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<DIV><B>From:</B> <A title=voices@tbtv.org href="mailto:voices@tbtv.org">loud 'n
clear</A> </DIV>
<DIV style="FONT: 10pt arial"><BR> </DIV>
<DIV>
<DIV>
<DIV>
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<DIV style="FONT-SIZE: 11px; MARGIN: 0px"><FONT class=Apple-style-span
face=Helvetica><I>"Pills not prison - our only crime was
breathing.</I></FONT><FONT class=Apple-style-span face=Helvetica><I>
</I></FONT><FONT class=Apple-style-span face=Helvetica><I>Yours may be violating
human rights."</I></FONT></DIV><SPAN class=Apple-style-span
style="FONT-SIZE: 11px"></SPAN>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><I
style="FONT-SIZE: 11px">25.01.07 </I><I
style="FONT-SIZE: 11px">Open Letter to:</I></DIV>
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face=Arial size=2></FONT><BR></DIV>
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face=Arial size=2></FONT><BR class=khtml-block-placeholder></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Your
Excellency Dr. Manto TSHABALALA-MSIMANG</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Minister of
Health</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Private Bag
X399</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Pretoria
0001</FONT><FONT class=Apple-style-span face=Helvetica> </FONT><FONT
class=Apple-style-span face=Helvetica>South Africa</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Madame
Minister,</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>As your MOH
website biography highlights your 'greatness', we turn to you for the leadership
cited as one of your qualities.</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT><FONT class=Apple-style-span
face=Helvetica>Specifically, we seek your immediate intervention in the XDR /
MDR-TB emergency in Southern Africa. </FONT><FONT class=Apple-style-span
face=Helvetica> </FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>The recent
reckless propositions to forcibly incarcerate and isolate our comrades suspected
of having this extremely drug resistant strain of tuberculosis requires a
statement from you before the recent gains made in combatting TB and TB-HIV in
the region are lost, and human rights further violated.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>We are an
international organization of people with tuberculosis (TB, TB-HIV, MDR/XDR),
either on treatment or former patients who understand the painful horror of the
disease, the long often toxic treatment, and the stigma, loneliness, and fear
that accompany it.</FONT><FONT class=Apple-style-span face=Helvetica>
</FONT><FONT class=Apple-style-span face=Helvetica>We know well about the
seriousness of spreading the infection, and the importance of early detection
and adherence. We drafted, with many of our peers, the rights and
responsibilities found in the Patients' Charter for Tuberculosis Care, adopted
by WHO as an essential element of the Stop TB Strategy for 2006-2015.
</FONT><FONT class=Apple-style-span face=Helvetica> </FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><B>Access
to drugs, diagnostics and dignity, not death row in isolation.</B></FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Careless
words and reporting from so called experts in South Africa concerning XDR has
begun a process of increasing stigma and discouraging people to seek testing for
tuberculosis and/or HIV for fear of being forced into isolation with no rights,
nor any hope for appropriate care if needed.</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT><FONT class=Apple-style-span
face=Helvetica>Although the highly infectious nature of the disease warrants
extreme precaution, creating an environment of 'panic in the streets' only
increases the problem. The reason there are XDR and MDR outbreaks are because
the TB program has not been as effective as it could be - case detection is
shamefully low and the high drop out rates are indicators of programatic
failings.</FONT><FONT class=Apple-style-span face=Helvetica> </FONT><FONT
class=Apple-style-span face=Helvetica>Lack of diagnostics, drugs, and effective
management are not the fault of patients. The cause of the problem is how people
with TB and TB-HIV are cared for. Criminalizing those unfortunate enough to
breathe at the wrong moment is both medically and morally wrong.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>There are
other methods of dealing with XDR / MDR than what is being recklessly proposed
in South Africa, and the means to scale up TB-HIV programs are
available. </FONT><FONT class=Apple-style-span face=Helvetica>The WHO has
been working late in the night putting into place mechanisms to help Southern
Africa confront the problem, as have a number of the members of the Stop TB
Partnership. Civil society organizations and activists in many countries are
very concerned, and solidarity with the struggle you face is growing
quickly.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>We call
your attention to the statement from WHO yesterday (attached below), which
outlines the human rights considerations.</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT><FONT class=Apple-style-span face=Helvetica>Guided
by the Siracusa Principles, the WHO states that forcibly isolating people with
drug resistant tuberculosis must be used only as the last possible resort when
all other means have failed, and only as a temporary measure.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>If it can
be proven through evidence-based analysis that forced isolation is temporarily
required, patients must be provided with the quality care that includes, among
other rights, free access to all of the second line drugs, laboratory support
including effective drug sensitivity testing, social support; and be treated
with respect and dignity.</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT><FONT class=Apple-style-span
face=Helvetica>Patients must be informed clearly in their language of their
rights and responsibilities, as outlined in the Patients' Charter for
Tuberculosis Care. Independent monitoring is required to assure that the human
rights of the person are not violated.</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT><FONT class=Apple-style-span face=Helvetica>Health
authorities and providers choosing the extreme measure of involuntary treatment
should only do so if they can assure that they endeavor to meet the best
practices of the International Standards for Tuberculosis Care, also an
essential element of the Stop TB Strategy.</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><B>Scale-up
programs not lock-up patients.</B></FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>We call on
you, Your Excellency, to issue a policy statement that leads to massively
scaling-up the response to the TB Emergency in Southern Africa, and protects the
human rights of people with tuberculosis or suspected of having the disease.
Your leadership now would put a stop to reckless rumors and recommendations that
will only increase the suffering of people with TB, their families, and their
communities. Engaging the resources needed to confront an emergency and
protecting human rights are two of the components of the 'greatness' that is now
urgently needed.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>We thank
you for your consideration, and your support in the global struggle to Stop TB.
</FONT><FONT class=Apple-style-span face=Helvetica> </FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Maxime
Lunga, Neichu Angami, Carol Nyirenda, </FONT></DIV>
<DIV style="MARGIN: 0px">Victory Brahmana<FONT class=Apple-style-span
face=Helvetica>, Erica Blair, Steve Amolo, </FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Pervaiz
Tufail, </FONT><FONT class=Apple-style-span face=Helvetica>Fermina Barajas,
Mauricia Corona, </FONT><FONT class=Apple-style-span
face=Helvetica></FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Razza
Charpé, Alberto Colorado, <FONT class=Apple-style-span face=Arial>Lawrence
Monteiro</FONT>, </FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>Bernard
Hopi, Bertrand Kampoer, Case Gordon</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span
face=Helvetica>TBTV</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span
face=Helvetica>www.tbtv.org</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span
face=Helvetica>--------------------</FONT></DIV>
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face=Arial size=2></FONT><BR></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>WHO
guidance on human rights and </FONT><FONT class=Apple-style-span
face=Helvetica>involuntary treatment for XDR-TB</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>24 January
2007. </FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>WHO places
prevention and care of XDR-TB as a priority through the strengthening of basic
TB control and the necessary interventions to cure existing cases. This includes
strengthening political will throughout affected countries to reduce the burden
of TB, rapid accurate bacteriological diagnosis, a secure supply of high quality
drugs, supervised and standardised treatment, and recording of the outcome of
every single patient at the end of treatment. It also includes ensuring that the
capacity to identify and treat drug-resistant TB is in place, with a secure
supply of second-line anti-TB drugs required for treating multidrug-resistant TB
obtained through the Green Light Committee (in resource-limited settings)(1), as
well as implementing good infection control procedures.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>These
measures are currently the best approach to the prevention and care of XDR-TB
and were listed among the recommendations supported by international health
experts at the first meeting of the WHO Global Task Force on XDR-TB in October
2006(2).</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>WHO's
position with respect to the legal and ethical issues surrounding compulsory TB
treatment was published in 2001(3) with the specific purpose of ensuring
prevention and control is strengthened within a legal and human rights'
framework. The publication of a PLoS Medicine journal report(4) has highlighted
again the issues around compulsory treatment, particularly in relation to
drug-resistant TB.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>WHO
strongly recommends that governments must ensure, as their top priority, that
every patient has access to high quality TB diagnosis and treatment for TB and
drug-resistant forms of TB. It also fully supports the rights and
responsibilities of TB patients as recommended in the Patients' Charter for TB
Care(5).</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>In this
regard, if a patient wilfully refuses treatment and, as a result, is a danger to
the public, the serious threat posed by XDR-TB means that limiting that
individual's human rights may be necessary to protect the wider public.
Therefore, interference with freedom of movement when instituting quarantine or
isolation for a communicable disease such as MDR-TB and XDR-TB may be necessary
for the public good, and could be considered legitimate under international
human rights law.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>This must
be viewed as a last resort, and justified only after all voluntary measures to
isolate such a patient have failed.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>A key
factor in determining if the necessary protections exist when rights are
restricted is that each one of the five criteria of the Siracusa Principles(6)
must be met, but should be of a limited duration and subject to review and
appeal. The Siracusa principles are:</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>
</FONT><FONT class=Apple-style-span face=Helvetica>* The restriction is
provided for and carried out in accordance with the law;</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>
</FONT><FONT class=Apple-style-span face=Helvetica>* The restriction is
in the interest of a legitimate objective of general interest;</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>
</FONT><FONT class=Apple-style-span face=Helvetica>* The restriction is
strictly necessary in a democratic society to achieve the
objective;</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>
</FONT><FONT class=Apple-style-span face=Helvetica>* There are no less
intrusive and restrictive means available to reach the same
objective;</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>
</FONT><FONT class=Apple-style-span face=Helvetica>* The restriction is
based on scientific evidence and not drafted or imposed arbitrarily i.e. in an
unreasonable or otherwise discriminatory manner.</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span
face=Helvetica>Responsibilities of TB treatment-providers to their patients are
detailed in The International Standards for Tuberculosis Care(7).</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><FONT face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span
face=Helvetica>Footnotes</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><FONT face=Arial size=2></FONT><FONT face=Arial
size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(1)
Instructions for Applying to the Green Light Committee for Access to Second-Line
Anti-TB Drugs (WHO, 2006)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.369_eng.pdf">http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.369_eng.pdf</A>
[pdf 404kb]</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><FONT face=Arial size=2></FONT><FONT face=Arial
size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(2) Report
of the meeting of the WHO Global Task Force on XDR-TB (WHO, 2006)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://www.who.int/tb/xdr/globaltaskforcereport_oct06.pdf">http://www.who.int/tb/xdr/globaltaskforcereport_oct06.pdf</A>
[pdf 608kb]</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><FONT face=Arial size=2></FONT><FONT face=Arial
size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(3) Good
Practice in Legislation and Regulations for TB Control: An Indicator of
Political Will (WHO, 2001)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://whqlibdoc.who.int/hq/2001/WHO_CDS_TB_2001.290.pdf">http://whqlibdoc.who.int/hq/2001/WHO_CDS_TB_2001.290.pdf</A>
[pdf 163kb]</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(4)
Medicine journal (Public Library of Science, 22 January 2007)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040050">http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040050</A></FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(5) The
Patients' Charter for TB Care (World Care Council, 2006)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://www.who.int/tb/publications/2006/istc_charter.pdf">http://www.who.int/tb/publications/2006/istc_charter.pdf</A>
[pdf 1.01Mb]</FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(6)
Siracusa Principles on the Limitation and Derogation Provisions in the
International Covenant on Civil and Political Rights (United Nations, Economic
and Social Council, 1985)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://www1.umn.edu/humanrts/instree/siracusaprinciples.html">http://www1.umn.edu/humanrts/instree/siracusaprinciples.html</A></FONT></DIV>
<DIV style="MIN-HEIGHT: 14px; MARGIN: 0px; FONT: 12px Helvetica"><FONT
face=Arial size=2></FONT><BR></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica>(7)
International Standards for TB Care (TB Coalition for Technical Assistance,
2006)</FONT></DIV>
<DIV style="MARGIN: 0px"><FONT class=Apple-style-span face=Helvetica><A
href="http://www.who.int/tb/publications/2006/istc_report.pdf">http://www.who.int/tb/publications/2006/istc_report.pdf</A>
[pdf 1.99Mb]</FONT><FONT class=Apple-style-span
face=Helvetica> </FONT></DIV></DIV><BR></DIV><BR></DIV><BR></DIV><BR></BODY></HTML>