COMMENTATOR (COMM): Previously on Life...
HEALTH MINISTER JOSE SERRA (TRANSLATION): Brazil is fighting for access to drugs to fight AIDS for all its people.
ELOAN PINEIRO (TRANSLATION): Any country with the political will could do this because these drugs are actually not hard to make.
HEALTH MINISTER JOSE SERRA (TRANSLATION):
And what is our case? It is that access to medicines is a basic human right.
DR PETER MUGYENYI, Director, Joint Clinical Research Centre, Kampala: We have got the biggest problem of AIDS in the world. Eighty per cent of AIDS patients are found in Africa and it has paralysed and devastated our health systems, it has ruined families, it has stopped our progress in economic terms. Africa is dying.
COMM: Vincent is 14 years old. He is one of literally millions of AIDS orphans in Africa.
DR MUGYENYI: Vincent been ill for quite a long time and is currently suffering from cryptococcal meningitis.
COMM: The anti-retroviral drugs that could save his life are too expensive for most people in Africa.
DR MUGYENYI: We want to keep you a little bit longer so that your headache goes. And this pain in your chest is treated.
VINCENT: OK.
COMM: It's Sub-Saharan Africa that's been hardest hit by the AIDS epidemic, today there are an estimated 25 million HIV-positive people in the region. Most of them will die in the next 10 years unless life-saving anti-retroviral drugs become more widely available.
PROFESSOR FRANCIS OMASWA, Ministry of Health, Uganda: Today in Uganda you can actually talk about the period before AIDS and the period after AIDS in terms of the way society conducts its affairs.
COMM: In most Western countries anti-retroviral drugs - ARVs -have transformed AIDS from a death sentence to a chronic illness and saved thousands of lives. Over the last year developing countries have been intensifying their fight to bring down the cost of these drugs. And they've had some success; prices have fallen, sometimes by a factor of ten.
DR YUSUF HAMIED, Chairman CIPLA: I will tell you the name of the game. In pharmaceuticals the name of the game is monopoly. If you have a monopoly you can charge what you like, so what we are saying the only way to bring prices down is by competition.
BEN PLUMLEY, Strategy Development Adviser, UNAIDS: If we talk about anti-retroviral therapy we're talking about three drugs that patients have to take - at least each day. And over the course of the last few years pharmaceutical companies, both research and development based and generics or copies companies, have reduced prices from somewhere between, you know, $12,000 in - as you find in the US and Europe - down to around somewhere between $300 - $1,000 per annum.
COMM: But even $300 per year is beyond the reach of most of the developing world. Uganda has been widely hailed as Africa's showcase for HIV/AIDS management programmes.
PROFESSOR OMASWA: The only way forward was to warn the people that, look, there is a disease which has come; it is new; there is no cure; it is transmitted through sex and please take note. And they came out openly - the government came out openly and declared that there was an AIDS problem in Uganda and we needed help.
COMM: An early education and prevention programme has lowered the HIV rate from over 14% to 8% in ten years.
DR MUGYENYI: This is a big achievement but I want it put in perspective: 8% prevalence and the current rate of a hundred thousand new cases of HIV/AIDS per year is appallingly high. It's still too high.
COMM: Ten years ago the Ugandan government set up centres dedicated to HIV research and treatment to find ways of dealing with the epidemic. Dr Peter Mugyenyi is Director of the Joint Clinical Research Centre in Kampala.
DR MUGYENYI: The appalling nature in which the AIDS patients found themselves forced us to go into providing treatment, at least for those who could afford it. Our primary role was research on HIV/AIDS, but we built up expertise in HIV treatment and it looked unethical for us to sit by while patients were suffering, so we started offering HIV treatment and this has become a centre of excellence.
COMM: Uganda realised that the most effective way of tackling the disease was to provide sufferers with the same treatment they'd receive in the West.
DR MUGYENYI: If you want to achieve prevention beyond a certain level you need to supplement it with treatment. People on the treatment are more likely to participate in preventive programmes because they have hope for living.
COMM: Uganda is one of several African countries currently taking part in a scheme known as the Accelerating Access Initiative. It was introduced last year by UNAIDS in response to the growing AIDS crisis in the developing world.
BEN PLUMLEY: Accelerating Access is really the redoubling of support that the UN agencies provide to countries, primarily developing countries, right across the world in strengthening their national responses to HIV from psycho-social support um right up to treatments for opportunistic infections and most notably anti-retroviral therapy.
COMM: Up to now, the scheme's only been available in the capital, Kampala. Even here patients have to pay for their drugs.
DR MUGYENYI: The UNAIDS project came at the time when nobody else wanted to do anything about anti-retroviral drugs, so I think they deserve some credit. It didn't substantially get the cost of the drugs reduced but it had side important benefits, which included training of medical care givers in the use of anti-retrovirals and above all it really demystified anti-retrovirals.
COMM: Evacy Kalemeera is an English teacher who lives near Kampala.
EVACY KALEMEERA: In 1997 when my husband started falling sick on and off we found out that we were HIV-positive. Well it came as a big blow but I had got some blood transfusion from somebody who later died of Aids. Then we, we accepted it as me being the cause and from that time we agreed we lived perfectly normal because we were not blaming each other. In 1998 our child became very sick and passed away. I also became very sick and was hospitalised for some time.
COMM: Last year Evacy's husband died. By then she was too ill to work or care for her family.
EVACY KALEMEERA: I was really sick. I wouldn't say even recognise people at that time. And I was delirious most of the time I was in hospital.
COMM: But even the lower prices negotiated by UNAIDS are beyond the reach of most Ugandans.
DR MUGYENYI: We started looking for alternatives and we found that we could get the same drugs at half the cost and when we started getting the same drugs at half the cost it either coincided with a reduction by brand manufacturers or the brand manufacturers responded to competition.
BEN PLUMLEY: What we need here are a range of suppliers. Clearly the pharmaceutical companies, the research based industries, have a role to play but also the generics industries have a role to play. And it's quite clear that you know in many developing companies prices have come down because of competition.
DR MUGYENYI: And the cost now of the brand is now a third of what it used to be, and the cost of generics has also come down because they are also traders just like brand manufacturers. And they also respond to competition.
COMM: Generic drugs are cheaper copies of the patented originals. But some question whether they are of the same quality. The Indian drug company, CIPLA is one of the biggest generic manufacturers in the world.
DR YUSUF HAMIED, Chairman, CIPLA: Do you mean to say the multi-national companies have not picked up our products in the open market and tested them? Believe me, if there was anything wrong with the products that we are marketing they would be shouting from the rooftops. COMM: The Accelerating Access Initiative is already making a difference in Uganda. But to afford the drugs families often have to pool their resources for treatment. Evacy was close to death when she was taken to the Mildmay Centre, one of the clinics that participates in the drugs programme. She's now been on the drugs for six months.
EVACY KALEMEERA: Since I started them I got a change. My appetite was reactivated and I began feeling stronger from that time and I was able to go back to work - after almost two years without stepping in class now I am able to attend to some lessons.
COMM: The argument that these drugs are too complicated for use in the developing world no longer holds any credence.
DR MUGYENYI: Some of the most sophisticated medical drugs are anti cancer drugs; anti cancer drugs are highly toxic but are used in every country in Africa. So why do they have to select anti-retroviral drugs that are less complicated than anti cancer drugs and say - these are the ones that are not going to be used because they are too sophisticated? And, after all, think about a patient - you are dying and you got a drug which can turn around your life, are you not going to take it?
COMM: Evacy is dramatic evidence of how anti-retroviral drugs can transform a patient's life.
DR MUGYENYI: I can tell you that my life, and I believe the lives of my colleagues, has changed. A patient who comes to you - you know there is hope for such a patient. Previously it was like a funeral, only postponed.
COMM: Vincent is being treated for his meningitis caused by AIDS. His family's now found someone to help pay for lifesaving drugs.
DR MUGYENYI: I'll be coming again to see you later on in the evening.
COMM: To date, ARV drugs have only been available in the capital. Now Uganda is extending the programme to rural areas.
PROFESSOR OMASWA: I think the most important message we have is that it can be done. You can reduce your infection rates. Anyone who doubts that, they should come here.
COMM: The fight for affordable drugs in Africa first made world headlines last year. A consortium of 42 major pharmaceutical companies took the South African government to court over its right to import or manufacture generic drugs to treat AIDS sufferers. After a global campaign by activist groups, Trades Unions and NGOs, the 42 companies finally withdrew the case in April 2001. It was widely regarded as a humiliating climb-down. But even before they announced they were dropping the case, the companies had begun reducing the prices of their patented drugs. It was a victory for the developing world.
PROFESSOR OMASWA: It was very important that that court case went the way it did because first of all it highlighted the issue globally and then I think it made us read the laws more accurately. And I think all along the South African government was right. And I think even those pharmaceuticals with their power and resources had not hired the best lawyers!
DR ERIC GOEMAERE, Médecins Sans Frontières, South Africa: Symbolically that showed that with public opinion pressure you can change pharmaceutical companies' position. They are the biggest power in the world nowadays and it showed that public opinion can change them and they're scared about it. For the developing world it was a very important victory and it has given I think a positive sign for a lot of developing countries to go for generics. They understood that the patent-holder would not sue them if they choose the generic way.
COMM: But despite the court case outcome, the South African government shocked the world by announcing that it would NOT start using ARV drugs. It claimed the cost was still beyond the reach of the public health system which simply did not have the infrastructure to administer the drugs.
SUPERIMPOSED HEADLINES: 'South Africa kills hope of Aids drugs'
'State stands firm on anti-retrovirals'
DR ERIC GOEMAERE: Amazingly the court case was in Pretoria in this country. Unfortunately almost the next day the Minister of Health announced that they would not import anti-retroviral drugs for the public health system.
SIPHO MTHATHI, Treatment Action Campaign: Our government has let us down and in many ways, and has not shown real leadership in this issue. And has not you know, really focussed on finding solutions.
DR NONO SIMELELA, Ministry of Health, South Africa: There has never been an in principle stance that says that these drugs are never ever going to be available to South Africans in the public sector. It's always been - fight for what we can do on a long term sustainable basis.
COMM: South Africa has the highest rate of HIV infection in the world with 4.7 million HIV-positive people - one in nine. So far national government initiatives have done very little to contain the epidemic.
MTUTUZELI TOM, President, National Union of Metal Workers: If the government continues to move at this pace that it does currently, we are going to run out of patience and we are going to do what we did to the apartheid government on this particular matter to our own democratic government. And-and, on the basis of our democratic constitution, that is our right.
DR MUGYENYI: South Africa is one of the richest countries on the continent. Uganda is a very, very poor country by comparison. If Uganda can do it, albeit on a smaller scale like we are doing it, South Africa can do it many, many times better, and on a larger scale. Use your brains - improvise. It is a crisis, and in every crisis methods of dealing with it can be found.
COMM: But while the government prevaricated, organisations such as Médecins sans Frontières in partnership with provincial clinics, had already started projects like these. They provide AZT to pregnant women to reduce rates of MTCT - mother to child transmission of the virus. Khunjulwe lives in this shack in Khayalitsha. She is HIV-positive.
KHUNJULWE (TRANSLATION): I am 34 years old. I have four children. The youngest is one year and two months.
COMM: Khunjulwe's husband died of AIDS last year. She was given AZT when she was pregnant and her baby was born free of the virus.
DR ERIC GOEMAERE: More than seven thousand women have been through this MTCT programme and we have now the first results of the transmission rate - how many babies were infected. And in fact we got now 11% transmission rate instead of 30-35% which means basically that hundreds of babies have been prevented to get HIV-positive, to be infected by the disease. And that's definitely good news.
COMM: Influenced by the success of projects like these, national government has at last bowed to pressure and started a programme to reduce mother to child transmission of the disease.
DR SIMELELA: We're targeting 90,000 women. Ja, it's a significant number, considering we've got - what, a million deliveries in South Africa a year? And that's a 23/24% rate of 200,000 women who probably will be positive and 30% of those will transmit without an intervention and with intervention you halve that.
COMM: AZT has saved her baby, but Khunjulwe now has full blown AIDS.
KHUNJULWE (TRANSLATION): I was four months pregnant when I started getting sick. I was sick until last January when I got TB. I was very ill and just gave up completely. I gave the title deeds of my house to my mother, I said - I'm giving them to you in case I die.
COMM: It is the private sector in South Africa that is beginning to understand the real cost of AIDS to the country, and to their profits if the drugs don't become available.
MTUTUZELI TOM: All along the question of HIV/AIDS we have been struggling with the employers that it is part and parcel of the activities that are taking place in the work place. It should not be isolated from other health and safety issues, it must be within the health and safety policy of companies.
COMM: Big corporations like Daimler Chrysler have started supplying the HIV-positive members of their workforce and their families with ARVs. It is ironic that major global corporations, usually seen as socially and morally unaccountable, are stepping in to fulfil what should be the government's responsibility.
HEADMAN JASS, Shop Steward, Daimler-Chrysler South Africa: Everyone in South Africa I mean is worried about this virus so workers are very happy when the management is also taking initiatives in order to help them.
COMM: In partnership with provincial clinics, Médecins sans Frontières have started an anti-retroviral programme in Khayalitsha on the outskirts of Cape Town. Khunjulwe has been chosen to take part and has begun her treatment.
DR ERIC GOEMAERE: We have started pilot project with triple therapy using anti-retrovirals, and it's really rewarding to see those people that you see going down and down through the month, and as soon as you use this powerful cocktail they are suddenly going up - and very quickly!
KHUNJULWE (TRANSLATION): I started taking the pills on the 29th May. For the first two weeks I had headaches and nausea. But then it stopped and I started feeling better. I'm eating normally and I'm feeling strong now.
DR ERIC GOEMAERE: It's amazing how powerful it works. We knew that it works but it's good to see and it's rewarding for doctors that you see you can suddenly make people go up the mountain instead of going down.
COMM: Khunjulwe visits the clinic weekly to have her progress monitored and to collect her drugs.
KHUNJULWE (TRANSLATION): I take the pills every day.
COMM: Now her health is improving, she is beginning to plan a future.
KHUNJULWE (TRANSLATION): Now that I'm feeling in much better health I'm thinking of going back to school and trying for something better for my children - so I can get a good job. The thing I want most is to protect my children from getting ill. I know that they depend on me and it would be terrible if I were to be sick and also be looking after sick children at the same time. That's the thing that makes my heart sore. I do have hope. I have faith that I will be well and be stronger than before. I am so much stronger since I started taken the pills.
COMM: Dr Herman Reuter used to work with the Mother to Child prevention project. Now he's with the anti-retroviral pilot programme at the same clinic.
DR HERMAN REUTER, MSF South Africa: In my clinic, for the first year where we didn't use anti-retrovirals, we saw many patients die. And it was always difficult telling the patients there are medicines that could help - but we don't have them, they're too expensive.
COMM: Matthews Damane is one of his patients. He works as a cleaner at the clinic. He refused to accept that he was HIV-positive until he became seriously ill with AIDS.
MATTHEWS DAMANE: I mean I knew about this disease but the problem is that here in South Africa we took the issue of the HIV light. Here in South Africa we always said there is no such thing you know - this disease is from the other countries like America you know.
COMM: Counselling and treatment in the clinic have changed his attitudes and given him hope.
MATTHEWS DAMANE: I can say I'm a hero of the drugs now.
DR HERMAN: You're a hero of the drugs? Obviously we are doing this project to show to everybody - especially our government - that it is possible to treat people with anti-retrovirals in South Africa, in a township - in a squatter camp.
COMM: Will projects like this one finally force the government into starting a national anti-retrovirus programme?
MATTHEWS DAMANE: There is this disease what you call HIV and this now in South Africa - and then we need to face it.
COMM: Matthews belongs to a support group - he feels he is able to help others. He would like to train to be a counsellor.
MATTHEWS DAMANE: I'm the one who is giving them the hope. So they say to me now - you are strong and you are healthy, and then you are the one who give us the hope that there is life, you know.
DR ERIC GOEMAERE: Prevention without treatment doesn't work. Treatment without prevention is not acceptable. That prevention without treatment doesn't work, we all know that nowadays.
COMM: These clinics work closely with local educational and activist groups like Ulwazi and Treatment Action Campaign to get the message across. But the battle for access to affordable drugs isn't over yet. Can the drug companies go on ignoring growing outrage from around the world - and still protect their patents and profits?
COMM: Developing countries want change. They've tabled a whole day debate to clarify trade and intellectual property rights at the next World Trade Organisation meeting this November. They want to ensure their rights to the drugs they need for health emergencies. Drugs can't save everyone in Africa who has AIDS, but access to them at affordable prices will go a long way to help contain this epidemic.
DR MUGYENYI: We are talking about people dying. This is what we are talking about. We are talking about people in severe pain, some of it excruciating. This is what we are talking about. Where is the compassion?
HEALTH MINISTER JOSE SERRA (TRANSLATION): Brazil is fighting for access to drugs to fight AIDS for all its people.
ELOAN PINEIRO (TRANSLATION): Any country with the political will could do this because these drugs are actually not hard to make.
HEALTH MINISTER JOSE SERRA (TRANSLATION):
And what is our case? It is that access to medicines is a basic human right.
DR PETER MUGYENYI, Director, Joint Clinical Research Centre, Kampala: We have got the biggest problem of AIDS in the world. Eighty per cent of AIDS patients are found in Africa and it has paralysed and devastated our health systems, it has ruined families, it has stopped our progress in economic terms. Africa is dying.
COMM: Vincent is 14 years old. He is one of literally millions of AIDS orphans in Africa.
DR MUGYENYI: Vincent been ill for quite a long time and is currently suffering from cryptococcal meningitis.
COMM: The anti-retroviral drugs that could save his life are too expensive for most people in Africa.
DR MUGYENYI: We want to keep you a little bit longer so that your headache goes. And this pain in your chest is treated.
VINCENT: OK.
COMM: It's Sub-Saharan Africa that's been hardest hit by the AIDS epidemic, today there are an estimated 25 million HIV-positive people in the region. Most of them will die in the next 10 years unless life-saving anti-retroviral drugs become more widely available.
PROFESSOR FRANCIS OMASWA, Ministry of Health, Uganda: Today in Uganda you can actually talk about the period before AIDS and the period after AIDS in terms of the way society conducts its affairs.
COMM: In most Western countries anti-retroviral drugs - ARVs -have transformed AIDS from a death sentence to a chronic illness and saved thousands of lives. Over the last year developing countries have been intensifying their fight to bring down the cost of these drugs. And they've had some success; prices have fallen, sometimes by a factor of ten.
DR YUSUF HAMIED, Chairman CIPLA: I will tell you the name of the game. In pharmaceuticals the name of the game is monopoly. If you have a monopoly you can charge what you like, so what we are saying the only way to bring prices down is by competition.
BEN PLUMLEY, Strategy Development Adviser, UNAIDS: If we talk about anti-retroviral therapy we're talking about three drugs that patients have to take - at least each day. And over the course of the last few years pharmaceutical companies, both research and development based and generics or copies companies, have reduced prices from somewhere between, you know, $12,000 in - as you find in the US and Europe - down to around somewhere between $300 - $1,000 per annum.
COMM: But even $300 per year is beyond the reach of most of the developing world. Uganda has been widely hailed as Africa's showcase for HIV/AIDS management programmes.
PROFESSOR OMASWA: The only way forward was to warn the people that, look, there is a disease which has come; it is new; there is no cure; it is transmitted through sex and please take note. And they came out openly - the government came out openly and declared that there was an AIDS problem in Uganda and we needed help.
COMM: An early education and prevention programme has lowered the HIV rate from over 14% to 8% in ten years.
DR MUGYENYI: This is a big achievement but I want it put in perspective: 8% prevalence and the current rate of a hundred thousand new cases of HIV/AIDS per year is appallingly high. It's still too high.
COMM: Ten years ago the Ugandan government set up centres dedicated to HIV research and treatment to find ways of dealing with the epidemic. Dr Peter Mugyenyi is Director of the Joint Clinical Research Centre in Kampala.
DR MUGYENYI: The appalling nature in which the AIDS patients found themselves forced us to go into providing treatment, at least for those who could afford it. Our primary role was research on HIV/AIDS, but we built up expertise in HIV treatment and it looked unethical for us to sit by while patients were suffering, so we started offering HIV treatment and this has become a centre of excellence.
COMM: Uganda realised that the most effective way of tackling the disease was to provide sufferers with the same treatment they'd receive in the West.
DR MUGYENYI: If you want to achieve prevention beyond a certain level you need to supplement it with treatment. People on the treatment are more likely to participate in preventive programmes because they have hope for living.
COMM: Uganda is one of several African countries currently taking part in a scheme known as the Accelerating Access Initiative. It was introduced last year by UNAIDS in response to the growing AIDS crisis in the developing world.
BEN PLUMLEY: Accelerating Access is really the redoubling of support that the UN agencies provide to countries, primarily developing countries, right across the world in strengthening their national responses to HIV from psycho-social support um right up to treatments for opportunistic infections and most notably anti-retroviral therapy.
COMM: Up to now, the scheme's only been available in the capital, Kampala. Even here patients have to pay for their drugs.
DR MUGYENYI: The UNAIDS project came at the time when nobody else wanted to do anything about anti-retroviral drugs, so I think they deserve some credit. It didn't substantially get the cost of the drugs reduced but it had side important benefits, which included training of medical care givers in the use of anti-retrovirals and above all it really demystified anti-retrovirals.
COMM: Evacy Kalemeera is an English teacher who lives near Kampala.
EVACY KALEMEERA: In 1997 when my husband started falling sick on and off we found out that we were HIV-positive. Well it came as a big blow but I had got some blood transfusion from somebody who later died of Aids. Then we, we accepted it as me being the cause and from that time we agreed we lived perfectly normal because we were not blaming each other. In 1998 our child became very sick and passed away. I also became very sick and was hospitalised for some time.
COMM: Last year Evacy's husband died. By then she was too ill to work or care for her family.
EVACY KALEMEERA: I was really sick. I wouldn't say even recognise people at that time. And I was delirious most of the time I was in hospital.
COMM: But even the lower prices negotiated by UNAIDS are beyond the reach of most Ugandans.
DR MUGYENYI: We started looking for alternatives and we found that we could get the same drugs at half the cost and when we started getting the same drugs at half the cost it either coincided with a reduction by brand manufacturers or the brand manufacturers responded to competition.
BEN PLUMLEY: What we need here are a range of suppliers. Clearly the pharmaceutical companies, the research based industries, have a role to play but also the generics industries have a role to play. And it's quite clear that you know in many developing companies prices have come down because of competition.
DR MUGYENYI: And the cost now of the brand is now a third of what it used to be, and the cost of generics has also come down because they are also traders just like brand manufacturers. And they also respond to competition.
COMM: Generic drugs are cheaper copies of the patented originals. But some question whether they are of the same quality. The Indian drug company, CIPLA is one of the biggest generic manufacturers in the world.
DR YUSUF HAMIED, Chairman, CIPLA: Do you mean to say the multi-national companies have not picked up our products in the open market and tested them? Believe me, if there was anything wrong with the products that we are marketing they would be shouting from the rooftops. COMM: The Accelerating Access Initiative is already making a difference in Uganda. But to afford the drugs families often have to pool their resources for treatment. Evacy was close to death when she was taken to the Mildmay Centre, one of the clinics that participates in the drugs programme. She's now been on the drugs for six months.
EVACY KALEMEERA: Since I started them I got a change. My appetite was reactivated and I began feeling stronger from that time and I was able to go back to work - after almost two years without stepping in class now I am able to attend to some lessons.
COMM: The argument that these drugs are too complicated for use in the developing world no longer holds any credence.
DR MUGYENYI: Some of the most sophisticated medical drugs are anti cancer drugs; anti cancer drugs are highly toxic but are used in every country in Africa. So why do they have to select anti-retroviral drugs that are less complicated than anti cancer drugs and say - these are the ones that are not going to be used because they are too sophisticated? And, after all, think about a patient - you are dying and you got a drug which can turn around your life, are you not going to take it?
COMM: Evacy is dramatic evidence of how anti-retroviral drugs can transform a patient's life.
DR MUGYENYI: I can tell you that my life, and I believe the lives of my colleagues, has changed. A patient who comes to you - you know there is hope for such a patient. Previously it was like a funeral, only postponed.
COMM: Vincent is being treated for his meningitis caused by AIDS. His family's now found someone to help pay for lifesaving drugs.
DR MUGYENYI: I'll be coming again to see you later on in the evening.
COMM: To date, ARV drugs have only been available in the capital. Now Uganda is extending the programme to rural areas.
PROFESSOR OMASWA: I think the most important message we have is that it can be done. You can reduce your infection rates. Anyone who doubts that, they should come here.
COMM: The fight for affordable drugs in Africa first made world headlines last year. A consortium of 42 major pharmaceutical companies took the South African government to court over its right to import or manufacture generic drugs to treat AIDS sufferers. After a global campaign by activist groups, Trades Unions and NGOs, the 42 companies finally withdrew the case in April 2001. It was widely regarded as a humiliating climb-down. But even before they announced they were dropping the case, the companies had begun reducing the prices of their patented drugs. It was a victory for the developing world.
PROFESSOR OMASWA: It was very important that that court case went the way it did because first of all it highlighted the issue globally and then I think it made us read the laws more accurately. And I think all along the South African government was right. And I think even those pharmaceuticals with their power and resources had not hired the best lawyers!
DR ERIC GOEMAERE, Médecins Sans Frontières, South Africa: Symbolically that showed that with public opinion pressure you can change pharmaceutical companies' position. They are the biggest power in the world nowadays and it showed that public opinion can change them and they're scared about it. For the developing world it was a very important victory and it has given I think a positive sign for a lot of developing countries to go for generics. They understood that the patent-holder would not sue them if they choose the generic way.
COMM: But despite the court case outcome, the South African government shocked the world by announcing that it would NOT start using ARV drugs. It claimed the cost was still beyond the reach of the public health system which simply did not have the infrastructure to administer the drugs.
SUPERIMPOSED HEADLINES: 'South Africa kills hope of Aids drugs'
'State stands firm on anti-retrovirals'
DR ERIC GOEMAERE: Amazingly the court case was in Pretoria in this country. Unfortunately almost the next day the Minister of Health announced that they would not import anti-retroviral drugs for the public health system.
SIPHO MTHATHI, Treatment Action Campaign: Our government has let us down and in many ways, and has not shown real leadership in this issue. And has not you know, really focussed on finding solutions.
DR NONO SIMELELA, Ministry of Health, South Africa: There has never been an in principle stance that says that these drugs are never ever going to be available to South Africans in the public sector. It's always been - fight for what we can do on a long term sustainable basis.
COMM: South Africa has the highest rate of HIV infection in the world with 4.7 million HIV-positive people - one in nine. So far national government initiatives have done very little to contain the epidemic.
MTUTUZELI TOM, President, National Union of Metal Workers: If the government continues to move at this pace that it does currently, we are going to run out of patience and we are going to do what we did to the apartheid government on this particular matter to our own democratic government. And-and, on the basis of our democratic constitution, that is our right.
DR MUGYENYI: South Africa is one of the richest countries on the continent. Uganda is a very, very poor country by comparison. If Uganda can do it, albeit on a smaller scale like we are doing it, South Africa can do it many, many times better, and on a larger scale. Use your brains - improvise. It is a crisis, and in every crisis methods of dealing with it can be found.
COMM: But while the government prevaricated, organisations such as Médecins sans Frontières in partnership with provincial clinics, had already started projects like these. They provide AZT to pregnant women to reduce rates of MTCT - mother to child transmission of the virus. Khunjulwe lives in this shack in Khayalitsha. She is HIV-positive.
KHUNJULWE (TRANSLATION): I am 34 years old. I have four children. The youngest is one year and two months.
COMM: Khunjulwe's husband died of AIDS last year. She was given AZT when she was pregnant and her baby was born free of the virus.
DR ERIC GOEMAERE: More than seven thousand women have been through this MTCT programme and we have now the first results of the transmission rate - how many babies were infected. And in fact we got now 11% transmission rate instead of 30-35% which means basically that hundreds of babies have been prevented to get HIV-positive, to be infected by the disease. And that's definitely good news.
COMM: Influenced by the success of projects like these, national government has at last bowed to pressure and started a programme to reduce mother to child transmission of the disease.
DR SIMELELA: We're targeting 90,000 women. Ja, it's a significant number, considering we've got - what, a million deliveries in South Africa a year? And that's a 23/24% rate of 200,000 women who probably will be positive and 30% of those will transmit without an intervention and with intervention you halve that.
COMM: AZT has saved her baby, but Khunjulwe now has full blown AIDS.
KHUNJULWE (TRANSLATION): I was four months pregnant when I started getting sick. I was sick until last January when I got TB. I was very ill and just gave up completely. I gave the title deeds of my house to my mother, I said - I'm giving them to you in case I die.
COMM: It is the private sector in South Africa that is beginning to understand the real cost of AIDS to the country, and to their profits if the drugs don't become available.
MTUTUZELI TOM: All along the question of HIV/AIDS we have been struggling with the employers that it is part and parcel of the activities that are taking place in the work place. It should not be isolated from other health and safety issues, it must be within the health and safety policy of companies.
COMM: Big corporations like Daimler Chrysler have started supplying the HIV-positive members of their workforce and their families with ARVs. It is ironic that major global corporations, usually seen as socially and morally unaccountable, are stepping in to fulfil what should be the government's responsibility.
HEADMAN JASS, Shop Steward, Daimler-Chrysler South Africa: Everyone in South Africa I mean is worried about this virus so workers are very happy when the management is also taking initiatives in order to help them.
COMM: In partnership with provincial clinics, Médecins sans Frontières have started an anti-retroviral programme in Khayalitsha on the outskirts of Cape Town. Khunjulwe has been chosen to take part and has begun her treatment.
DR ERIC GOEMAERE: We have started pilot project with triple therapy using anti-retrovirals, and it's really rewarding to see those people that you see going down and down through the month, and as soon as you use this powerful cocktail they are suddenly going up - and very quickly!
KHUNJULWE (TRANSLATION): I started taking the pills on the 29th May. For the first two weeks I had headaches and nausea. But then it stopped and I started feeling better. I'm eating normally and I'm feeling strong now.
DR ERIC GOEMAERE: It's amazing how powerful it works. We knew that it works but it's good to see and it's rewarding for doctors that you see you can suddenly make people go up the mountain instead of going down.
COMM: Khunjulwe visits the clinic weekly to have her progress monitored and to collect her drugs.
KHUNJULWE (TRANSLATION): I take the pills every day.
COMM: Now her health is improving, she is beginning to plan a future.
KHUNJULWE (TRANSLATION): Now that I'm feeling in much better health I'm thinking of going back to school and trying for something better for my children - so I can get a good job. The thing I want most is to protect my children from getting ill. I know that they depend on me and it would be terrible if I were to be sick and also be looking after sick children at the same time. That's the thing that makes my heart sore. I do have hope. I have faith that I will be well and be stronger than before. I am so much stronger since I started taken the pills.
COMM: Dr Herman Reuter used to work with the Mother to Child prevention project. Now he's with the anti-retroviral pilot programme at the same clinic.
DR HERMAN REUTER, MSF South Africa: In my clinic, for the first year where we didn't use anti-retrovirals, we saw many patients die. And it was always difficult telling the patients there are medicines that could help - but we don't have them, they're too expensive.
COMM: Matthews Damane is one of his patients. He works as a cleaner at the clinic. He refused to accept that he was HIV-positive until he became seriously ill with AIDS.
MATTHEWS DAMANE: I mean I knew about this disease but the problem is that here in South Africa we took the issue of the HIV light. Here in South Africa we always said there is no such thing you know - this disease is from the other countries like America you know.
COMM: Counselling and treatment in the clinic have changed his attitudes and given him hope.
MATTHEWS DAMANE: I can say I'm a hero of the drugs now.
DR HERMAN: You're a hero of the drugs? Obviously we are doing this project to show to everybody - especially our government - that it is possible to treat people with anti-retrovirals in South Africa, in a township - in a squatter camp.
COMM: Will projects like this one finally force the government into starting a national anti-retrovirus programme?
MATTHEWS DAMANE: There is this disease what you call HIV and this now in South Africa - and then we need to face it.
COMM: Matthews belongs to a support group - he feels he is able to help others. He would like to train to be a counsellor.
MATTHEWS DAMANE: I'm the one who is giving them the hope. So they say to me now - you are strong and you are healthy, and then you are the one who give us the hope that there is life, you know.
DR ERIC GOEMAERE: Prevention without treatment doesn't work. Treatment without prevention is not acceptable. That prevention without treatment doesn't work, we all know that nowadays.
COMM: These clinics work closely with local educational and activist groups like Ulwazi and Treatment Action Campaign to get the message across. But the battle for access to affordable drugs isn't over yet. Can the drug companies go on ignoring growing outrage from around the world - and still protect their patents and profits?
COMM: Developing countries want change. They've tabled a whole day debate to clarify trade and intellectual property rights at the next World Trade Organisation meeting this November. They want to ensure their rights to the drugs they need for health emergencies. Drugs can't save everyone in Africa who has AIDS, but access to them at affordable prices will go a long way to help contain this epidemic.
DR MUGYENYI: We are talking about people dying. This is what we are talking about. We are talking about people in severe pain, some of it excruciating. This is what we are talking about. Where is the compassion?