NO VALLEY WITHOUT SHADOWS, co-written by South African journalist and writer Liz McGregor, provides unique insight into the struggle for affordable treatment and the international and local alliances that were forged to fight Aids denialism, and the powerful global pharmaceutical lobby in order to save lives.
The book will be launched today during the Aids conference under way in Durban.
Book Outline: No Valley Without Shadows– 2016 Médecins Sans Frontières (MSF) in South Africa 1999-2008: Revolutionising the HIV/Aids response in the period of government denial.
This book reflects a candid exploration, from an insider’s view, of MSF’s pioneering Aids treatment care programmes in South Africa during the period of state denialism between 1999-2008.
The story begins in 1999 when Dr Eric Goemaere arrives in South Africa to investigate and report how he believes the medical humanitarian organisation could help respond to the Aids epidemic infecting an estimated five million people.
The book traces the period up to 2008, the end of state Aids denialism led by president Thabo Mbeki.
It chronicles how MSF and close allies such as the Treatment Action Campaign (TAC) changed the international and national agenda on the Aids response in poor countries, the medical and political strategies used, the human stories, legal battles and accusations, the programme's influence on models of care, policy and pricing of medicines, and its successes and failures.
It also explores the internal dilemma MSF faced as an independent humanitarian organisation bound to maintain neutrality, but out of need required to co-operate with some yet oppose others in government.
In the late 1990s in South Africa, as many as 800 people were dying a day from HIV.
The Aids crisis prompts outrage about the worldwide inequalities of access to lifesaving antiretroviral (ARV) medicines.
By 2001, MSF starts pilot sites testing medical feasibility of ARV therapy in developing countries to show that it is possible in "resource-poor" settings.
The pilot projects used cheaper, generic versions of ARV drugs to prove the affordability of ARV therapy and models of decentralised care for use in national treatment programmes. And the method to push for generics in South Africa is dramatic. MSF and allies illegally import them from Brazil.
MSF wins the 1999 Nobel Peace Prize for its “pioneering humanitarian work on several continents” and its “rebellious humanitarianism”.
With its new potential legitimacy (and responsibility) and a bit of money, it invests in a campaign to close the global gap for access to medicines, the Access to Essential Medicines Campaign (CAME).
MSF employs a group of multi-skilled smart campaigners in key countries around the world. A combination of the work of MSF visionaries in South Africa, advocacy by CAME, unflappable health and Aids activists, unexpected "bedfellows", using the law and breaking the law, and individual determination of people living with HIV/Aids makes the Khayelitsha model of Aids care in less-developed countries. While the book tells the story of a highly visible, visited and documented (by others) Aids programmes, in Khayelitsha and Lusikisiki in South Africa, the messages and lessons are as relevant today as they are timely.
Today, urgently needed Aids funding is diminishing and the G8 and funders such as PEPFAR are reneging on commitments.
The new sentiment is that HIV has had enough attention, when in fact still one-third of people (five million), who need ARVs to survive still need them. Approximately four million people are on ART in low- and middle-income countries, and they require the drugs for life (UNAids, 2009).
The benefits of ARV treatment and prevention to the health and wealth of a nation are irrefutable.
Not only in South Africa today are Aids programmes experiencing drug stock-outs.
The same grave realities MSF and doctors in South Africa faced in 1999 with life-prolonging ARV drugs priced out of reach, despite the spectacular fall in the price of ARVs due to generic competition, MSF doctors are in the untenable position again of telling some patients that the medicine is simply too expensive or unavailable.
Ten years after the first people were started on ART (May 2011), Khayelitsha remains a crystal ball as it has one of the largest and oldest cohorts of patients on ARVs in sub-Saharan Africa.
A total of fifteen thousand people today are on ART in Khayelitsha.
“Médecins Sans Frontières’ clinics in Khayelitsha, Médecins Sans Frontières South Africa Book Outline South Africa are both a success story in the global battle against Aids and a harbinger of problems to come,” according to Forbes Magazine in December 2009.
The final chapter written by Goemaere, who launched MSF into South Africa and remains there fighting for patients, reflects on the accomplishments and failures of 10 years of its ARV programmes, the universal lessons, but also the threats today.
It highlights how easily successes in favour of the global poor are dismantled in favour of greed.
Goemaere describes how he found himself 10 years ago telling patients that unfortunately there is no affordable treatment available and how he now has to say the same thing to some who needs second- generation ART that is priced out of reach.
The story is also a testimony about the human and humanitarian impact of a disease that was buried for years by stigma, discrimination and state denial.
“Public health researchers in South Africa and at Harvard University have independently investigated the effect of Aids denialism. Their estimates attribute 330 000 to 340 000 Aids deaths, along with 171 000 other HIV infections and 35 000 infant HIV infections, to the South African government’s former embrace of Aids denialism.” (Wiki, Harvard Science 2008)
The book also tries to honour all the women and men affected by Aids in South Africa and their supporters who had the courage to confront not just the impact of HIV/Aids itself, but to confront the pharmaceutical industry and their own government.
Pragmatic and passionate risk-takers with a common goal demonstrated that a life-threatening epidemic and government neglect could be tackled.
The format of the book is a combination of a narrative by the main author, Dr Marta Darder, who worked with MSF South Africa in Khayelitsha between 2002 and 2007.
The book describes MSF's pioneering HIV/Aids programmes in South Africa during the period 1999-2008, describing the history, the colourful players, allies, opponents, medical methodology, dilemmas and choices faced, and analysing the impact achieved and relevance today.
The largely chronological narrative is enhanced with interviews from key internal and external players, but supportive to and also critical of MSF, photos, graphs and press clips.
Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, health-care exclusion and natural or man-made disasters in more than 70 countries.
In carrying out humanitarian assistance, MSF seeks also to raise awareness of crisis situations; MSF acts as a witness and will speak out, either in private or in public, about the plight of populations in danger for whom MSF works.
In doing so, MSF sets out to alleviate human suffering, to protect life and health, and to restore and ensure respect for the human beings and their fundamental human rights.
The book was a collaboration between authors Marta Darder, Liz McGregor and Carol Devine.