Mandisa Mbali,
"Women in South African AIDS Activism:
Towards a Feminist Economic and Political Agenda to Address the Epidemic"
(page 6 of 8)
Drug pricing is an economic issue that has been taken up by AIDS
activists. Over the past decade, AIDS activists internationally have
been very effective in advocating for reductions in the cost of
first-line antiretroviral regimens by pushing for change to global trade
agreements, acting as amicus curiae in court cases and involving
themselves in vocal popular protests. This popular pressure was most
effective when it was combined with competition from generic drug
manufacturers and negotiations for voluntary price reductions in branded
medicines led by the Clinton Foundation's H.I.V./AIDS Initiative (CHAI).
However, these gains cannot justify complacency in this area. H.I.V.
eventually mutates around antiretroviral drugs, a process that leads to
the development of drug-resistant strains of the virus. It is estimated
that 10 to 15 percent of people living with the disease require the
newer, better-tolerated, second-line drugs after their first four to
five years on combination antiretroviral therapy (AVERT 2009).
Second-line drugs such as Kaletra and Efavirenz are frequently ten
times more expensive than older first-line regimens (WHO, UNICEF and
UNAIDS 2008: 32-5). This is because the patents on second-line drugs
remain in force. Patents enforce the exclusive legal right of a company
to produce a drug, and thereby inflate drug prices by prohibiting
generic production. The World Trade Organization's Trade Related Aspects
of Intellectual Property agreement (TRIP) forces developing countries
such as South Africa to move towards greater enforcement of patents.
While the agreement allows for the issuing of compulsory licences where
there are public health emergencies, many developing countries have been
hesitant to take up these flexibilities for fear of actions that would
jeopardize their ongoing trade negotiations with wealthier countries,
such as being placed on the U.S. Trade Representative's "watch list,"
which happened to Brazil, Thailand and South Africa. Governments in
developing countries have good reason to fear threats from Western
multinational pharmaceutical companies that they will withdraw from
their markets, as actually happened in Thailand (AVERT 2009). One way
around this problem is for developing countries to collectively issue
compulsory licenses to prevent individual countries from being punished,
and to pool their resources for the sustainable production of generic
antiretrovirals.
The need to reduce the price of antiretrovirals through such measures
is critical to the realization of women's rights and gender equality in
South Africa for two reasons. First, more women than men are living with
H.I.V. in South Africa, and in this context a lack of access to
affordable second-line antiretrovirals is a critical women's health
issue. Second, it is mostly poor women who bear the social impact of
lack of access to second-line antiretrovirals, because they perform most
of the unpaid labor of caring for those who are ill with AIDS and
the orphaned children many adults leave behind after dying from
preventable AIDS-related opportunistic infections.
In this regard, it is important to note that just because the
home-based care provided by many NGOs is free, through unpaid
"volunteers," it is far from free for the women who undertake such work,
as they are mostly poor and unemployed. The time such women spend caring
for sick community members and relatives is time not spent developing
their skills or seeking paid employment. Such "volunteerism" is not
entirely voluntary, as home-based careers are usually driven by a
woman's desire to keep their community and family members, and
themselves, alive. In our 2005 ethnographic study, one woman activist
described her experience of working as a "voluntary" home-based care
worker as follows:
You wake up in the morning, you are hungry. You go to
bathe a very sick person . . . you have nothing in your stomach. You have
to feed that person. You have to wash them. And you even have to wash
their clothes. But you don't get paid. And the government says it's
because you are doing voluntary work, and that's not fair (interview,
April 26, 2005; Mbali and Connor 2007).
Dr. Olagoke Akintola has pointed out:
The burden of caring for the sick weighs
disproportionately on women not only because they are the main providers
of care in homes, but also because many have lost their male partners or
have never been married, and therefore have to bear alone the financial
costs of caring for self and sick family members (2004: 4).
He has gone on to argue that men rarely assist in caring for the
sick, both because they are often involved in formal or informal
income-generating activities, and because it is not socially expected
for them to do so (Akintola 2004: 4).
The problems experienced by home-based caregivers graphically
illustrate how poor women bear most of the impact of insufficient social
grant provision and the inflated prices of second-line antiretrovirals.
While successful advocacy around these issues may take some time, in the
interim, NGOs working on AIDS that are concerned about reducing new
H.I.V. infections should avoid entrenching women's economic
marginalization by disproportionately relying on their unpaid labor in
home-based care programs.
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