Pronunciation: (ZACK-ee AHK-mut)

Biography from Current Biography International Yearbook (2003) Copyright (c) by The H. W. Wilson Company. All rights reserved.

As the leader of South Africa's Treatment Action Campaign (TAC), an organization dedicated to complete and no-cost treatment for HIV-infected South Africans, Zackie Achmat has struggled to bring hope to his AIDS-ravaged country. (Currently, approximately 11 percent of South Africa's 46 million residents are HIV-positive.) When TAC began in the late 1990s, treatment of AIDS and HIV required drugs that were too expensive to be widely distributed among South Africa's HIV-positive residents. After Achmat and the TAC succeeded in their goal of gaining access to cheaper drugs, they faced another obstacle: the South African government, officially skeptical of the relationship between HIV and AIDS as well as the effectiveness of drug treatments. Adurrazack Achmat, known as Zackie, was born on March 21, 1962 in Johannesburg, South Africa. Perhaps because of South Africa's sensitive racial climate, many reporters have incorrectly pinpointed Achmat's background. According to Nicol Degli Innocenti and David Pilling, writing for the Financial Times (April 21, 2001), and Samantha Power, in her extensive profile of him for the New Yorker (May 19, 2003), Achmat is of Malaysian descent. When Matt Steinglass wrote for the Boston Globe (December 8, 2002) that Achmat was Indian, a correction followed a week later, declaring him "colored, not Indian." According to Rory Carroll of the Guardian (December 10, 2002), Achmat is "the son of conservative Muslims" and is "of mixed descent." Mark Schoofs wrote for the Village Voice (December 28, 1999) that "although [Achmat's] ancestry is mixed-race, he called himself black, a tactic of solidarity." One of six children of a communist, furniture maker-father, Achmat was raised by his mother and his aunt, both of whom were garment-industry union representatives, in Cape Town, South Africa. "There were times when I was a kid when we went to bed without food but my aunt and mother never begged: it was critical to our sense of dignity," he told Innocenti and Pilling. One aspect of Achmat's childhood that drew him to activist causes was his interaction with his grandmother, who favored the lighter-skinned siblings in his family to the darker ones. When he was 14 Achmat convinced several of his older classmates to help burn down their high school, Salt River High, during the 1976 Soweto uprising against apartheid education. (Apartheid was the system of government-sanctioned discrimination against blacks.) Soon after, he was arrested for organizing a demonstration that coincided with a visit by the U.S. secretary of state, Henry Kissinger, to South Africa's prime minister, John Vorster. "I had been grabbed and beaten up by the cops before, but that was the first time I was properly arrested and beaten," he told Anso Thom for the Health-e Online Health News Service (October 27, 2000). "It was horrible, but . . . I learnt a lot about politics and law. That's where I learnt that one can use law to defend people even in the worst circumstances possible." Achmat never graduated from high school--he spent much of the late 1970s in prison for his political activities. In the 1980s he worked as an African National Congress (ANC) activist but often clashed with the organization's hierarchy. (The ANC, led by Nelson Mandela, was devoted to ending South Africa's widespread apartheid.) Within the ANC Achmat worked on education initiatives and publicity campaigns--one event he organized was the first mass ANC funeral, a politically charged eulogy for those who died as a result of the violence between the ANC and the reigning government. In 1990, many years after he had supported himself as a male prostitute, Achmat was diagnosed with HIV. "The doctor said I had six months to live," he told Rory Carroll. "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." (He did not announce his diagnosis to the public until 1998.) "When I looked around after six months and noticed I was still alive," he recalled to Samantha Power, "I concluded it might be time to leave the house." Achmat earned a bachelor's degree in English in about 1993 from the University of the Western Cape, in Bellville; the school administration made a special exception and allowed him to enroll without a high school diploma. In the mid-1990s he worked for the legal team that defended the ANC in the aftermath of the March 1994 "Shell House shootings," during which more than a dozen people were killed and hundreds injured in a clash between the ANC and Zulu dissidents. Achmat served briefly as the director of the AIDS Law Project in 1994, but left later that year to found the National Coalition for Gay and Lesbian Equality. (He is openly gay.) The organization led the effort to include a clause in the 1996 South African constitution forbidding discrimination on the basis of sexual orientation. Following the adoption of such a statement, the coalition fought to overturn anti-gay legislation passed during South Africa's era of apartheid. Through the efforts of Achmat and the National Coalition for Gay and Lesbian Equality, a sodomy law was declared illegal and same-sex partners were granted financial and legal status equal to those of married couples. During this time, Achmat was a supporter of the political ambitions of Thabo Mbeki, who succeeded Nelson Mandela as the ANC's leader in late 1997 and as South Africa's president in 1999. In 1998 Achmat fell ill with candidiasis, often called thrush, a condition frequently associated with the third stage of HIV infection, when the body can no longer fight off minor contagions. (Although the definition of AIDS has changed since its discovery, it is now widely classified as the fourth stage of HIV, when the patient's immune system weakens beneath a certain threshold.) While he was being treated for thrush, Achmat refused to take anti-retroviral medications, which prevent more serious future outbreaks in an HIV-infected individual, because their high cost--around $500 per month--put them out of reach for most HIV-positive South Africans. Anti-retrovirals have measurably decreased AIDS deaths among populations in countries that have health care systems with enough money to provide drug treatment to HIV-infected residents, but South Africa's government was unable to afford the medications. Nor, it seemed, was the ANC hierarchy in the South African government willing to push for more affordable methods. A program in South African hospitals that freely gave HIV-positive pregnant women AZT to combat passing HIV to their newborns was discontinued in late 1998. Achmat and others, angered by the program's suspension, formed the TAC to push for wider drug availability for HIV-positive South Africans. Achmat, who had already gained a reputation as a loyal but unruly ANC member, met with the government's health minister, Nkosazana Zuma, in May 1999; afterwards, Zuma announced her intention to reinstate the policy of allowing all HIV-positive pregnant women access to preventive drugs. She had previously encouraged passage of the 1997 Medicines Act, which allowed the government to bypass pharmaceutical patents to manufacture or import cheaper but nearly identical versions of AIDS drugs. In response to the 1997 legislation, the 39 major pharmaceutical companies that comprised the Pharmaceutical Manufacturers Association initiated a lawsuit against the South African government. The companies argued that the patents were in place to raise money for research and development of new treatments. In September 1999 the United States government--specifically Vice President Al Gore--threatened South Africa with sanctions for the importation of generic drugs. After the TAC rallied international pressure against the U.S. stance on the issue, Gore withdrew the threat. But just as that hurdle had been overcome, President Thabo Mbeki announced in October 1999 that AIDS drugs were ineffective and dangerous. (Mbeki shared a widely-held view among many South Africans, and at one time by Achmat himself, that the AIDS virus had been exaggerated by profit-seeking drug companies capitalizing on the racial stereotype that Africans were prone to disease. Mbeki's belief was that poverty was the primary scourge.) Many people--government officials, health care workers, and private citizens--were stunned by Mbeki's pronouncement; speculations arose that his motivation to suppress the demand for AIDS drugs was economic, or that his source was the Internet or unreliable research. To the consternation of many AIDS activists, Mbeki's new health minister--Zuma had been transferred to the Foreign Affairs ministry in June 1999--supported his claims. Despite Mbeki's announcement, the TAC continued their lobbying efforts for cheaper drugs. In March 2000 TAC's efforts turned specifically to the drug company Pfizer, which held the patent on the drug Fluconazole, an effective treatment for thrush and cryptococcal meningitis, another common infection among HIV-infected patients. TAC demanded that Pfizer choose one of two options: either reduce the price of Fluconazole's 200-milligram pill from its high price--capsules were sold at $12 each to private practices and $7.50 each to public hospitals--to 50 cents, or give the South African government the legal ability to import generic drugs of the same design. Instead, Pfizer offered to donate another drug, Difulcan, which treated only cryptococcal meningitis, to all HIV-infected people in South Africa for two years, after which the patent would expire. TAC representatives requested that Pfizer include treatments for thrush as well, and to extend the offer to other poor countries. Several months later, no part of Pfizer's donation had arrived in South Africa. "Our patience had run out," Achmat later explained to the Multinational Monitor (January 1, 2001). "The government had not responded to a TAC request to issue a compulsory license against the company and Pfizer announced record profits. In the interim, thousands of people continued to die of systemic thrush and cryptococcal meningitis." In October 2000 Achmat visited Thailand, where he purchased 5,000 capsules of Biozole, a generic version of Fluconazole, for $1,250--25 cents per pill. He publicized the trip as part of a larger defiance campaign against unjust trade laws. "The choice is clear," Achmat said upon his return from Thailand, as quoted by a reporter from the South African Press Association (October 17, 2000). "The rights to life and access to health care are non-negotiable. Profiteering, at the expense of life, even when protected by law, is not a right." The TAC supplied evidence of Biozole's safety and planned to distribute it through an organized network of doctors and pharmacists. The South African government's approval organization, the Medicines Control Council (MCC), charged Achmat and TAC with illegally smuggling the drug into the country. Achmat handed himself in to the local police, but he was never arrested for the crime: after many doctors supported TAC's actions and announced their willingness to distribute the drug, the MCC announced that they were granting TAC an exemption from a drug trafficking law for importing Biozole. After achieving the legal means to import generic versions of Pfizer's Fluconazole, TAC announced their intention to challenge other costly patents. After three years of delays, the Pharmaceutical Manufacturers Association's lawsuit against the 1997 Medicines Act began in April 2001; TAC representatives, including Achmat, attended the court proceedings in Pretoria, South Africa. For the pharmaceutical companies, the suit was a public relations disaster. The judge for the case allowed TAC to submit a statement as a "friend of the court," according to Chris McGreal for the Manchester Guardian Weekly (May 2, 2001). When the drug companies asked to respond to the statement, the judge ordered them to respond to every point presented by the TAC; any allegation they failed to address would be taken as an admission of its accuracy. TAC's submission disputed the drug companies' charge that money from inflated drug prices was used toward research, arguing that other organizations, such as universities or the U.S. National Institutes of Health, had paid the costs of the development of all five of the leading HIV treatments. TAC also argued that the companies were guilty of price-fixing, and that South Africa's attempt to provide universal health care--as promised in the 1996 constitution--held greater legal weight than patents. Less than a month after the lawsuit began, all 39 pharmaceutical companies withdrew their claims. After the proceedings, Achmat stated, as quoted by McGreal, "The government told the court under oath that anti-retrovirals are effective against Aids. The difficult job starts now, to ensure our government mobilises the resources it has to implement an appropriate treatment plan for Aids." With the court case pending, TAC mounted a publicity campaign, replete with marches, rallies, and conferences, aimed at achieving a government-sponsored treatment plan that included anti-retroviral medications. One of TAC's primary objectives was to encourage the government to distribute Nevirapine, a new drug that helped prevent transmission of HIV from pregnant women to their babies. Despite winning the Medicines Act case, Mbeki's government failed to establish a national treatment plan, and TAC continued its campaign for universal coverage. Based on a December 2001 court ruling, the Mbeki government was obliged to begin a widespread program of HIV drug distribution; the administration, however, appealed the decision and initiated a much smaller treatment program. In February 2002 TAC participated in a large protest that demanded HIV/AIDS treatment for all infected people, as well as a basic income grant for all citizens, regardless of their HIV status. Several months later a South African court ruled that the state must provide Nevirapine to all women who need it. (Achmat had argued at the trial that HIV/AIDS treatment actually lessened the costs to the government, since fewer deaths and hospital trips would reduce the amount of money spent in the health sector.) Achmat was too sick to travel to the 14th International AIDS conference, held in Barcelona, Spain, in July 2002. He was hospitalized with bronchitis, but many South Africans feared for his life. Achmat's illness--originally rumored to be tuberculosis--cast a shadow over Thabo Mbeki's inaugural African Union (AU) summit. (The African Union, a grouping of African states based in part on the European Union and aiming to provide economic progress and democratic rule to the continent, replaced the Organization of African Unity, which had largely supported dictators.) Instead of appearing in person, Achmat sent a videotaped speech to the AIDS conference, in which he called on large drug companies to license their products to other companies at a 3-4 percent royalty. When Achmat was hospitalized in July 2002, former South African president Nelson Mandela visited and announced that he would join TAC's lobbying effort for a comprehensive AIDS treatment plan, calling Achmat a national hero. "He is a role model and his action is based on a fundamental principle which we all admire," Mandela explained, as quoted by the Agence France Presse (July 27, 2002). "What I've come here to do is to find out under what conditions he will then be able to take treatment." But instead of Mandela persuading Mbeki to change his view on AIDS treatments, most analysts found that the ANC had split into two camps, one advocating Mandela's views on AIDS and the other supporting those of Mbeki. Mbeki seemed to remain unconvinced of the AIDS crisis, noting in his February 2003 state of the nation speech that tuberculosis was the leading cause of death in South Africa. But he failed to link tuberculosis to AIDS patients, who are at a higher risk for contraction and death from the disease. Mbeki shied away from speaking publicly on the AIDS crisis in the months after his state of the nation speech. Mbeki's health minister, Manto Tshabalala-Msimang, blocked a $72 million grant from the Global Fund aimed at helping to pay for anti-retroviral programs. In response, in March 2003 TAC organized massive demonstrations demanding the implementation of an anti-retroviral treatment program and calling for the arrest of Tshabalala-Msimang and Industry Minister Alec Erwin on the charge of culpable homicide. "The difficult decision for me was not to take off my suit and go to the streets to fight for treatment," Achmat told Samantha Power. "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." TAC protesters occupied a police station near Johannesburg, an act that caused the arrest of more protestors than there were available jail cells. The demonstrations received worldwide news coverage, and TIME Europe announced it was going to list Achmat as one of the world's "heroes" in the April 28, 2003 issue of the magazine. Such publicity caused significant embarrassment for the Mbeki administration, and on May 17 the government convinced TAC to suspend the civil disobedience program by announcing that an additional $400 million would be allocated toward distributing medical treatments for HIV/AIDS victims. During Achmat's "drug strike" many of his relatives, colleagues and friends implored Achmat to take medicines, but he remained unwilling to do so until his demand of AIDS treatment for all South Africans was met. "I don't want to live in a world where people die every day simply because they are poor," he told Nicol Innocenti and David Pilling. But when one South African newspaper called his refusal heroic, according to Matt Steinglass, Achmat responded, "I don't think it's noble, I think it's dumb. But it's a conscience issue." Achmat had earlier stated that he did not want to die, but rather wanted to resurrect morality in South African politics: "The political scenario in South Africa has lost its moral content," he told Nawaal Deane for the Johannesburg Mail and Guardian (July 12, 2002). "The poorest of the poor are dying, only the rich have access to treatment. My fight is essentially about this. If we don't have morals in our politics, then South Africa is doomed." In December 2002 doctors gave Achmat a 50-50 chance of surviving another year without taking anti-retrovirals. Despite his insistence on remaining true to his pledge, by the spring of 2003 he told Samantha Power that the situation in South Africa had changed significantly enough that "there's a strong possibility, indeed a probability, that I'll take [anti-retrovirals]." Achmat had begun his strike when he felt pharmaceutical companies to be responsible for the unavailability of affordable drug distribution, but he told Power that the struggle seemed to have become solely a battle with Mbeki. "I don't want to kill myself for Thabo. I want to make sure that people get medicines." In the months following the TAC's first wave of civil disobedience, Mbeki's cabinet failed to produce a comprehensive HIV/AIDS drug treatment plan, and during the four-day South African AIDS Conference 2003 in August, TAC once again organized demonstrations demanding a pledge from the government to treat HIV/AIDS patients. At that same conference, TAC leadership urged Achmat to begin taking anti-retrovirals. On August 4 Achmat announced that he intended to begin treatment. "I am not going to die because [Thabo Mbeki and other government officials] want us to die," he told a crowd at the AIDS conference, according to Elliott Sylvester of the Associated Press (August 4, 2003). (Achmat first began taking anti-retrovirals on September 4.) Four days later, Mbeki's cabinet instructed the health ministry to develop a plan for distributing anti-retrovirals by the end of September. "We think it is the best news in many years," Achmat told the press, as reported by Dina Kraft of the Associated Press (August 8, 2003). In November 2003 the government unveiled their new plan: through a vastly increased AIDS budget, thousands of health professionals would be trained to work in health centers established in all 250 South African municipalities, at which free anti-retrovirals would be distributed to millions of HIV-infected citizens. Achmat lives in Muizenberg, South Africa, near Cape Town. In 2002 he was awarded an honorary master's degree in social science by the University of Cape Town, for his "astounding ability to produce high quality detailed research" and his "exceptional" political skills, according to Tamar Kahn for Johannesburg's Business Day (July 10, 2002). In April 2002 Achmat was awarded the Homo Homini prize by the organization People in Need; the prize is granted annually "to an individual who has made a significant personal contribution to the protection of human rights and the promotion of democracy through non-violent means," according to the organization's Web site. He was awarded an honorary Doctorate of Laws from the University of Natal in April 2003, and the following month received the 2003 Jonathan Mann Award for Health and Human Rights, an award administered by Doctors of the World, the Association Francois-Xavier Bagnoud, and the Global Health Council. In 2001 It's My Life, a documentary film about Achmat's struggles, was released and has since been shown at several film festivals. Achmat has also directed a film, Apostles of a Civilised Voice, the culmination of research he conducted while working toward a master's degree at the University of Western Cape in the early 1990s. A history of South African homosexuality, it was released in 1999 and has been screened on South African television stations and at gay-oriented film festivals. Aside from his ongoing struggles for social justice, Achmat hopes to also make more movies and to write a novel. --S.H. 

Suggested Reading: Boston Globe D p1 Dec. 8, 2002, with photo; Johannesburg Business Day July 10, 2002; Financial Times p9 Apr. 21, 2001; Guardian p22 Dec. 1, 2001, p8 Dec. 10, 2002; Health-e Online Health News Service Oct. 27, 2000, with photo; Johannesburg Mail & Guardian July 12, 2002; Manchester Guardian Weekly p24 May 2, 2001, with photo; Multinational Monitor p29 Jan. 1, 2001; New York Times A p20 Jan. 13, 2003; New Yorker p54 May 19, 2003, with photo

Profession: AIDS activists; Activists; Social reformers

Name Cross Reference: Achmat, Adurrazack