Short, stocky and filled with a defiant energy, Achmat, 40, is an old hand at fighting deadly foes. As a schoolboy in the 1970s in a segregated Cape Town township, he was caught up in the violent student campaign against apartheid. He helped to set fire to his own school and was arrested and detained five times. For 10 years he operated as an underground activist for the banned African National Congress, evading the secret police and organizing youth resistance groups.
The end of apartheid brought a fearsome new enemy. In 1990 Achmat, who was openly homosexual and active in the gay and lesbian movements, discovered he was HIV positive. "The disease was regarded as taboo," he recalls. "The cost of treatment, if you could find any, was way out of the reach of poor people. To have AIDS was a death sentence." Achmat began working with voluntary community organizations concerned with the growing AIDS crisis in their midst; in 1998, he co-founded the TAC. Its objectives: to ensure access to affordable treatment for people with HIV/AIDS, to prevent new HIV infections and to improve health-care access for all. Before long church groups, civic groups and high-profile individuals were backing the TAC, which has become the country's leading AIDS pressure group and, through Achmat, its most compelling voice for people with the disease.
The TAC fights two battles: against international drug companies that Achmat accuses of manipulating the markets and profiteering at the expense of HIV/AIDS sufferers, and against bureaucratic bungling and political obfuscation, which, he says, delay treatment while each day thousands of people die from the scourge. Achmat has scored some notable successes. In 2000 he went to Thailand and defiantly brought back a shipment of generic drugs for AIDS treatment enough for 700 sufferers that he had bought for a hundredth of the South African cost.
The following year lobbying by the TAC helped force 39 major pharmaceutical companies to withdraw their legal challenge against South African laws allowing the production and import of generic drugs for HIV/AIDS. In its battle against official neglect, the TAC has won an important court injunction ordering the government to ensure that HIV-positive pregnant women have access to affordable, if not free, antiretroviral treatment.
Achmat's energies are now focused on getting the government to finalize a long-delayed national treatment strategy. Time is running out. Without a campaign that makes treatment available to all, 5 to 6 million South Africans will die of AIDS by 2010.
The clock is also ticking for Achmat. In recent weeks he has lost 8 kg, and he's plagued by stomach cramps and diarrhea. He refuses to take antiretroviral drugs until everyone in South Africa has affordable access to them. "When the program of treatment is established and irreversible, then, and only then, I might go into some serious treatment of my own."
In July, Achmat got a visit from Nelson Mandela, who pleaded with him to take his antiretrovirals. Mandela came away describing Achmat as "a role model whose activism is based on principles that are admired way beyond South Africa's borders." But Achmat still won't take his medicine.