The Zimbabwean government has declared an "emergency" for six months to allow the issue of compulsory licences and the use of generic antiretrovirals as part of its response to the growing HIV/AIDS crisis.

TAC and our allies welcome this step. But we do so with great caution. Antiretroviral therapy is one of the most critical elements for dealing with the treatment of people with HIV/AIDS. But, equitable access to these medicines - not only in Zimbabwe, but elsewhere - will require more than a "six-month emergency" and a "compulsory licence". Our approach is guided by the question: will poor and working class Zimbabweans gain access to life-saving medicines? What is required to ensure that the mass of ordinary people in Zimbabwe get access to medicines? The underlying question this measure raises is: What has happened to the health services of Zimbabwe?

INDEPENDENCE GAINS REVERSED

In the early years of Independence, Zimbabwe established a primary health care service that reached millions of poor people. It cut infant mortality from 110 per 1 000 people (1980) to 53 per 1000 people (1988). In the same period, the proportion of severely underweight children dropped from 17.7% to 1.3% over the same period. These achievements are now undone.

A combination of factors destroyed these gains - the lack of good governance by Robert Mugabe and Zanu PF, as well as, misguided support for the structural adjustment programme imposed by the World Bank and IMF in 1991. The introduction of "user fees" at clinics and hospitals led to a decline in health care support because people could not afford the fees. As part of its "cuts", the Zimbabwean government had laid off 7000 nurses by 1998. This blow to the health care services happened at the same time as the HIV/AIDS epidemic was taking root. The results of the failure to deal holistically with HIV/AIDS and an economic melt-down led to a calamitous decline in life expectancy for Zimbabweans from 60 years in 1991 to 49 years in 1997. Over the last two years and because of the political crisis, thousands of doctors, nurses, pharmacists and other health professionals have fled Zimbabwe.

THE PEOPLE CARRY AN EXTRAORDINARY BURDEN

Ordinary people in Zimbabwe are carrying an extraordinary burden: impending famine, inflation, joblessness, disruption of the health care and social services, as well as the daily violations of their dignity and human rights. In the midst of this broader economic and political crisis the HIV/AIDS epidemic claims thousands of human lives every month.

HIV/AIDS exacerbates inequalities between the elite and the poor, between rural and urban communities. It also underscores gender inequality. But, most starkly, it exposes the fact that the vast majority of Zimbabweans - the urban and rural poor, peasants, workers, professionals and many middle class people die because they do not have access to health care services including antiretroviral medicines.

Today, the whole of Southern African is at a crossroads - millions of people face death from HIV/AIDS, tuberculosis, malaria and other illnesses because of high medicine prices, lack of health care infrastructure, bad governance and regressive social spending priorities. Zimbabwe is one of the countries worst affected by a social, economic and political crisis.

RETURN TO DEMOCRACY AND INVEST IN SOCIAL DEVELOPMENT

Though the declaration of an 'emergency' and issuing 'compulsory licenses' are important steps, dealing with the impact of HIV/AIDS in this context will require much more. The Zimbabwean government must ensure that every generic antiretroviral is safe, effective and of good quality. This can be done through independent bio-equivalence tests approved by the World Health Organisation. Measures to ensure access to essential medicines can work only if all Zimbabweans have access to health care services - including life-saving antiretrovirals - on a sustainable basis.

For this reason, the Zimbabwean government must support a return to good governance, the rule of law, a social development plan and clear investment in health care services. There is huge international support for access to life-saving medicines. It would be a tragedy if the Zimbabwean government cynically used this issue as a lever to try to end its international pariah status.

TAC and our allies support the Zimbabwe Congress of Trade Unions, the AIDS organisations, the women's organisations and other civil society bodies of Zimbabwe in their day-to-day struggles to ensure that all Zimbabweans have food, health-care, jobs, land and justice. As citizens of the Southern African Development Community, our destinies are inter-linked, as are our rights and responsibilities. Therefore, we call on the Zimbabwean government to adopt a comprehensive plan to deal with the HIV/AIDS crisis, including a return to democracy and good governance. Without freedom and equality, healthcare will remain the privilege of a few instead of the right of every person.

SOUTH AFRICAN GOVERNMENT'S RESPONSIBILITY

The South African government cannot ignore its responsibilities towards people with HIV/AIDS in the region. The government must publicly call on all the drug companies to issue voluntary licences for the generic production of antiretrovirals. These can be produced on a regional basis to ensure a regular, quality supply of medicines. In South Africa and in many countries of Africa, high prices and patent profiteering are directly responsible for daily deaths.

We urge drug companies, international agencies and governments to work with civil society to lower the prices of medicines and monitoring tools.

We urge every person and agency involved in HIV/AIDS to support the use of compulsory licences and to stop the drug companies and their supporters and apologists from misusing the Zimbabwe government's decision to use compulsory licences.

We urge every AIDS activist to work for democracy, development and access to essential medicines for all people.