HIV/AIDS, tuberculosis, and malaria are among the world's biggest killers, and all have their greatest impact on poor countries and poor people. It is also observed that HIV particularly strikes at youth and for social and physiological reasons women and girls are more vulnerable to HIV infection that men and boys. Today, women make up slightly less than half of adults living with HIV/AIDS around the world. In areas, where the epidemic is spreading, prevalence rates are rising fastest among young women. In parts of Sub-Saharan Africa young women are more than three times as likely as young men to be infected. This is mostly because of failure to provide women with the knowledge and services needed to avoid infections.

Another disease taking toll on young lives is malaria. Malaria is endemic in large parts of the developing world, particularly in tropical and subtropical regions. A large number of malaria cases are not clinically diagnosed or reported to official agencies. It is therefore hard to gauge the full extent of the epidemic. The World Health Organization estimates that 300-500 million cases occur each year, leading to more than one million deaths. Almost 90 percent of all cases occur in Sub-Saharan Africa, where children are the most affected and malaria may account for as much as 25 percent of child mortality.

All these diseases interact in ways that make their combined impact worse. The economic burden of epidemics such as tuberculosis, malaria, and HIV/AIDS on families and communities is enormous. Estimates suggest that tuberculosis costs the average patient three or four months of lost earnings, which can represent up to 30 percent of annual household income.

What needs to be done?
A problem of this magnitude can be tackled effectively through campaign mode. A campaign is a sustained effort to bring about change at local, regional, national or international level; it is not one single action, but a combination of a number of actions, strategies and events put together in a sequenced plan. An effective campaign draws community's attention to an important issue and directs it towards speaking up, taking actions and decisions towards solutions. This calls for a strong communication strategy.

Let us look at the example of Treatment Action Campaign carried out in South Africa to combat HIV/AIDS.

Treatment Action Campaign
The Treatment Action Campaign has campaigned for reversal of HIV/AIDS since before the goal was adopted. This case study provides an innovative civil society response to holding their government responsible to the targets of the MDG It is an excellent example of how to run a local campaign linked to an international movement.

On 10 December 1998, International Human Rights Day, a group of about 15 people protested in Cape Town to demand medical treatment for people living with HIV/AIDS. Passers-by were surprised. They did not realize AIDS could be treated or that medication was freely available in Western countries. By the end of the day the group had collected over 1000 signatures calling on government to develop a treatment plan for people living with HIV, and the Treatment Action Campaign (TAC) was born. The next challenge in this journey was to fight for access to treatment. The launch of TAC opened a new chapter in AIDS politics in South Africa.

TAC aims to:

• Campaign for affordable treatment for all people with HIV/AIDS
• Fight for treatment for pregnant women with HIV to reduce the number of children who contract the virus
• Campaign for a health system that provides equal treatment for all South Africans
• Teach ourselves and others about HIV/AIDS treatment
• Train a leadership of people living with HIV.

TAC has over 8000 members and offices around South Africa. In addition, it has mobilised a network of supporting organisations including the unions, religious groups and an NGO coalition. Each of these campaigns have had a strong networking, capacity-building and training strategies. The campaign utilized the following tools from which it derived its own learnings. Let us look at each one in detail.

Campaign plan
Every successful campaign needs a clear analysis of the problem, a clear campaign goal and a well thought out plan that takes into account the local context and the organisation's resource base. The TAC effectively identified the problem and a solution, and has focused on creating the political will to implement the solution. The campaign objective was always been clear affordable treatment for all. TAC successfully identified supporters (HIV+ people, NGOs, unions), potential supporters (the medical profession, academics, officials), opponents (government and the pharmaceutical companies) and potential opponents (ANC). It worked on each group to win them over. At different times, different tactics and tools were used. Throughout all these actions the message was consistent.

Finally TAC continually expanded its support base by appealing to the public through personalised heart-rending stories about TAC members. In particular, people responded to the human angle and the drama contained in media coverage of the campaign leader Achmat's declining health and his continuing refusal to take drugs until the Government committed itself to treatment for all. This was accentuated further by coverage of visits by Mandela to the ailing Achmat, with parallels being drawn between the two activists' principled stands, demonstrating the power of public support by a high profile figure.

Network One of TAC's real strengthens has been its network. Locally in South Africa TAC forged an alliance with the biggest trade union federation, religious leaders and NGOs. Every time it took a step, with the exception of civil disobedience, it brought these partners along with it. Internationally, TAC mobilised activists around the world to support its campaign and put pressure on the government. This meant that each time government failed to respond, the whole world knew. This proved to be deeply embarrassing for the South African government.

Lobbying with government
While TAC has been in almost constant conflict with certain Cabinet members, it has maintained contact and collaboration with senior officials. In short, TAC has in the main managed to walk the advocacy tightrope. Whilst on the one hand it would threaten government with direct and legal actions, on the other hand it would offer government a partnership, research and rational arguments to complement the protests. For example, its support for government around the Medicines and Related Substances Control Act on the one hand, and its court case against government to secure mother-to-child-treatment on the other hand.

Wherever possible, TAC has used formal processes. It has made presentations to Parliament. It has participated in task teams. It turned its calls to the negotiating forum NEDLAC. This, combined with the direct action, led to the final victory around treatment.

Direct action
Marches, heckling, sit-ins, graffiti, walk-outs, breaking laws, treatment strikes and finally civil disobedience have all formed part of TAC strategy over the years. Initially the organisation focused on more conventional forms of action marches, pickets, etc. But in the face of government's lack of action they became more assertive.

TAC found that generally society welcomes a social movement that is skilful, loud and non-threatening as a victory for democracy. But there is greater ambivalence when there is poor do away with decorum, display of anger and breaking of the law. This ambivalence was reflected in even TAC's staunchest allies the unions and religious leaders. Both refused to support the civil disobedience campaign. While this ambivalence was not shared by TA's mass membership, who wanted an end to the political prevarication, the lesson for TAC and other campaigns is that civil disobedience can only ever be a last resort and needs to be very carefully considered.

Research Research underpinned TAC's proposals and recommendations, enabling it to win over practitioners and academics in the field. The research also provided a platform for engaging officials.

Using the law
South Africa's Consitution provides one of the most progressive social and economic rights frameworks in the world. TAC used this to their advantage when they used the legal process to enforce people's right to treatment. But as TAC discovered, winning a judgement is just the first step. Too often governments do not honour the judgement. Implementation needs to be carefully monitored and any transgressions brought into the public eye. This requires a pool of activists on the ground working alongside the legal team. Thanks to its mass base, TAC was quick to react against government's non-delivery with its complaint to the Human Rights Commission.

Media strategy
The media has been one of TAC's key vehicles from day one. It has planned events to capture and maximise media coverage, using this to spread their message. TAC's focus on creative actions has been an important part of its media success. It has provided stories of real people's struggle for life and through this, built up a core of 'friends' in the media who work with TAC. Where necessary it has used high profile people to carry its message forward.

Leadership Last but not least every good campaign requires excellent leadership. TAC has benefited from the inspired and inspiring role of its leader, Zackie Achmat. He has provided the strategic leadership and courage to take difficult next steps each time the campaign has reached a stalemate. As important has been the role of the rest of the leadership team who have provided the management direction and capacity to realize TAC's visions.

Facts:

• HIV has infected more than 60 million people worldwide. Each day 14,000 people are newly infected, more than half of them under age 25.
• The proportion of adults living with HIV/AIDS in Sub-Saharan Africa has stabilized not because the epidemic has been halted, but because the death rate now equals the rate of new cases.
• Prevention programmes reach fewer than one in five people who need them. Comprehensive prevention could avert 29 million of the 45 million new infections projected by 2010.
• In Africa, a child dies from malaria every 30 seconds. More than 90 per cent of all malaria deaths in the world occur in sub-Saharan Africa.
• Pregnant women are more susceptible to malaria infection than non-pregnant women. During a Malaria epidemic, they are also up to three times as likely to develop serious Malaria as other adults.
• In Africa, it is a leading cause of death for children under five years, causing at least 18 per cent of all deaths. But it is also true that the use of insecticide treated bed-nets could save 500,000 children's lives in Africa each year.
• Malaria can cause an immense burden on health systems. For example, in sub-Saharan Africa, Malaria is estimated to account for 25-35 per cent of all outpatient visits, 20-45 per cent of hospital admissions and 15-35 per cent of hospital deaths.
• Economic costs due to malaria in Africa are estimated to be about US$12 billion per year. In addition, it is estimated that Malaria is responsible for slowing economic growth in some African countries by 1.3 per cent per year.
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  ¡ Each year, there are an estimated 350-500 million cases of malaria, resulting in over 1 million deaths. The vast majority are among children under five years old. More...