Zackie Achmat is not hungry, but tucks into the chocolate cake just the same. Achmat is HIV positive, yet refuses to take the antiretroviral drugs that could prolong his life. But he does boost his immune system with protein — with chocolate cake.
Achmat is not a shanty dweller unable to afford the drugs; he is not a so-called ”Aids dissident” who believes the drugs are poison; he is not mad, and he is not suicidal. Zackie Achmat, according to Nelson Mandela, is a national hero: an ordinary man whose extraordinary resolve could help save thousands of African lives, at the cost of his own.
At a reception in Johannesburg last week, the former president turned to Achmat and asked him, with cameras rolling, to take the antiretrovirals. ”Give me, as an old man, your promise that you will now take your medicine.” Not for the first time, the national hero, dressed as ever in T-shirt and jeans, said no.
A few days later, in a suburban Johannesburg garden, between mouthfuls of cake, he explains why. ”It is a personal issue of conscience. I have become middle class but my brothers are working class, and if they were infected they could not afford the medicines.”
Twelve years after he was diagnosed with HIV, the virus that causes Aids, and given six months to live, Achmat has turned his health into a hammer against the government. All his life he has fought authority, but never did he expect to fight his own party, the African National Congress (ANC), or the leader he campaigned for, Thabo Mbeki.
Mandela is not alone in fearing that this will be a fight to the death. South Africa braced itself for an emotional funeral several months ago when the 40-year-old became too weak to do more than whisper, yet still rebuffed friends’ pleas to relent.
The scythe missed and Achmat recovered — even put on weight — but sometimes the hands shake and the strain shows. ”I wouldn’t recommend anyone to take this stand. There is no longer a need.”
There is no longer a need because the organisation that he chairs, the Treatment Action Campaign (TAC), is winning its battle. The drug companies have lowered their prices, and the government has promised to distribute antiretrovirals. But until that promise is kept, Achmat will not take his medicine.
It has been a long, strange fight waged in courtrooms, hospitals and cabinet meetings. But stranger still is the odyssey of the teenage rioter who became a prisoner, a prostitute, a gay leader and finally, for some, a saviour.
Achmat’s unease at such superlatives was visible at the Johannesburg reception. He awkwardly shuffled his feet as 700 doctors, business executives and journalists gave him a standing ovation. As he says in his soft but fast Cape Town cadence, many others have joined the fight, not least of them Mandela.
The stakes are colossal. HIV/Aids has infected at least 4,5 million South Africans, more than in any other country. The 360 000 who died last year may only be a prelude to a steep upward curve that will devastate a generation in its prime and turn millions of children into orphans.
The crisis is as unprecedented as it is complex. A society and economy poisoned by decades of apartheid was bound to be hit hard. But not this hard. Some 70 000 babies are born with HIV each year, and Johannesburg is so short of space for the dead that it is reportedly considering putting disused mine shafts into service as catacombs.
President Mbeki’s suspicion that HIV is not a cause of Aids but a con by drug companies hungry for profits has been blamed for crippling the state’s response. Doctors have been prevented from giving antiretrovirals and other drugs because the president deemed them too toxic.
There was little to suggest at Mbeki’s inauguration in June 1999 that a sick ANC cadre in Cape Town would become his dogged foe. Of mixed descent, his mother a garment maker, his father a furniture maker, Achmat began his political career at the age of 14 when he tried to burn his school during the uprising against apartheid education.
They were violent, chaotic times and, when not in jail, the son of conservative Muslims was sleeping on the streets or in a stranger’s bed. ”Yes, I was a sex worker. I have never hidden that.”
It was when he emerged from the underground in 1990, a Trotskyist turned social democrat, that he was diagnosed with HIV.
”The doctor said I had six months to live. I went home and took out every film I could — I had always wanted to make films. But instead of getting worse, I got better.”
Reprieved, Achmat flung himself into a gay rights campaign, took a degree in English at the University of Western Cape, and canvassed for Mbeki after Mandela stepped down from the ANC leadership. ”I thought he’d make a good leader.”
In November 1998 he fell seriously ill with thrush, an opportunistic infection common to those with HIV, and came close to a painful death of sores and wasting away, unable to swallow. Friends chipped in for drugs, which he took, and he recovered.
Later, doctors said he should go on a permanent course of antiretrovirals, but by now Mbeki’s Aids policy, or lack of one, had emerged. ”At first I said yes because I wasn’t feeling well, but then I thought about it and said no.” The people he grew up with were falling sick but did not have middle-class friends to buy them drugs — why should he be different?
TAC used legal and moral arguments to shame the pharmaceutical multinationals into allowing South Africa to import cheaper generic copies of patented Aids drugs. It was an epic victory, and one that raised hopes that millions of Aids sufferers would finally be able to gain access to drugs that could prolong their lives.
But there were more battles to be fought. Mbeki continued to keep drugs such as nevirapine, which can halve the incidence of mother-to-child transmission of the virus, from the public sector.
”The central problem,” says Achmat, ”is the absence of political will. Why is the president like this?” He smiles and plays with his spoon. ”Unfortunately, there is no God, so you won’t get an answer there. We may never know.”
Some say that Mbeki’s intellectual vanity was seduced by the ”dissident” scientists who challenged Aids orthodoxy; some say he resents the strain that the drugs would exert on the exchequer. Achmat’s theory is this: ”The president doesn’t want to believe that people in Africa have a lot of sex.”
Whatever the reason, TAC rebutted each government objection and showed that existing funds to fight Aids were enough — if only they were spent properly. Mbeki refused to meet the activists, but the official denigration has evaporated since Mandela visited a very sick Achmat at home earlier this year.
”We were really under siege, and Nelson has given us protection. It was not for us that he did it. He’s not interested in opposing the government. He’s interested in doing what is right.” Despite his gratitude, Achmat has twice refused the old man’s request to take the drugs.
Chastened by the international outcry, last April the South African cabinet announced a U-turn and promised to distribute antiretrovirals. Yet in some provinces they remain unavailable because officials fear the president’s wrath, and avoidable deaths continue, says Achmat. In addition to the drugs, the government needs to do what other African countries did long ago: coordinate a national response, train nurses and doctors in Aids care, and urge people to take HIV tests.
More recently, TAC has toned down its criticism as it senses a move by the government to realise its promises — but still has a February deadline for a campaign of civil disobedience if there is no real change.
For the chairman, the stakes do not get more personal. Ask what will persuade him to take his medicine and the body stiffens, the smile vanishes. ”As soon as it is feasible,” he says; a calculated ambiguity. His death would be a public relations disaster for a government which knows that the next time Achmat falls sick, it may be too late for drugs to stay the scythe. And a rebel with a cause will have become a martyr to it. – Guardian Unlimited (c) Guardian Newspapers Limited 2001