February 12, 2003

cc: Mr JG Zuma; Deputy President; Fax: 012 3233114 Mr A. Erwin; Minister of Trade and Industry; Fax: 012 3227851 Treatment Action Campaign (TAC), info@tac.org.za

Mr TM Mbeki
President of the Republic of South Africa
Pretoria
Fax: 012 3238246

Dear Sir,

The Treatment Action Campaign (TAC) and thousands of South Africans are mobilising on 14 February in Cape Town to demand a national HIV/AIDS prevention and treatment plan that includes antiretroviral (ARV) therapy for all people in South Africa who need it. Médecins Sans Frontières (MSF) joins them to express our profound disappointment that the South African government has failed to do so to date, and to ask you to announce by the end of February a comprehensive HIV/AIDS treatment plan that includes ARV treatment.

For the past four years, MSF has witnessed first-hand the daily devastation caused by the AIDS epidemic in South Africa and the extraordinary clinical benefits-and hope-that the availability of ARV treatment brings to the community. Our work in Khayelitsha in the Western Cape, where we provide ARV treatment for nearly 350 people with AIDS, clearly demonstrates the feasibility of ARV treatment in resource-poor settings; there is no longer any question that it is possible. Our new programme in a rural remote setting in the Eastern Cape explores the specific challenges of providing ARV treatment, building on our experience with similar programmes in other rural settings elsewhere in Africa. But, despite their success, such programmes cannot become a substitute for what is ultimately the responsibility of the South African government.

MSF supports people living with HIV/AIDS in South Africa and around the world in their fight to have the same opportunity as people in wealthy countries to live longer, healthier lives by having access to ARV treatment. We have fought to support measures that will ensure that governments, including the South African government, have every available tool to ensure they can fulfil their right and obligation to care for the health of their citizens. As you know, MSF advocates strongly to ensure that public health needs take priority over the protection of private intellectual property rights. Along with other organisations, we were instrumental in securing the adoption of the historic World Trade Organization (WTO) Ministerial Declaration on the TRIPS Agreement and Public Health by all member states in Doha, and we have continued to advocate that it be implemented in good faith by all member states. We are deeply concerned about the current state of WTO negotiations about paragraph 6 of the Doha Declaration and are dismayed at the position South Africa has taken, which would effectively create two classes of WTO members, one that can make full use of compulsory licensing to promote access to medicines, and another (the poorest countries), which will be seriously hampered in their efforts to do so. This represents a major backtracking on the Doha Declaration and we urge you to abandon this position immediately.

In South Africa in 2001, MSF began demonstrating in Khayelitsha that it is possible to utilise low-cost quality generic ARVs to provide affordable treatment. In April of that same year, 39 pharmaceutical companies attempted to block the government's right to incorporate provisions in the Medicines and Related Substances Control Act that would allow South Africans access to low-cost ARVs. MSF collected 250,000 signatures from around the world, which were sent directly to all pharmaceutical companies implicated, demanding that they drop the case. We now join TAC and thousands of other South Africans in urging the South African government to make use of provisions, such as compulsory licensing, and to promote local production to guarantee generic competition and access to the least expensive quality ARVs.

Today, five million South Africans are infected with HIV, and nearly 1,000 are dying every day of AIDS-related complications. The 600,000 South Africans who clinically require ARV treatment now to stay alive do not have time to wait. Their families do not have time to wait. There can be no excuses for further delays.

We urge you to act now and to announce before end of February a national HIV/AIDS treatment plan.

Sincerely,

Dr Morten Rostrup
President Médecins Sans Frontières International Council
Tel: +41 228498400
e-mail: msf-international-gva@geneva.msf.org

Dr. Eric Goemaere
Head of Mission
MSF South Africa
PO Box 27401
Rhine Road, 8050
Cape Town, South Africa
Tel : 021 3645490
Fax : 021 3617051
e-mail: msf.sa@mweb.co.za

This letter is being co-signed by the general directors of the different MSF sections and country co-ordinators of field projects throughout the world and sent to SA embassies and/or high commissioners before the march for a national HIV/AIDS treatment plan of February 14 in Cape Town.