Nursing students learned by e-mail on Monday that they would receive a one-time $400 credit to the bookstore in a further attempt by the Nursing program and Financial Aid to lessen the blow of a $1,200 fee each student will pay for her clinical classes.
The letter from Gerry Koocher, the dean of the School of Health Studies (SHS), and Judy Beal, the associate dean of SHS and the chair of the Nursing program, said that the credit was added because it made more sense "to get $400 directly into the pocket of every student rather than work one at a time.
"Combined with the $135 elimination of the software fee and the grants to students through the modification to their financial aid package, our intention is to buffer the effect of these fees for this academic year."
The decision to charge nursing students the fee was determined by the Board of Trustees in March, but students were not informed of it until they received their bills at the end of July, according to Beal.
"When I saw the increase on my tuition bill I did a double-take. I was shocked and angry," said junior Hannah Desrochers. "Many nursing students are self-sufficient and pay for education while taking classes. I know I don't have an extra $1,200 floating around. $1,200 is rent for two months, food for six months."
Yvonne Chan, a second degree Dix Scholar, also thinks students should have been given more time to plan for the fee.
"I think the Administration should have given students at least six months notice prior to implementing this fee. Many students budget and manage their finances strategically. Giving students earlier notice would help them better prepare for such a financial burden," she said.
Diane Hallisey, director of Student Financial Services, said her department worked to increase aid for the students who would be charged the fee.
"For the undergraduate students who applied for financial aid, the level of aid was reviewed and additional grant funds were awarded to students whose review demonstrated increased need after the clinical fee was added into their financial aid budget," said Hallisey.
Beal said the reason students were not alerted earlier about the fee was because all departments involved assumed someone else would do it.
An e-mail was sent to all nursing students by Beal on July 25 apologizing for the lack of communication about the fee and assuring students that they would receive more information in the coming days.
Chan wasted little time responding and worked to rally a response from her peers. She sent a letter the next day with an electronic petition for all nursing students to sign.
When the petition was sent to the SHS and Nursing department, it had 161 signatures.
The petition said that the students felt the fee was "arbitrary and excessive" compared to other schools, especially since Simmons has not charged a fee before.
"Northeastern University School of Nursing does not charge a clinical fee. Boston College charges $205-$210 per clinical and UMass Boston charges $55.00 per clinical. Based on this research we find the additional $1200.00 clinical fee unjustifiable and extreme," it said.
For next year, in an attempt to get rid of the fee, the nursing program is looking to implement a differential tuition for nursing students, according to Beal. Students will pay a higher tuition their sophomore, junior, and senior years, which allows students to pay the fee spread out over the course of six semesters.
Students met with Beal and Koocher during the summer and beginning of the fall semester, and with President Susan Scrimshaw, per request of the students, on Monday last week.
"The meeting [with Scrimshaw] was similar to the meeting held by Dean Koocher and Dean Beal," Chan said. "The administration apologizes for their lack of communication. They explained that the fee is necessary in order to maintain Simmons Nursing program's reputation and the quality of its education.
"No real solution was given to the students at the meeting. The issue is not resolved," she said.
According to Beal, nursing classes cost about ten times more than a liberal arts course, partly because students are sent in groups of six or fewer to clinical rotations.
In the past, Simmons was able to absorb the extra costs of the program, but now that it is the largest undergraduate program, "the Trustees decided that this was no longer fiscally responsible or feasible for the school to continue to absorb these costs," said Beal.
An average clinical course, for example, Nursing 226, costs about $124,000, or $111,000 more than a comparable liberal arts course, for example, Nutrition 237, according to Koocher.
The extra costs come from the need for additional faculty.
Nursing 226 has two faculty members for classroom work, 11 clinical faculty, each of whom spend one eight-hour shift at the hospital with the students, and two clinical coordinators, who track student placement sites, medical clearance, and criminal records, according to Koocher.
He explained that each clinical coordinator costs the school more than $8,000 each, "so if six students each pay $1,200, we still do not break even on the cost."
Beal said that she thinks students understand the need for the fee, but the lack of communication is the source of tension.
Chan agreed with Beal. "Students understand that the fee is necessary in order to keep access to the best education. The problem here is the way and the timing in which the administration instituted the fee," she said.
Beal said that she will continue to meet with students on a monthly basis "should they choose to continue to discuss this over the next year."
This article was originally published here: http://media.www.thesimmonsvoice.com/media/storage/paper829/news/2007/09/20/News/Nursing.Students.Charged.1200.For.Clinicals-3749601.shtml
Thursday, September 20, 2007
South Africans push government on AIDS
This article is part of a series about human rights in South Africa. The series is the outcome of COMM-328 Human Rights in South Africa, which Professor Dan Connell led for the second time last Spring.
CAPE TOWN-Sitting at the end of the coffee shop counter, a cell phone glued to his ear, 23-year-old Julian Simcock gives an arriving stranger an inquisitive glance. After realizing this is the person he is waiting for, he says goodbye and puts away his phone. He folds up his newspaper and pushes his empty coffee cup and saucer to the side, clearing space on the wooden counter.
Simcock speaks with a slight accent, indicative of his youth in New Zealand and most likely brought back from spending the last year and a half in another former British colony as a Fulbright scholar. But with his fading tan, precisely-styled "casual" hair, and button-down blue cotton shirt, he looks like a typical American graduate student-which he is.
On first appearances alone, Simcock seems an unlikely coworker and confidante of someone The New Yorker once called the "AIDS Rebel," Zackie Achmat, co-founder and chairperson of the Treatment Action Campaign (TAC). But as he tells his story, it rapidly becomes obvious that he is that and much more.
Simcock says he did not come to South Africa with the intent to learn about HIV/AIDS, and definitely did not think he would end up working closely with Achmat on a range of projects relating to the high costs of the epidemic on society. But, he adds, the time he spent as a researcher for TAC was "hugely informative."
"I came holding some of the same reticence about HIV/AIDS that most people have, and meeting Zackie and working so closely with somebody everyday who has HIV is a very sort of personal and real way of countering those stigmatizations," says Simcock.
"You meet somebody and spend time with somebody who works around the clock like Zackie does, and is on top of it, and as charismatic as Zackie is, it reduces even any lingering thoughts about whether HIV is as debilitating as people say it is."
A report by three leading research groups found that between 4.5 and 5.7 million South Africans were HIV positive in the middle of 2006, according to the University of Pretoria's Centre for the Study of AIDS (CSA). With a population of 48 million, South Africa has one of the highest HIV infection rates in the world.
Yet the post-apartheid government of President Thabo Mbeki has been slow to respond to this problem, and independent organizations have had to fill the gap.
TAC is one of these organizations.
With its more than 60 employees and some 16,000 volunteers, however, TAC still only has one worker for every 330 South Africans with HIV that needs help.
"I wouldn't want this to end up in a South African newspaper, but the people of the Treatment Action Campaign are tired," says Simcock. "It's like fighting a long war."
TAC fills a gap
TAC was started in 1998 out of a need for nevirapine, a drug that prevents mother-to-child transmission of HIV and one the government was not supplying, according to Simcock.
"Many health care professionals had become frustrated by the government's lack of progress in supplying the drug, which, the government argued, was due to questions about its toxicity. Doctors had started applying to non-governmental organizations for grants to pay for nevirapine, and in some cases used their own money to buy the drug," according to the British charity AVERT. Doctors who provided the drug risked termination because doing so was forbidden.
"[TAC] was intended, to begin with, to challenge pharmaceutical companies at a time when pharmaceutical companies were able to charge huge rates. I think for a while in the states it cost $10,000 a year to treat someone with anti-retroviral medication. But obviously prices have come down since then, but it's been an ongoing battle for generic medication," says Simcock.
He speaks highly of Achmat and sits up a little straighter and speaks a bit faster when talking about one of the most highly publicized instances of AIDS activism here-when Achmat went to Thailand and attempted to bring back econazol, a generic-priced drug, to South Africa, which is illegal.
"But a huge amount of publicity was kicked up because the discrepancy between the pricing of this generic medication, and the price of what it cost to buy it from, I think it was Merck, a drug company, in South Africa was huge," says Simcock.
"The numbers are easy to calculate-how many more people could be treated? And that was a powerful thing. It openly defied a law, and Zackie was never trying to hide that. But for the purpose of the public, to one, to challenge whether the law is just, and two, to bring people's attention to the very real discrepancies that exist," he says.
Another TAC action that got a lot of media attention came in March 2003 when the organization charged the Health Minister and her Trade and Industry colleague with culpable homicide.
During a speech soon after charges were pressed, a TAC representative told Health Minister Mantombazana Edmie Tshabalala-Msimang: "We are angry. According to government's sources over 600 people will die of AIDS every day on average this year. We stand here today to say to you that you have willfully and negligently failed to implement the necessary interventions, including antiretroviral treatment, that would prevent many of these deaths."
TAC has used the courts in South Africa both to ally with the government against pharmaceutical companies and to challenge the government over its own practices. "They didn't perceive at the outset that it was going to be this long a fight with the government," says Simcock.
TAC also focuses on education, particularly breaking down the stereotype of HIV/AIDS.
A large problem with the fight against HIV/AIDS is making people aware of "the scientific and medical reality of HIV/AIDS, which has become a hugely important task since the government, as you must know, champion a different set of policies sometimes," says Simcock.
Because of widespread public ignorance on the issue, there is also a stigma attached to people with the virus that causes AIDS. One tactic TAC has used to change this is to distribute T-shirts that say "HIV Positive." The idea came from the actions of the Danish king when the Nazis were set to invade, says Simcock.
When the Nazis told him to have all Jews in Denmark wear a yellow star, making it easy for them to be found, the king encouraged all Danes to wear the star and did so himself. This helped the Jews feel accepted in the community and made it difficult for the Nazis to find their targets. Simcock says the TAC T-shirts follow the same logic.
"The HIV Positive T-shirts aren't limited to people who have HIV," says Simcock. "The idea is actually opposite-that you can't tell who has HIV just by looking at them and that there shouldn't be a stigma."
The third part of TAC's work, after lobbying and education, is service delivery. An example of this can be seen in the clinic set up in Site B of Khayelitsha, the largest township outside of Cape Town. The clinic was opened in 2001 and is a partnership between the Western Cape Health Department and MSF.
"The idea isn't to one day assume the HIV/AIDS service delivery responsibility for South Africa," says Simcock. "It's to sort of push the government where they need pushing to provide more comprehensive coverage.
"And the way to do that, in some instances, is to prove to the government and to the world that you can be in a place where there's very limited resources, where there's often very little education and low rates of literacy and those sorts of things, you can change HIV/AIDS. You can change the epidemic."
HIV/AIDS in South Africa
Between 1993 and 2000, South Africa experienced a huge increase in the instances of HIV/AIDS when the country was focused on the transition between the apartheid regime and the newly-elected democratic government. The economic emphasis on mining, which required men to live in single-sex housing for extended periods of time, and the government's unwillingness to address the problem, made South Africa extremely vulnerable.
"It's sort of the unfortunate issue that if the government had been more cognizant early on, been more honest early on, a huge amount of damage could have been prevented and now it's grown to the point of mammoth proportions," says Simcock. "Now it's very difficult to do without a huge investment."
The executive director of UNAIDS, Dr. Peter Piot, said in a presentation earlier this year that the prevalence of AIDS in southern Africa is because of "decades of colonialism, migration, gender inequality and apartheid, combined with denial and inadequate action on AIDS."
The accepted medical field treatment for HIV is taking antiretrovirals (ARV), something the government has been slow to provide and pharmaceutical companies have made more difficult by maintaining high prices.
"Amongst the scientific community there is little doubt about the benefits of ARVs; a recent study in South Africa reported that 93% [sic] of HIV positive people surveyed were alive after one year of treatment," according to the Integrated Regional Information Network (IRIN), the UN's humanitarian news and analysis service in Africa.
In South Africa, because the dispersal of ARVs is limited, Piot says three people become infected with HIV for every one person who starts ARV therapy. "If we don't reduce infection levels today, tomorrow's treatment bills will be exorbitant. And millions more will die," he says.
The CSA report projects that introducing a comprehensive ARV program now, delayed as it is, would have a dramatic impact on the number of AIDS deaths a year.
Without ARVs, it is expected that South Africa will experience 505,000 deaths a year by 2010. However, with ARVs, the projected number of deaths drops by more than 100,000 to 388,000 a year. Furthermore, the CSA report suggests that if 90 percent of people with HIV were to receive treatment, the number could drop further to 291,000.
The possible impact of ARVs on the number of deaths per year is heavily contingent on the service delivery by the government, which does not have a strong track record. However, it has shown progress in recent months under different leadership.
The Mbeki government started supplying the drugs in 2004, but has been slow to reach all who need it. "Even since 2004, the distribution of antiretroviral drugs has been relatively slow, with only around 33% [sic] of people in need receiving treatment at the end of 2006," according to the World Health Organization Web site.
The CSA report estimates that in 2006, 225,000 of the 711,000 people needing ARVs received them. Because of the rapid increase in new cases of HIV, by 2015-even if coverage dropped to 20 percent-500,000 people would be receiving it and if numbers increased to 90 percent, two million people would be on it.
One obstacle in the way of rolling out ARVs is price. "The government had frequently argued that an increase in access to antiretroviral treatment was not necessarily the best way to stop the AIDS epidemic, and that other treatment options needed to be considered," says AVERT in a Web-based critique.
Those pushing for access to cheaper prices for the medication achieved a victory in the court case when several pharmaceutical companies, including GlaxoSmithKline, agreed to allow low-cost versions of their drugs to be made in South Africa, according to the BBC.
Another cost, often not part of the debate over providing treatment to those living with HIV, is the ripple-effect impact on society.
"What I've learned since is the way that HIV/AIDS is connected to so many things - social forces, political forces, and economics forces," says Simcock. "And so, with the numbers that are this high and people are dying at this rate, it has profound consequences well beyond the health sector or well beyond mortality rates.
"I mean, you have in some age groups, one in five teachers affected with the disease. And you can't afford to have one in five teachers, and you can't afford to have your nurses sick because you need the nurses there to treat AIDS-related illnesses and other illnesses. And then you get into the realm of children who have been orphaned by AIDS."
Simcock believes that there is money available for these drugs, and it is an issue of the government prioritizing what it wants to spend it on: "I mean keeping people alive, if that isn't one of your priorities, then I struggle to know how prioritization is working. But, there is money. There is definitely money. The government is running a surplus at the moment.
"There have been a lot of ministries that don't spend their allocations. It's about capacity. They need a huge increase in nurses and professionals in the health care industry. And they need to enlist, in some cases, the private sector. And they're dragging their feet because of politics and because of not wanting to increase jobs, but there's no time for it as far as people who have the disease are concerned."
"Denialism" starts at the top
Some officials in the South African government, including President Thabo Mbeki and Health Minister Tshabalala-Msimang, are under fire for questioning the link between HIV and AIDS, and the best way to treat HIV.
"The biggest problem we have in South Africa is that we have a president who doesn't believe that HIV causes AIDS," Achmat told the Mail & Guardian, one of South Africa's leading newspapers.
Desmond Tutu, winner of the Nobel Peace Prize and a former Anglican archbishop, is also critical of the current administration, especially Tshabalala-Msimang's suggestion that nutrition is as important as ARVs in treating HIV.
"We are playing with the lives of people, with the lives of mothers who would not have died if they had had drugs. If people want garlic and potatoes let them have them, but let's not play games. Stop all this discussion about garlic," he told IRIN.
"South Africa is the unkindest cut of all," said Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, at the 2006 International AIDS Conference in Toronto. Lewis called it the only country in Africa "whose government is still obtuse, dilatory and negligent about rolling out treatment."
"It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state," he added. "I'm of the opinion that they can never achieve redemption."
The South African government received a letter titled "Expression of Concern by HIV Scientists" late last year from more than 80 scientists, including the co-discoverer of AIDS, Robert Gallo, calling for the immediate removal of Dr. Tshabalala-Msimang as Minister of Health.
The letter also called for "an end to the disastrous, pseudo-scientific policies that have characterised the South African Government's response to HIV/AIDS."
Simcock says that the lack of strong leadership is the biggest disadvantage South Africa has in the fight against HIV/AIDS. He cites the successes of Brazil and Thailand and acknowledges that they were based on leadership.
"Members of the South African government have constantly reiterated that ARVs are just one aspect of their treatment approach, and that there are other measures that can help to treat HIV. Manto Tshabalala-Msimang has questioned the effectiveness of ARVs, and famously urges people to eat lots of beetroot and garlic to fight off HIV," says AVERT.
"At the 2006 International AIDS Conference in Toronto, these food products were even displayed prominently on South Africa's exhibition stand. Allegedly, ARVs were only added to the display when reporters started to question their absence."
The health minister has also supported the Dr. Rath Health Foundation, an organization that pushes vitamin supplements instead of ARVs. "The foundation has previously published adverts in South Africa claiming that ARVs are toxic and cause AIDS," says AVERT. "The TAC has strongly criticised the government for failing to condemn the organization."
The former South African deputy president, Jacob Zuma-a leading candidate to replace Mbeki in the 2009 presidential elections-also caused controversy over how to properly treat HIV in 2006 when he claimed that taking a shower after having sex with a HIV-positive woman would prevent him from contracting it, according to the BBC.
Simcock believes that spreading this information makes them responsible for deaths: "That has cost lives. I mean at a very fundamental level, those people are responsible for deaths, right? Because they're spreading incorrect information and they know better, there's plenty of access to the truth.
"They're spreading incorrect information in that, if you're a 14 or 15-year-old teenager in South Africa and you listen to what your health minister has to tell you, which should be a trusted figure of authority, you're not going to think very hard about the dangers of HIV and AIDS, and where's the incentive then to use a condom?"
Simcock says that he and many South Africans are unsure of the reasons behind the government's response to the epidemic.
"One, which is not speculated, it's true, is that there was an encouragement for one reason or another of this pseudo-science, these denialists and pseudo-scientists were flown in from all over the world to speak with the president and give this appearance of credibility of criticizing antiretrovirals."
"So that's definitely part of it, that there was some belief, at least for a little while, condemning antiretrovirals and suggesting in some cases HIV doesn't cause AIDS or AIDS doesn't exist," says Simcock. "It's just malaria that kills people. It's just tuberculosis that kills people. And all those things are not helped by the complexity of AIDS.
"I mean the reason AIDS is called AIDS, acquired immunodeficiency syndrome, the reason it's called syndrome, is because it's a series of symptoms. You don't have one disease. You have something that is killing your immune system and exposes it to other diseases that are eventually what kills you. So, that lends itself to mischievous stuff.
"One of the other reasons is the suggestion, I think, that there isn't the money to pay for the drugs, and that's accompanied by all sorts of things, like if we give people antiretrovirals they'll just live longer and keep spreading the disease and that will kill more people," says Simcock. "And one of the good things about that is that antiretrovirals actually reduce your infectiousness."
Simcock acknowledges that not all members of the government are part of this highly-criticized group, and that some have been very helpful.
"There's huge, huge progress over the past couple of months and that's been, for me, wonderful and a historic thing to watch. History in South Africa really does unfold on a daily basis," says Simcock. "Here, the Deputy Minister of Health, Nozizwe Madlala-Routledge, she's been an incredible leader in the health department.
"And the Deputy President, as well, has been a leadership figure. That's not to say that there aren't still plenty of denialists. Manto Tshabalala-Msimang was reinstated as the Health Minister," he says.
"People believe government authorities," says Simcock. "Those government authorities have an obligation to use truth and it sounds like a trite thing to say, and a simplistic thing to say, and they do, a moral and professional obligation."
This article was originally published in "Old Wrongs, New Rights: Student Views of the New South Africa," (Africa World Press, 2008). It can be purchased here: http://www.africaworldpressbooks.com/servlet/Detail?no=360
This article was republished here: http://media.www.thesimmonsvoice.com/media/storage/paper829/news/2007/09/20/Features/South.Africans.Push.Government.On.Aids-3749620.shtml
CAPE TOWN-Sitting at the end of the coffee shop counter, a cell phone glued to his ear, 23-year-old Julian Simcock gives an arriving stranger an inquisitive glance. After realizing this is the person he is waiting for, he says goodbye and puts away his phone. He folds up his newspaper and pushes his empty coffee cup and saucer to the side, clearing space on the wooden counter.
Simcock speaks with a slight accent, indicative of his youth in New Zealand and most likely brought back from spending the last year and a half in another former British colony as a Fulbright scholar. But with his fading tan, precisely-styled "casual" hair, and button-down blue cotton shirt, he looks like a typical American graduate student-which he is.
On first appearances alone, Simcock seems an unlikely coworker and confidante of someone The New Yorker once called the "AIDS Rebel," Zackie Achmat, co-founder and chairperson of the Treatment Action Campaign (TAC). But as he tells his story, it rapidly becomes obvious that he is that and much more.
Simcock says he did not come to South Africa with the intent to learn about HIV/AIDS, and definitely did not think he would end up working closely with Achmat on a range of projects relating to the high costs of the epidemic on society. But, he adds, the time he spent as a researcher for TAC was "hugely informative."
"I came holding some of the same reticence about HIV/AIDS that most people have, and meeting Zackie and working so closely with somebody everyday who has HIV is a very sort of personal and real way of countering those stigmatizations," says Simcock.
"You meet somebody and spend time with somebody who works around the clock like Zackie does, and is on top of it, and as charismatic as Zackie is, it reduces even any lingering thoughts about whether HIV is as debilitating as people say it is."
A report by three leading research groups found that between 4.5 and 5.7 million South Africans were HIV positive in the middle of 2006, according to the University of Pretoria's Centre for the Study of AIDS (CSA). With a population of 48 million, South Africa has one of the highest HIV infection rates in the world.
Yet the post-apartheid government of President Thabo Mbeki has been slow to respond to this problem, and independent organizations have had to fill the gap.
TAC is one of these organizations.
With its more than 60 employees and some 16,000 volunteers, however, TAC still only has one worker for every 330 South Africans with HIV that needs help.
"I wouldn't want this to end up in a South African newspaper, but the people of the Treatment Action Campaign are tired," says Simcock. "It's like fighting a long war."
TAC fills a gap
TAC was started in 1998 out of a need for nevirapine, a drug that prevents mother-to-child transmission of HIV and one the government was not supplying, according to Simcock.
"Many health care professionals had become frustrated by the government's lack of progress in supplying the drug, which, the government argued, was due to questions about its toxicity. Doctors had started applying to non-governmental organizations for grants to pay for nevirapine, and in some cases used their own money to buy the drug," according to the British charity AVERT. Doctors who provided the drug risked termination because doing so was forbidden.
"[TAC] was intended, to begin with, to challenge pharmaceutical companies at a time when pharmaceutical companies were able to charge huge rates. I think for a while in the states it cost $10,000 a year to treat someone with anti-retroviral medication. But obviously prices have come down since then, but it's been an ongoing battle for generic medication," says Simcock.
He speaks highly of Achmat and sits up a little straighter and speaks a bit faster when talking about one of the most highly publicized instances of AIDS activism here-when Achmat went to Thailand and attempted to bring back econazol, a generic-priced drug, to South Africa, which is illegal.
"But a huge amount of publicity was kicked up because the discrepancy between the pricing of this generic medication, and the price of what it cost to buy it from, I think it was Merck, a drug company, in South Africa was huge," says Simcock.
"The numbers are easy to calculate-how many more people could be treated? And that was a powerful thing. It openly defied a law, and Zackie was never trying to hide that. But for the purpose of the public, to one, to challenge whether the law is just, and two, to bring people's attention to the very real discrepancies that exist," he says.
Another TAC action that got a lot of media attention came in March 2003 when the organization charged the Health Minister and her Trade and Industry colleague with culpable homicide.
During a speech soon after charges were pressed, a TAC representative told Health Minister Mantombazana Edmie Tshabalala-Msimang: "We are angry. According to government's sources over 600 people will die of AIDS every day on average this year. We stand here today to say to you that you have willfully and negligently failed to implement the necessary interventions, including antiretroviral treatment, that would prevent many of these deaths."
TAC has used the courts in South Africa both to ally with the government against pharmaceutical companies and to challenge the government over its own practices. "They didn't perceive at the outset that it was going to be this long a fight with the government," says Simcock.
TAC also focuses on education, particularly breaking down the stereotype of HIV/AIDS.
A large problem with the fight against HIV/AIDS is making people aware of "the scientific and medical reality of HIV/AIDS, which has become a hugely important task since the government, as you must know, champion a different set of policies sometimes," says Simcock.
Because of widespread public ignorance on the issue, there is also a stigma attached to people with the virus that causes AIDS. One tactic TAC has used to change this is to distribute T-shirts that say "HIV Positive." The idea came from the actions of the Danish king when the Nazis were set to invade, says Simcock.
When the Nazis told him to have all Jews in Denmark wear a yellow star, making it easy for them to be found, the king encouraged all Danes to wear the star and did so himself. This helped the Jews feel accepted in the community and made it difficult for the Nazis to find their targets. Simcock says the TAC T-shirts follow the same logic.
"The HIV Positive T-shirts aren't limited to people who have HIV," says Simcock. "The idea is actually opposite-that you can't tell who has HIV just by looking at them and that there shouldn't be a stigma."
The third part of TAC's work, after lobbying and education, is service delivery. An example of this can be seen in the clinic set up in Site B of Khayelitsha, the largest township outside of Cape Town. The clinic was opened in 2001 and is a partnership between the Western Cape Health Department and MSF.
"The idea isn't to one day assume the HIV/AIDS service delivery responsibility for South Africa," says Simcock. "It's to sort of push the government where they need pushing to provide more comprehensive coverage.
"And the way to do that, in some instances, is to prove to the government and to the world that you can be in a place where there's very limited resources, where there's often very little education and low rates of literacy and those sorts of things, you can change HIV/AIDS. You can change the epidemic."
HIV/AIDS in South Africa
Between 1993 and 2000, South Africa experienced a huge increase in the instances of HIV/AIDS when the country was focused on the transition between the apartheid regime and the newly-elected democratic government. The economic emphasis on mining, which required men to live in single-sex housing for extended periods of time, and the government's unwillingness to address the problem, made South Africa extremely vulnerable.
"It's sort of the unfortunate issue that if the government had been more cognizant early on, been more honest early on, a huge amount of damage could have been prevented and now it's grown to the point of mammoth proportions," says Simcock. "Now it's very difficult to do without a huge investment."
The executive director of UNAIDS, Dr. Peter Piot, said in a presentation earlier this year that the prevalence of AIDS in southern Africa is because of "decades of colonialism, migration, gender inequality and apartheid, combined with denial and inadequate action on AIDS."
The accepted medical field treatment for HIV is taking antiretrovirals (ARV), something the government has been slow to provide and pharmaceutical companies have made more difficult by maintaining high prices.
"Amongst the scientific community there is little doubt about the benefits of ARVs; a recent study in South Africa reported that 93% [sic] of HIV positive people surveyed were alive after one year of treatment," according to the Integrated Regional Information Network (IRIN), the UN's humanitarian news and analysis service in Africa.
In South Africa, because the dispersal of ARVs is limited, Piot says three people become infected with HIV for every one person who starts ARV therapy. "If we don't reduce infection levels today, tomorrow's treatment bills will be exorbitant. And millions more will die," he says.
The CSA report projects that introducing a comprehensive ARV program now, delayed as it is, would have a dramatic impact on the number of AIDS deaths a year.
Without ARVs, it is expected that South Africa will experience 505,000 deaths a year by 2010. However, with ARVs, the projected number of deaths drops by more than 100,000 to 388,000 a year. Furthermore, the CSA report suggests that if 90 percent of people with HIV were to receive treatment, the number could drop further to 291,000.
The possible impact of ARVs on the number of deaths per year is heavily contingent on the service delivery by the government, which does not have a strong track record. However, it has shown progress in recent months under different leadership.
The Mbeki government started supplying the drugs in 2004, but has been slow to reach all who need it. "Even since 2004, the distribution of antiretroviral drugs has been relatively slow, with only around 33% [sic] of people in need receiving treatment at the end of 2006," according to the World Health Organization Web site.
The CSA report estimates that in 2006, 225,000 of the 711,000 people needing ARVs received them. Because of the rapid increase in new cases of HIV, by 2015-even if coverage dropped to 20 percent-500,000 people would be receiving it and if numbers increased to 90 percent, two million people would be on it.
One obstacle in the way of rolling out ARVs is price. "The government had frequently argued that an increase in access to antiretroviral treatment was not necessarily the best way to stop the AIDS epidemic, and that other treatment options needed to be considered," says AVERT in a Web-based critique.
Those pushing for access to cheaper prices for the medication achieved a victory in the court case when several pharmaceutical companies, including GlaxoSmithKline, agreed to allow low-cost versions of their drugs to be made in South Africa, according to the BBC.
Another cost, often not part of the debate over providing treatment to those living with HIV, is the ripple-effect impact on society.
"What I've learned since is the way that HIV/AIDS is connected to so many things - social forces, political forces, and economics forces," says Simcock. "And so, with the numbers that are this high and people are dying at this rate, it has profound consequences well beyond the health sector or well beyond mortality rates.
"I mean, you have in some age groups, one in five teachers affected with the disease. And you can't afford to have one in five teachers, and you can't afford to have your nurses sick because you need the nurses there to treat AIDS-related illnesses and other illnesses. And then you get into the realm of children who have been orphaned by AIDS."
Simcock believes that there is money available for these drugs, and it is an issue of the government prioritizing what it wants to spend it on: "I mean keeping people alive, if that isn't one of your priorities, then I struggle to know how prioritization is working. But, there is money. There is definitely money. The government is running a surplus at the moment.
"There have been a lot of ministries that don't spend their allocations. It's about capacity. They need a huge increase in nurses and professionals in the health care industry. And they need to enlist, in some cases, the private sector. And they're dragging their feet because of politics and because of not wanting to increase jobs, but there's no time for it as far as people who have the disease are concerned."
"Denialism" starts at the top
Some officials in the South African government, including President Thabo Mbeki and Health Minister Tshabalala-Msimang, are under fire for questioning the link between HIV and AIDS, and the best way to treat HIV.
"The biggest problem we have in South Africa is that we have a president who doesn't believe that HIV causes AIDS," Achmat told the Mail & Guardian, one of South Africa's leading newspapers.
Desmond Tutu, winner of the Nobel Peace Prize and a former Anglican archbishop, is also critical of the current administration, especially Tshabalala-Msimang's suggestion that nutrition is as important as ARVs in treating HIV.
"We are playing with the lives of people, with the lives of mothers who would not have died if they had had drugs. If people want garlic and potatoes let them have them, but let's not play games. Stop all this discussion about garlic," he told IRIN.
"South Africa is the unkindest cut of all," said Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, at the 2006 International AIDS Conference in Toronto. Lewis called it the only country in Africa "whose government is still obtuse, dilatory and negligent about rolling out treatment."
"It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state," he added. "I'm of the opinion that they can never achieve redemption."
The South African government received a letter titled "Expression of Concern by HIV Scientists" late last year from more than 80 scientists, including the co-discoverer of AIDS, Robert Gallo, calling for the immediate removal of Dr. Tshabalala-Msimang as Minister of Health.
The letter also called for "an end to the disastrous, pseudo-scientific policies that have characterised the South African Government's response to HIV/AIDS."
Simcock says that the lack of strong leadership is the biggest disadvantage South Africa has in the fight against HIV/AIDS. He cites the successes of Brazil and Thailand and acknowledges that they were based on leadership.
"Members of the South African government have constantly reiterated that ARVs are just one aspect of their treatment approach, and that there are other measures that can help to treat HIV. Manto Tshabalala-Msimang has questioned the effectiveness of ARVs, and famously urges people to eat lots of beetroot and garlic to fight off HIV," says AVERT.
"At the 2006 International AIDS Conference in Toronto, these food products were even displayed prominently on South Africa's exhibition stand. Allegedly, ARVs were only added to the display when reporters started to question their absence."
The health minister has also supported the Dr. Rath Health Foundation, an organization that pushes vitamin supplements instead of ARVs. "The foundation has previously published adverts in South Africa claiming that ARVs are toxic and cause AIDS," says AVERT. "The TAC has strongly criticised the government for failing to condemn the organization."
The former South African deputy president, Jacob Zuma-a leading candidate to replace Mbeki in the 2009 presidential elections-also caused controversy over how to properly treat HIV in 2006 when he claimed that taking a shower after having sex with a HIV-positive woman would prevent him from contracting it, according to the BBC.
Simcock believes that spreading this information makes them responsible for deaths: "That has cost lives. I mean at a very fundamental level, those people are responsible for deaths, right? Because they're spreading incorrect information and they know better, there's plenty of access to the truth.
"They're spreading incorrect information in that, if you're a 14 or 15-year-old teenager in South Africa and you listen to what your health minister has to tell you, which should be a trusted figure of authority, you're not going to think very hard about the dangers of HIV and AIDS, and where's the incentive then to use a condom?"
Simcock says that he and many South Africans are unsure of the reasons behind the government's response to the epidemic.
"One, which is not speculated, it's true, is that there was an encouragement for one reason or another of this pseudo-science, these denialists and pseudo-scientists were flown in from all over the world to speak with the president and give this appearance of credibility of criticizing antiretrovirals."
"So that's definitely part of it, that there was some belief, at least for a little while, condemning antiretrovirals and suggesting in some cases HIV doesn't cause AIDS or AIDS doesn't exist," says Simcock. "It's just malaria that kills people. It's just tuberculosis that kills people. And all those things are not helped by the complexity of AIDS.
"I mean the reason AIDS is called AIDS, acquired immunodeficiency syndrome, the reason it's called syndrome, is because it's a series of symptoms. You don't have one disease. You have something that is killing your immune system and exposes it to other diseases that are eventually what kills you. So, that lends itself to mischievous stuff.
"One of the other reasons is the suggestion, I think, that there isn't the money to pay for the drugs, and that's accompanied by all sorts of things, like if we give people antiretrovirals they'll just live longer and keep spreading the disease and that will kill more people," says Simcock. "And one of the good things about that is that antiretrovirals actually reduce your infectiousness."
Simcock acknowledges that not all members of the government are part of this highly-criticized group, and that some have been very helpful.
"There's huge, huge progress over the past couple of months and that's been, for me, wonderful and a historic thing to watch. History in South Africa really does unfold on a daily basis," says Simcock. "Here, the Deputy Minister of Health, Nozizwe Madlala-Routledge, she's been an incredible leader in the health department.
"And the Deputy President, as well, has been a leadership figure. That's not to say that there aren't still plenty of denialists. Manto Tshabalala-Msimang was reinstated as the Health Minister," he says.
"People believe government authorities," says Simcock. "Those government authorities have an obligation to use truth and it sounds like a trite thing to say, and a simplistic thing to say, and they do, a moral and professional obligation."
This article was originally published in "Old Wrongs, New Rights: Student Views of the New South Africa," (Africa World Press, 2008). It can be purchased here: http://www.africaworldpressbooks.com/servlet/Detail?no=360
This article was republished here: http://media.www.thesimmonsvoice.com/media/storage/paper829/news/2007/09/20/Features/South.Africans.Push.Government.On.Aids-3749620.shtml
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