Many people only know the tip of the iceberg of the early HIV movement’s history in South Africa and their battle to access life-saving ARVs. This David versus Goliath story is now captured in MSF’s new book ‘No Valley Without Shadows’.

Now available as an e-book here: bit.ly/NoValleyWithoutShadows – which captures the incredible acts of solidarity and vast behind-the-scenes mobilisation between international and South African civil society networks between 1998 to 2006.

In 1999, MSF sent one of its volunteer doctor Dr Eric Goemaere, to South Africa hoping to prove that ARVs could be given on a large scale with a public health approach to people living in settings with limited resources, starting with preventing the transmission of HIV to mothers and children.

Eric worked with countless TAC and MSF staff to help introduce ARVs in Khayelitsha, in collaboration with UCT and the Western Cape Department of Health, and supported TAC in the historic Big Pharma vs Mandela Case (2001).

HeHere, Eric narrates this short photo selection which includes key moments in the ght for ARVs in the early HIV movement.

Pretoria, 5 March 2001

In 1998, the Pharmaceutical Manufacturers Association (PMA) representing 39 pharmaceutical companies took the South African government to court over clauses in the Medicines Act which the government said would allow to import much cheaper generic ARV drugs.

AAt that time, South Africa was estimated to have 5 million people living with HIV and thousands were dying. Incredibly, a year’s worth of ARVs cost for one single patient cost $10,000 in South Africa, while generic versions in Brazil, India and Thailand were a fraction of the cost.

The case was called ‘Big Pharma versus Nelson Mandela’ and was suspended for three years.

In March 2001, when the PMA resumed the case, MSF marched with thousands of activists and people living with HIV from the Treatment Action Campaign (TAC), COSATU and civil society organisations in the streets of Pretoria against this ruthless proteering.

Pretoria, 5 March 2001

“The atmosphere that day was very impressive. There were sick patients who were desperate fortreatment, saying ‘we don’t want to die.’ It wasn’t a peaceful march, you could see people’s anger anddetermination.

When the march reached the US Embassy, I was one of the speakers. Our contribution as doctors wasto explain how treating Aids was possible and affordable and was a right not a privilege.

BBehind the scenes, MSF staff worked with the TAC and a huge international network of patent lawyers,HIV doctors, activist organisations, and university students to launch a huge online campaign called‘Drop The Case’

Pretoria, 19 April 2001.

“We were jubilant! The day after the PMA dropped their case, we held a press conference and crackedopen the champagne.

But our celebration was short-lived. Within days, the South African government announced that ARVswere still unaffordable and questioned the safety of generic versions. It turned out that the government was in fact in complete denial about HIV.

TThabo Mbeki had stunned everyone at Durban Aids conference in July 2000 the previous year by announcing that there wasn’t conclusive evidence that HIV caused AIDS in Africa.

We quickly realised that our next huge battle was with the South African government.

Cape Town, 27 January 2002

In late 2001, MSF started organising a clandestine trip to Brazil for TAC’s Matthew Damane, Nomandla Yako and Zackie Achmat, with the agreement of the Brazilian state company Pharmaguinos and the South African Medicines Controls Council (MCC).

On 27 JanuaOn 27 January, they landed at Cape Town airport with 6 months-worth of generic ARV treatment, enough for 50 people, in their bags. A year’s treatment cost just $200 per person per year, compared to the $10,000 price tag in South Africa.

Johannesburg, 29 January 2001

“We had actually, secretly started a few dozen patients on treatment with the generic ARVs since mid-2001 but that day we wanted to make it open. Two days later we held a press conference with TAC, Oxfam and COSATU to say what we’d done. It was the start of a public deance campaign against the government position.

We were very nervous about government potential reaction. Once you started someone on ARV ttreatment, you cannot stop.

In response, Presidential Spokesperson Parks Mankahlana announced that importing generics was irresponsible and opened the country to biological warfare. And they sent a Health Ministry official to Khayelitsha to seize our ARV stocks. Luckily we’d hidden most of it away.”

Khayelitsha, Cape Town, 27 July 2002

“I vividly remember the rst time I met Nelson Mandela. It was at Zackie Achmat’s house. Zackie was refusing to take ARV treatment as long as it was available for everyone in South Africa and Mandela was pleading with him to reconsider.

We told Mandela that HIV was treatable and that treatment was affordable with generic drugs. He de-cided to put on his gloves to ght HIV publicly.”

Khayelitsha, Cape Town, 12 December 2002

“Mandela came to our rescue when the ANC government threatened to close MSF’s HIV programme in Khayelitsha. On 12 December, he visited Khayelitsha and toured one of the three clinics where we were offering free ARV treatment.

The iconic HIV POSITIVE T-shirt had been our sign of public deance against the government. We wondered if Mandela would dare to wear it.

WWhen our rst patient Matthew Damane offered Mandela the t-shirt, he instantly took off his own traditional shirt and swopped it. People were crying, shouting ‘viva Mandela’. With Mandela on our side, nothing could stop the movement.”

Lusikisiki, 1 January 2002

“By December 2002, the Khayelitsha project was showing good results. But could MSF repeat this model in a much poorer province? Many of our patients in Khayelitsha were ‘treatment migrants’ coming from remote Eastern Cape districts that had never even heard of HIV.

When the Eastern Cape Health Department blocked us, we partnered with the Mandela Foundation to start an HIV programme in Lusikisiki, one of the poorest districts in the country.

TThis photo of a little boy looking with bemusement at his ARVs in a remote Lusikisiki village came to symbolise that time.”

Khayelitsha, 1 December, World Aids Day 2004

“This mural painted by the community for World Aids Day is still there, near the main entrance toKhayelitsha. It represented a huge milestone against stigma by stating clearly: treatment is now largelyavailable.

In early 2000, when MSF’s headquarters in Belgium gave approval to put 180 people on treatment(at a cost of $10,000 a patient), we had to choose one from every four extremely sick patients to getAARVs, literally condemning the rest to death.

Four years later, with generic ARVs in the country we had grown to 1000 patients on ARVs.Looking back its hard to imagine that today, South Africa’s HIV programme has 3.2 million on treatment

Pretoria, 17 October 2013

“But our battle continues. To get the HIV epidemic properly under control, we will need get double this number – 6 million people – on treatment. As we’ve seen, this struggle can only be won by a civil society network for national and international activists.

TToday, one of its pioneer representatives, the TAC is slowly being silenced from lack of funding. TAC’s survival is our best guarantee to not return to the old days, when HIV treatment was the privilege for the rich and connected, not a right for all living in South Africa today.”

Read MSF’s new book ‘No Valley Without Shadows’, the story of MSF’s role in the vast behind-the-scenes mobilisation to access ARVs in South Africa between 1998 - 2006.

To download the e-book version of ‘No Valley Without Shadows’

visit: bit.ly/NoValleyWithoutShadows