Zackie Achmat on the future

Zackie Achmat, chairperson of the Treatment Action Campaign (TAC) and South Africa’s most famous purveyor of the slogan ”HIV-positive” has been an activist for 30 years. First fighting the apartheid government since 1976, for the past decade he has worked on improving the lives of people living with HIV and Aids.

From his earlier refusal to take antiretroviral (ARV) drugs until the government made them available to all South Africans, to branding Health Minister Manto Tshabalala-Msimang a ”murderer” for her views on the epidemic, Achmat and the TAC have always been blatant in their activism.

Now, eight years since the TAC’s inception, and in commemoration of World Aids Day on December 1, this international activist, hero and face of the TAC speaks to the Mail & Guardian Online about taking a softer approach, building trust with the government, the successes of the TAC and his own future prospects in the world of politics.

1. How are you?
Well, my health is perfect. I’m just a bit tired from running around so crazily, and the last few months, the battle with government [and] now the negotiations with government have seriously interrupted my exercise programme. Apart from that, I am perfectly healthy.

2. Do you ever feel like you are too tired to carry on the fight because like it’s too difficult, or because the government will never come around?
I think that many of us in the beginning of the year, even up until July, thought that this was going to be a very hard battle which may take another couple of years. That changed with three things, in relation to what happened in August and then also what happened in Toronto [when the government’s display at the 2006 world Aids conference came under fire from activists].

In August, the TAC and the Aids Law Project were involved in a court case about Westville correctional services prisoners. We had sent them 34 letters over the course of five months to try to sort the thing out instead of having to go to court.

When that didn’t work, we went to court … we knew that there would be a problem, and some people had died already. The case came to court; government lost in the first round; they appealed that; they lost that round; they got a right to appeal at higher [level]; we brought an application that said that, while the appeal goes on, they must treat people because people can die. And the court said you have the right to do that and it is not appealable.

Not only did the government appeal an unappealable order, but when we went to visit the Aids Law Project clients at Westville prison, we found out that one of the prisoners had died the week before and they hadn’t told us; they were hiding it. All of which, unfortunately for them [the government], happened in the same week as the Toronto conference opened, so there was already a focus on South Africa.

Then, the most unfortunate thing for government is that the minister of health regrettably opened a vegetable stall [at the Toronto conference] instead of a display. People only talk about the vegetables at the display, but … it was the only display that had pictures of the president, the health minister and the deputy president, whereas every other display had pictures of people living with HIV, communities and so on.

3. Are you more positive this year about the TAC and the progress that has been made?
We took to the streets and [through] the combination of the [court] cases; the focus on South Africa; and the fact that we were quite prepared — and are still now quite prepared — to go to the streets for however long it takes to get a decent Aids plan, fortunately government came to see sense.

It doesn’t mean that things are sorted out yet. There are two or three problems. First, there are good people in government who want to do the right thing, from Cabinet right down, and they have begun to issue a new plan. Civil society found the plan [had] shortcomings, and we said, ”Please postpone it to next year so we can get a decent plan out,” and they listened to that.

But it’s very sad that there are officials in the Health Department who have no experience in health or on HIV but have political experience, and they see that if the government moves forward on this, they are going to have to find other political work to do, and they will lose their power there.

So, they have an interest in the conflict, and that is making the situation very tense at the moment because those officials are trying to use the health minister against the deputy health minister and against the deputy president, and trying to create that sort of conflict. And they are using government-funded NGOs to create that support. They are organising marches in support of the health minister and so on, instead of dealing with the issues.

4. The TAC website talks about a renewed coalition between the government and civil service. Is the TAC still calling for Tshabalala-Msimang’s dismissal as stipulated in the organisation’s five main demands (as listed on the website)?
We had a discussion in which the deputy president convinced me to sign a get-well card for the health minister, which I did because I don’t wish anyone ill, and all the other top leaders who were at the meeting co-signed the card, so that is not an issue for us. So, it’s not a personal issue, she messed up in [the national health programme]. It’s not about an individual being sick or not sick and so on.

We are of the opinion that the health minister is not the best person to do her job. And we have a list of eight pages long that lists all the problems with the Health Department — not with the minister — not doing its job properly. Now the government has said to us, ”Look, we are not going to let the TAC decide who to appoint in Cabinet.”

We don’t want to decide who is appointed in Cabinet; what we want is a decent health programme, and if government gives us that health programme, we don’t care who is in the job. We are still of the opinion that it would be better to have a different health minister, but if the president and the Cabinet decides to keep this health minister, we are going to keep quiet about pressing that demand. If we don’t get what we want, we will revisit that demand.

If you had to ask me what we [the TAC] are emphasising, we are emphasising getting a decent plan out and working together to implement that plan. If government doesn’t deliver on that, then obviously there will be conflict again, which is not what we want because conflict means that we don’t get to do what we need to do most, which is prevention, treatment, care of orphans, those sorts of things. The whole country needs to focus on that.

5. There seems to be sort of a symbiosis in the relationship between the government and the TAC —
Are you saying a mutually beneficent symbiosis or a generally corrupt relationship? [laughs]

What I am trying to say is, when the government had a hard and fast agenda against ARVs, you took an equally hard stand against taking them yourself. Now the TAC seems to be taking a softer approach. Do you think that the government’s changes — the action it is taking and the advances it is making — warrant this softer approach, and do you think they will be successful?
There are three things that warrant a softer approach. The first thing, and that is the most important, is that the deputy minister and the deputy president, above anyone, have begun to rebuild trust with civil society, and that for me is immeasurable and invaluable. You can’t put a value on that, because that is critical to dealing with the epidemic.

And this is a partnership that is not based on making us lapdogs, but it is a partnership based on constructive criticism from both sides, and it’s the beginning of that process, and that’s good.

The second thing is, government has said, ”We are prepared to address the weaknesses in the plan,” and they started drafting a new plan.

The third thing, which relates to price and to implementation, is that they said it is better to have a decent plan than to rush it to show fake unity.

The other thing they [the government] are doing for World Aids Day is that they have agreed on common messages. As we understand the common messages — and we have to see the final draft still — they say HIV treatment is a priority; HIV prevention is an absolute priority; treatment includes ARVs; and there is no difference between good nutrition and ARVs — you shouldn’t choose between the two, you need both.

That is what we’ve always said, so from our point of view, if that is the government’s plan and programme, if that is the principle it is based on … there is a basis for moving forward.

6. Do you think the deputy president and the deputy health minister followed a different approach to Aids policy because Tshabalala-Msimang was away, in hospital?
I prefer not to focus on the minister. But for me it is important what the deputy president did and what the deputy health minister has done. It is simply restating government policy, and they have acted with the full knowledge of the whole Cabinet.

So will it not change now that Tshabalala-Msimang is back?
Well, nothing is impossible; that is why it is very important always to remain vigilant. [I am] hopeful more than positive; hopeful and cautious. We have been here before. We were here in 1999; we were here in 2003.

Has the minister’s ”madness” ended?
I said I prefer not to talk about the health minister [laughs]. And I’m not avoiding your question. I really don’t think one ought to tell journalists what to write, but I think this conflict has been going on for so long that all of us just need to take a step back and see where the process goes and try to be as positive about the process as possible. If we come out on the right side, then its full steam ahead. If it comes out on the wrong side … I hope that won’t happen.

When people say Manto has been sidelined — [that] there has been a coup against her and stuff like that — all it does is it hardens. We are over that barrier; all it means is now we have to cross that barrier again. Because you know how human beings are: if you say to me, ”You are a bad person,” and then we all sit down and we say, ”Alright, let’s make peace,” and then we go away again and you say I’m a bad person somewhere else, then that means I don’t trust you.

So, I’m much more interested in building trust with the government at the moment. It’s not personality based; it’s based on the fact that every government minister is committed to this plan, I hope.

7. On November 22, some traditional healers came out in support of Tshabalala-Msimang and against the TAC. They are said to treat about 70% of the population. What does that say?
That was one traditional healers’ organisation. There are many different traditional healers’ organisations, and we are on fairly good working terms [with them]. In fact, as they were marching I was on a platform with Dr Trevor Majoro, who is both a medical doctor and a traditional healer.

It’s not traditional healers against the TAC, in support of Manto; it is one government-sponsored NGO in support of the health minister, of what they think the health minister wants. I don’t want to enter that conflict; they have the right to be critical of us, we have the right to be critical to them.

For us, more important is the fact that 12 years after democracy, this government has now appointed a half-baked committee to look at traditional healers. It is not us who are disrespecting traditional healers. That’s the first point.

The second thing, people consult traditional healers them for different reasons. I come from a Muslim background; I’m an atheist. Many Muslim people from Malay extraction, which is what my background is, go to what they call a dukum, and they’ll make the naarwater and the joomachies and all sorts of … traditional medicine, but they do it for different reasons. Sometimes they do it for illness; sometimes they do it just to ward off spirits; sometimes they do it to get a better business; sometimes they do it to get a better wife.

Yes, 70% of people may consult traditional healers, but they do so for very, very different reasons. And the point is not to say that traditional healers should or should not be part of the system. There should be one health system in the country that treats everybody, that incorporates traditional medicine and traditional healers, in which traditional healers get a decent education and recognition.

8. What do you think would happen to the TAC if the government drastically changed its policies and decided to embrace everything you have been saying for so many years?
Well, the TAC is an organisation of 20 000 members — most of them women, most of them people living with HIV, most of them unemployed. There is a helluva lot of work to do. And the work, first and foremost, is to help government get people on treatment and prevent new infections.

In addition to that, [the work is] to deal with gender inequality and gender-based violence, and by that I mean both violence against women and violence that men commit against themselves — how we beat each other up, how we kill each other. [Also,] gender-based inequality and class inequality, making sure that there is a decent social security system and that there is employment in the country. There is lots of work to do, and there are many great people in the TAC who will do that.

So it will just expand its reach in the future?
Well, I hope. We will have a congress next year to decide our future. This is my last year as chairperson of the TAC, as far as I am concerned. And I won’t go back on that promise, because there are many good people in the TAC who are smarter than me, younger than me and much more hardworking than I am, who will not only be ready to lead but must lead the organisation.

What I would like to see the organisation do is certainly continue to exist, continue to put pressure on government [and] not have conflict with government. I don’t believe that the conflict is necessary, but all of us as citizens, not only the TAC, must continue to put pressure on government — but more than government, [also] the private sector: we need to put pressure on them to deal with the epidemic and poverty.

What about citizen activism — websites such as Do actions like these take emphasis away from the issues and focus on individuals, or are they important to make the voice louder?
I think as South Africans we have become so thin-skinned. You must read a website called [with comments by] a crazy man called Anthony Brink and read all the bad things they say about me. Do I care a damn? No, because I know it’s not true. You can never base your policy, your work or your principles on what people think of you. So if the minister wants to be disturbed by what people call her, you know, just ignore them.

If the people have a valid point, the citizens can start it up, and even if they don’t have a valid point it’s good if it’s up. It keeps me on my toes to read that people don’t like me. If they have a valid point I am going to listen to it, and I may change my behaviour completely or partially, whatever the need is.

I think citizens must do as much of that sort of thing as possible; not simply sack Manto, but [ask:] Where is a great movement to improve education in this country; where is an organisation like the TAC that deals with unemployment or with housing in a political way, not in a policy way, not fighting all the time, but doing the research, dealing with the issues?

If you are asking me if people should be more active [and] raise their voices, should they be more or less critical … the mode of their work and activism is not the issue. The more the better. I would like to see informed, sensitive and strategic, but above all principled, activism.

9. Over the past eight years, what do you think were your biggest successes?
Our biggest success is that we got government to accept a treatment plan. [Our] second-biggest success: the mother-to-child [transmission] prevention court case that we won. The third-biggest success: the treatment that I take today. ARVs used to cost R10 000 a month in the private sector; my medical aid pays R450 a month now. The government gets those same medicines for about R150. So we fought with the drug companies to get the prices down significantly.

It costs the government R7 000 a year to keep someone alive on ARVs. It used to cost R10 000 a month just for the medicine just for that one [person], so that’s enormous. Those, for us, are the big things, and we would much rather spend our time fighting with drug companies, with the insurance industry and those things, than fighting with government.

Where could the TAC have done more?
I think sometimes we could have been less harsh. Patience we didn’t need; we have too much of that. But we certainly need to do a lot more in terms of public education. These [Aids issues] are things that every person — a principal at a school, an employer, a nurse — should understand.

And in terms of education and awareness campaigns, where do you think the primary responsibility lies?
With all of us. The government can give you condoms, as my comrade Sipho Mthathi says, but the government can’t put the condom on for you.

10. Where will the TAC be 10 years from now?
I have no idea. I have never liked to predict things, but I think that all of us working in the Aids epidemic need to have a 50-year plan because we are not going to be around, but people who come after us will still deal with the effects of this epidemic.

If you have a child now and you are 30 and you die of Aids, the impact of your death will be grieved today. But 30 years later, the loss to the community and the family and society will still be felt because you are not going to be there to transmit values [and] assist your child, and you are not going to be there to earn money to help your family, to help the economy, to educate yourself and to be productive.

We have to have a plan to stop the infection, we have to have a plan to treat people and we have to have a plan [for] 50 years or more that deals with the impact of this epidemic, and we have to work closely with the countries in the region that we destroying.

What is next for you, after you leave the TAC?
Politics [smiles]. No, I don’t want to become a parliamentarian, but I believe that there is a job to do to make sure that we have good politicians. I don’t want to be a politician, but I want to make sure that we have good politicians.

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