatment
As TAC members learned the science of HIV, they rolled out treatment education in communities. TAC’s treatment literacy programme educated and empowered ordinary South Africans in working class communities and rural areas to understand how HIV works in the body, how it can be treated and how its transmission can be prevented. This understanding of the science of HIV and antiretroviral treatment became one of TAC’s strongest tools in mobilising the masses to demand access to HIV treatment and prevention. Thousands joined forces to demand the treatment they needed to survive. The programme became highly political and created a cadre of informed activists that publically challenged the misinformation put out by political, traditional and religious leaders during the years of denialism.
Treatment literacy also proved to be a novel and effective public health intervention. Patients on antiretroviral therapy were counselled to take their regimens at the same time every day and not to miss a dose. Mothers were counselled on ways to reduce the risk of transmitting HIV to their babies. Treatment literacy created the basis for the successful rollout of antiretroviral therapy in poor African communities.
Access to treatment has been the centrepiece of TAC’s work since it formed in 1998. During the early days of the organisation, they fought against pharmaceutical giants that were reluctant to drop the prices of medicines despite skyrocketing profits and a government unwilling to properly address an epidemic of crisis proportions.
Positively cool: The iconic T-shirt
One of TAC’s simplest and most effective strategies was set in motion in 1999 with the printing of T-shirts to break down the secrecy, shame and stigma that surrounded HIV.
The T-shirts brandished the words ‘HIV POSITIVE’ onto the wearer’s chest. The shirts were prompted by the violent murder of Gugu Dlamini, who was kicked, beaten and stoned to death after revealing that she was HIV-positive. A photo of Gugu was printed on the back of TAC’s first T-shirts. Today the T-shirts have become an iconic symbol in South African society, representing the struggle for human rights.
Getting it right with the media
From the outset, TAC valued its relationship with journalists and worked hard to improve HIV reporting. For any activist organisation or social movement, it is essential to be reasonable and to come across as reasonable to the general public. TAC got this right.
They trained community journalists and published a magazine, Equal Treatment, which started as a four-page newspaper and blossomed into a 32-page glossy distributed throughout the country, including at book stores and by mail.
TAC also had a close relationship with Community Media Trust, who produce the HIV magazine programme, Siyayinqoba Beat It!, for which the footage in this archive was shot.
TAC’s electronic newsletter was another pioneering communication tool. Very few activist organisations had a free subscription newsletter list in 2000, when TAC’s newsletter began. Today, no activist or political group can do well without one. The Campaign even had its own choir, the Generics, which produced an album, Jikelele, with Scottish singer, songwriter Annie Lennox in 2003.
Defiance and civil disobedience
On 13 July 2000, TAC announced its Defiance Campaign against Patent Abuse and AIDS Profiteering at the International AIDS Conference in Durban. As part of the Campaign, TAC organised a visit by Zackie Achmat and Jack Lewis to Thailand, from where they imported generic fluconazole at the cost of R1.78 per capsule (in comparison to R29 per capsule in the South African public sector). They announced what they had done in a press conference. It made newspaper headlines and generated debates and greater public understanding about the high cost of medicines. A complaint was lodged against Achmat and he was nearly arrested for breaking the Medicines Act. Eventually Pfizer backed down and began donating fluconazole to the public health system for the treatment of systemic thrush as well.
That same year, Médecins Sans Frontières partnered with TAC to set up three clinics in Khayelitsha. The clinics initially provided antiretroviral treatment to people suffering from AIDS who were in need of immediate medication to survive. TAC’s volunteers supported the rollout by teaching patients about HIV and their medication regimens. Despite the dual challenge of community stigma and government denialism, the Khayelitsha project was a great success, helping to sway the opinion of scientists, academics, policymakers and donors towards the realisation that treating patients with antiretroviral therapy in poor countries could be done.
Still, government failed to deliver a treatment plan, so in March 2001 TAC launched its civil disobedience campaign, titled Dying for Treatment.
At its 2002 national congress, TAC voted to increase the use of marches, as well as a countrywide campaign of civil disobedience, to pressure the state to deliver a national treatment plan and antiretroviral programme. The pressure was primarily directed at Health Minister Tshabalala-Msimang and Trade and Industry Minister Alec Erwin.
The same year, TAC scored a major victory when former president Nelson Mandela visited the home of TAC chairperson, Zackie Achmat. At the time, Achmat was refusing to take antiretrovirals until they became available in the public health system. Mandela convinced Achmat to begin taking medicines. Shortly thereafter Nelson Mandela visited the clinics in Khayelitsha, wearing one of TAC’s HIV-positive T-shirts.
On 14 February 2003, nearly 15 000 people took part in TAC’s Stand Up for Our Lives march to the opening of Parliament in Cape Town. They handed over a memorandum to government which made it clear that the state either had to deliver a treatment plan or face civil disobedience.
Reaching out across the regions
After TAC and Médecins Sans Frontières successfully rolled out antiretroviral therapy in Khayelitsha, many still argued that it would not work in rural areas. So TAC and Médecins Sans Frontières set off for rural Lusikisiki in the Eastern Cape, where the work of Dr Hermann Reuter proved invaluable in making this project work. At first, residents of Lusikisiki were deeply suspicious of both Médecins Sans Frontières and TAC. But Dr Reuter worked tirelessly to develop a system that could deliver antiretrovirals despite numerous challenges such as poor infrastructure, clinics without electricity, long distances between facilities across extremely difficult terrain, and too few doctors and nurses.
Successful battles for sustained antiretroviral treatment programmes were waged at Frontier Hospital in Queenstown and in the Free State where a moratorium had blocked clinic staff from treating new patients and interfered with the treatment regimes of existing patients.
After years of campaigning, Cabinet finally approved the National Operational Plan on Comprehensive Care and Treatment for HIV (Operational Plan) on 19 November 2003. Within the first year of the Plan’s implementation, it became clear that the programme lacked a formal implementation timetable to ensure targets were met. It fell short of its target of 54 000 people on treatment by March 2004 (at which time only 15 000 people were receiving treatment).
In order to avoid further litigation by TAC, the state agreed to purchase antiretrovirals in the interim before a tender was finalised. The programme finally started properly in April 2004. TAC was involved in the rollout, prepping communities through treatment literacy campaigns and helping health workers to prepare for the task before them.
TAC realised that the initial government programme would not reach more than a third of those who needed treatment. As an emergency response to the absence of a comprehensive government programme, TAC launched the Treatment Project in 2003, rolling out HIV tests, CD4 tests and antiretrovirals to a number of activists and others who couldn’t afford them. It therefore provided a lifeline to members in need of treatment.
Today the TAC continues to represent users of the public healthcare system in South Africa, and to campaign and litigate on critical issues related to the quality of and access to healthcare. TAC’s work to campaign for quality healthcare for all has by necessity become intertwined with the struggle for good and accountable governance and management of the public health system.
On 17 May 2017, TAC released a statement under the headline: ‘Stop the killings – we must end violence against women’. ‘TAC is outraged and distressed by the violent killings of Karabo Mokoena, Nonki Smous, Tambai Lerato Moloi, Popi Qwabe, Bongeka Phungula, Mananki Annah Boys, Jeannette Cindi, Sthembile Mdluli, Mavis Mabala, Priska Schalk, Nicola Pienaar, Akhona Njokana, Thapelo Ramorotong, Meisie Molefe, Stasha Arendse, Iyapha Yamile, and many other women and young girls who have been killed in recent weeks,’ it reads. ‘A report released this week from Stats SA echoes this alarming trend of abuse in our society – stating that one in five women experience physical violence in their lives, rising to one in three for the poorest households…
‘Twenty-three years after the onset of democracy, women in South Africa continue to face disturbing levels of oppression, violence and injustice – be it in the streets, in the workplace, travelling in taxis, or in our homes. The South African Constitution guarantees equality and freedom for all regardless of sex, gender, or sexual orientation – however across the country reports of murder, rape – including spousal rape and the so called ‘corrective rape’ of lesbians, harassment, domestic violence and sexual violence is worryingly prevalent.’
TAC remains active with five key campaigns aimed at both direct improvement of healthcare services and achieving knock-on improvements in the healthcare system. The organisation currently has over 8,000 members and a network of 182 branches and provincial offices in seven of South Africa’s nine provinces.
SOURCES:
• Treatment Action Campaign. (2010) Fighting for Our Lives: The history of the Treatment Action Campaign 1998–2010, Cape Town: Treatment Action Campaign.
• Treatment Action Campaign. http://tac.org.za/about_us (last accessed 1 June 2017)
This section of the archive deals with the TAC’s winning strategies and includes footage covering the following topics:
• Spreading TAC across the country – taking TAC to the people
• Fighting for health workers
• TAC actions in the various regions
• Getting treatment to the rural areas – long distances to travel
• The home-based care network – TB treatment and traditional birth attendants in KZN
• Learning from doctors and other activists
• Proving that antiretrovirals can work in Africa
• Wearing the HIV-positive T-shirt – how it became ubiquitous across the struggle
• How Gugu Dlamini became an icon of the struggle (her image appears on T-shirts worn by activists)
