State of Denial

PBS Premiere: Sept. 16, 2003Check the broadcast schedule »

The AIDS Rebel


Mandela's actions made clear that the A.N.C. had split into two factions, and, for a moment, it appeared that Mandela's side was gaining control. In April, 2002, the President's Cabinet issued a striking statement: "The government's starting point is based on the premise that H.I.V. causes AIDS." The budget for AIDS prevention and treatment would be tripled. Rape survivors would be given prophylactic doses of antiretrovirals. And, at long last, the A.N.C. announced that it would explore the cost of offering antiretroviral drugs to the wider public.

Mbeki approved all of these actions, leaving many with the impression that he had finally changed his mind. He had not. Last spring, he sent his colleagues a rambling e-mail message. The document, which ran to a hundred and fourteen pages, was written mainly by Peter Mokaba, the former head of the A.N.C. Youth League. It attacked drug companies, antiretrovirals, and the mainstream "thesis" on H.I.V. The centerpiece of the document was a sarcastic monologue that lashed out at racial stereotypes:

Yes, we are sex-crazy! Yes, we are diseased! Yes, we spread the deadly
H.I.V. virus through our uncontrolled heterosexual sex! In this regard, yes, we are different from the U.S. and Western Europe! Yes, we, the men, abuse woman and the girl-child with gay abandon! Yes, among us rape is endemic because of our culture! Yes, we do believe that sleeping with young virgins will cure us of AIDS! Yes, as a result of all this, we are threatened with destruction by the H.I.V./AIDS pandemic! Yes, what we need, and cannot afford because we are poor, are condoms and antiretroviral drugs! Help!

Achmat was given the paper before he boarded a flight for a meeting at the U.N. He was crushed. "On the record, you had, for the first time, an indication of the madness, the irrationality, the blindness, the willfulness, the vindictiveness of Mbeki on this question," he said. Several weeks after Achmat read the essay, he learned that Mokaba had died of AIDS.

Mbeki disassociated himself from AIDS skeptics like Rasnick, but, because he had not stopped sympathizing with their position, he never retracted his earlier remarks, leaving many South Africans confused about the science of AIDS. Although fifteen hundred South Africans were being infected each day, he failed to assume a central role in the government's AIDS-prevention campaign, and he devoted no public speeches to the disease. In his few public references to AIDS, he persisted in calling it a disease "of poverty and underdevelopment."

In January, 2003, Tshabalala-Msimang invited Roberto Giraldo, a scientist and AIDS skeptic, to South Africa to deliver a presentation. Even though Giraldo declared that "the transmission of AIDS from person to person is a myth," the health minister eagerly took up his recommendations on nutrition. She urged AIDS patients to take "garlic, lemon, olive oil, and African potatoes" to boost their immune systems. "These things are affordable for South Africans," she said, "not like things like antiretrovirals." Indeed, when the KwaZulu-Natal province secured seventy-two million dollars from the Global Fund to help pay for antiretroviral programs, Tshabalala-Msimang blocked disbursement of the money, claiming that the grant application had been improperly filed. Meanwhile, Botswana had already begun providing antiretrovirals free to the public.

Achmat was forced to accept that nothing had really changed. TAC's leadership decided that it was time to organize a country-wide campaign of civil disobedience. They intended the protests to be the biggest in South Africa since the days of apartheid. "The difficult decision for me was not to take off my suit and go to the streets to fight for treatment," Achmat said. "That was easy. The emotionally torturous thing for me to do was to recognize we had to take on the A.N.C. Our A.N.C."

On March 20th, Achmat squatted near the Cape Town Central Police Station with a hundred or so black South Africans. "We have bail money for everyone," he told the crowd. "Who wants to be arrested first?" Dozens of arms shot into the air. Those gathered ranged in age from fifteen to seventy-one. Few had ever been to jail before.

That morning Achmat had left a polite message on the voice mail of Jacob Zuma, Mbeki's deputy, who had negotiated with TAC in the past. "If you call us back, we'll meet anytime, so we can sort out what can be sorted out," he had said. "Call anytime!"

At one o'clock, Achmat and his colleagues stood up. They walked with their arms linked to the police station, a couple of blocks away, carrying TAC's "Wanted" posters, the hallmark of the civil-disobedience campaign that was being launched that day. TAC protesters flooded the police station, catching a half-dozen officers off guard. Achmat asked to see the station commander. "We'd like you to arrest the minister of health and the minister of trade and industry," he said to the guard who greeted him. "We are staying right here. You either have to arrest the minister of health and the minister of trade and industry or you must arrest us."

Arrest us or them," Nyameka Ndashe, the young woman from Mitchell's Plain township, shouted. "They are killers!" She told me, "I can't take it that my mother must die because of H.I.V. that can be treated."

Achmat had just recovered from bronchitis, and he looked worn out. His CD4 count, a conventional measure of a person's immune system, was hovering around two hundred; AIDS patients in the United States are typically urged to begin taking antiretrovirals at three hundred and fifty. I asked Ndashe if Achmat should abandon his pledge and take his medicines. "He is our comrade," she said. "He will never take them until we get our treatment."

Achmat answered a ring on his cell phone, and gave the thumbs-up sign: two hundred TAC protesters had occupied a police station outside Johannesburg. The goal was to have six hundred volunteers arrested, in tribute to the six hundred South Africans who died of AIDS each day. The TAC protesters, most of whom had H.I.V., began dancing and stomping in unison. The few on antiretrovirals shook their green pill containers like tambourines. "In the parliament they are shivering," they sang in Xhosa. "Don't be scared, comrades!" Achmat disappeared with two TAC associates into a back room for negotiations with the police. An hour or so passed, and the crowd began to chant, "Bring out Zackie, we want Zackie!"

Achmat emerged from the rear of the station and announced, "The police have opened up a docket against the minister of health for culpable homicide." The protesters burst into song once more, and Achmat offered a dance of his own. Ndashe grimaced, watching him. "Zackie has many things," she told me, "but he has no rhythm. None!"

The protesters were then formally charged with unlawful entry. They filed into a booking area, where they proudly stated their names. Many were disappointed to learn that the police didn't have enough cells to hold them overnight. Achmat assured them, "You'll have plenty more chances to go to jail in the weeks ahead."

Just after the launch of the civil-disobedience campaign, six TAC volunteers died of AIDS, including several who had been involved in police-station takeovers. All were under forty. Achmat, who said that he had already lost about fifty friends to AIDS, wondered whether it was wrong to have waited four years before launching a campaign against the government. "Most of us who are A.N.C. members have put our party loyalty before people's lives," Achmat said bitterly.

In late March, at a health conference in Cape Town, Achmat's rage erupted in public for the first time. When Tshabalala-Msimang, the health minister, stepped up to the podium to speak, dozens of TAC protesters began shouting, "You're a disgrace!" When Achmat and a TAC colleague began reading a prepared statement, the minister left the podium and sidled up to Achmat in front of TV cameras.

"I'll stand next to you," Tshabalala-Msimang said.

"You should be in jail," he screamed.

"You're sweating, Zackie," she noted, seeming to mock his illness. "Shall I give you a tissue to wipe your sweat?"

"Does somebody decent have a tissue?" he asked, incensed. Achmat's hand shook wildly as he tried to continue reading the statement. "You never visited the pilot program in Khayelitsha," he said.

"Wipe your sweat," the minister commanded.

"Take your wig off!" Achmat replied.

The South African newspapers covered the incident on their front pages. Achmat was mortified that he had lost his temper. He was embarrassed further when, a few days later, the nurse at Khayelitsha asked him about the outburst. Yet he concluded that the AIDS crisis demanded an end to politeness. "I've never been afraid of making people uncomfortable," he told me. "I also know that the only reason you make people feel uncomfortable is when it's absolutely necessary."

After a month of protests, Jacob Zuma agreed to hold a meeting in late May with TAC leaders, who in turn agreed to suspend civil disobedience. In addition, the government announced that an extra four hundred million dollars would be budgeted for "appropriate medical treatment." All that was left was for the Cabinet to deem antiretrovirals "appropriate" and announce a national treatment program. If it didn't, TAC promised, civil disobedience would begin again.

The government's actions were encouraging, but Mbeki remained aloof. Indeed, people who had spoken with the President about AIDS did not believe that he would change his views. A prominent Cabinet member, who refused to be named, related a conversation that he once had with the President.

"I've been to so many AIDS funerals," the minister said. "I attend more every month."

The President was irritated by the comment. "What makes you so sure they died of AIDS?"

The official explained that young men in their twenties and thirties don't just die of pneumonia.

"Yes," Mbeki said, "but you don't really know how they died, do you?"

A few days after his arrest in Cape Town, Achmat wondered whether TAC's activism had made Mbeki more stubborn. "If we didn't act, would he have caved in and let people live?" he asked. "I doubt it. It's not the way he's approached this thing." He paused. "If we had remained quiet, the H.I.V. dissidents would have had a much stronger position. What would have happened is it would have looked like American white doctors telling the government what to do with its people, and Mbeki's cranky ideas -- which he still holds -- would have been the dominant position in the government. And that would have been a tragedy for the country."

Achmat said that his drug strike had damaged his immune system, which was now "seriously messed up." He was constantly exhausted and, despite being coddled by fellow TAC volunteers and friends, had been plagued all year by a recurrent lung infection. "My health is very consistent," he quipped. "It is going steadily downward."

Achmat had always rejected pleas that he resume taking medicine, citing the government's refusal to announce a treatment plan. He even resisted requests from Mandela. However, in March, when I asked what would persuade him to relent, I was startled by his response. "I'm seriously considering taking my medicines," he said. "There's a strong possibility, indeed a probability, that I'll take them, because the situation is so close to changing."

Achmat hadn't yet made public his readiness to take antiretrovirals, and he said he was afraid that he might still change his mind. He also worried that if he took medicine and then died -- antiretrovirals didn't save everyone -- his death would be exploited by AIDS skeptics. But, for the moment, he was prepared to retreat from his pledge, even if it earned him public scorn. Unlike Mbeki, he was not too proud to moderate his position. "I never took my stand in order to score a point," he said. "I did it as part of a campaign, and it served its purpose."

Achmat pointed to some of the positive developments that had occurred in the years since he began his drug strike. "So much has changed," he said. "There's a critical mass of people living openly with H.I.V. Drug prices have come way down. And now there's money allocated by the Treasury." Achmat knew that this sounded like a rationalization. Until the government officially reversed its policies, four hundred thousand South Africans who needed antiretrovirals wouldn't get them.

It seemed that what Achmat was really trying to say was that if he remained committed to his stand he would do more harm than good to his comrades -- who needed him alive and healthy in the struggle. "I don't want to kill myself for Thabo," he said, laughing. "I want to make sure that people get medicines."

Edwin Cameron was relieved when he was told about Achmat's change of heart. "We already have two hundred and fifty thousand deaths a year," he said. "We don't need another. And we certainly don't need to lose the most visionary voice in the movement."

Samantha Power is a Lecturer in Public Policy at Harvard University. She was the founding executive director of the Carr Center for Human Rights Policy at Harvard, and the Pulitzer prize-winning author of "A Problem from Hell: America and the Age of Genocide" (Basic Books, 2002).