Zackie's story: The man who took on Mbeki - and won

South Africa's record in dealing with its Aids epidemic is arguably the worst in the world. But that's now changing, thanks to one dedicated campaigner. John Carlin reports from Cape Town

Zackie Achmat was raised in a conservative Muslim family but when he was 14 years old he left home, burnt down his school and, for a brief while, sold his body for sex. A homosexual, an atheist and a militant anti-apartheid campaigner whose political ideas were forged on an intense reading of Marx, Lenin and Trotsky, he was diagnosed with the Aids virus in his late twenties and founded his country's first gay and lesbian rights movement. His father went to his grave hating him; his mother never got over the shame.

But today, in the country worst hit by Aids, Zackie Achmat is a national hero. Nelson Mandela himself has described him as such. Because there is no individual in South Africa, or anywhere else, quite probably, who has dedicated more time and energy more selflessly to the war against Aids; who has sacrificed so much for so many.

Achmat, born in 1962, evokes similar admiration outside his country and is recognised by Aids campaigners everywhere as an emblem of the global fight against a disease that affects 39.5 million people, according to the latest UN figures - 4.3 million more than at the end of 2005. Achmat, who has been nominated for the Nobel Prize, recently addressed the World Bank in Washington, where he argued that combating Aids should be a priority not only for the countries worst-hit - or big countries at risk of a pandemic like China, India and Russia - but a shared global responsibility. The rich countries that have largely inured themselves against the worst effects of the virus must get stuck in too. They must provide political and economic support commensurate with the scale of the catastrophe, he said, because not to do so - in a world of ever more porous borders - will impact adversely on the wealth and security of all.

But Achmat, speaking to me in Cape Town, said that overall there was reason to be encouraged on this, the 18th International Aids Day. The benefits of science are finally being felt in Africa, where three-quarters of the disease's victims live. One million Africans have access to the antiretroviral treatment that has been standard for some time in the rich countries. This is well short of what is needed, but it is progress.

Achmat has spent eight years at the head of an organisation he founded called Treatment Action Campaign (TAC), whose mission has been to pressure his own government, the pharmaceutical industry and international opinion to make Aids treatment accessible to rich and poor alike. The TAC is to Aids what former president Mandela's African National Congress was to apartheid. And just as in Mandela's days of political struggle South Africa was the epitome of racial discrimination, today South Africa offers the most deplorable example in the world of how to respond to the epidemic.

Mandela famously declared once that he was prepared to give his life for his cause. Achmat came even closer than Mandela to doing so. He refused for years to take anti-retroviral medication that would save his life not because he could not afford it, but because the drugs were not available to the South African poor. Mandela personally appealed to him in 2002 to back down but it was only a year later, once the government of Thabo Mbeki relented on its bizarre stand against the anti-Aids treatment that Achmat, with full-blown Aids and on the verge of death, began to take the Lazarus pills.

He has since suffered a heart attack that also had him within an inch of his life yet when we met he radiated good health and the optimism of a man whose effort has been rewarded, who has won battles both against his own government and against the international pharmaceutical country, helping cut the price of Aids drugs in South Africa by a factor of 25 since he founded the TAC in 1998. That things appear to be changing, that the South African government is at last extricating its head from the sand, is down in enormous measure to the activism of Achmat, who spent much of his adolescence in jail (he spent nine months in solitary confinement when he was 15 after burning down his school as an act of political protest). Having spent the Eighties underground for the ANC, he has dedicated the last eight years of his life to fighting the ANC government's position on Aids. He is winning.

President Mbeki still appears to cling to the "denialist" belief that the Aids virus does not kill, that the antiretroviral drugs do more harm than good (when Achmat and millions like him the world over are living proof that he is wrong), and that beetroot and garlic are the best cure for the disease. Yet the political pressure at home and abroad, much of it originating from the TAC, has reached critical mass, obliging him and - more particularly - future presidential aspirants within Mbeki's own party to change tack, to fall into line with international orthodoxy on the subject. Achmat indicated that there were signs, in fact, of a quiet revolution under way in the Mbeki cabinet on Aids policy, with moves afoot dramatically to increase the availability of anti-retroviral treatment and for the government to abandon its confused and - in the view of many - criminally misleading rhetoric.

In short, while the number of people infected with the Aids virus is matched only by India, a country with 25 times the population, things have never looked so hopeful for the TAC cause. So brimming with energy was Achmat at his meeting with me (he wore, as he always does in public, a T-shirt with the words HIV-POSITIVE emblazoned across the chest) that he even managed to extract some consolation out of the abominable Aids record of South Africa, a country where 900 people die from the disease and 1,000 are infected every day; which accounts for 5.5 million HIV positive people , according to the UN; where Aids has so far taken a cumulative total of one and a half million human lives.

"The Aids casualty figures in South Africa alone are far greater than those of the Iraq war," said Achmat, who spoke for a full four hours on his subject - first over a low-cholesterol (for his heart) and alcohol-free (for his Aids) restaurant dinner, and then well into the night at his home - with ceaseless good humour, lucidity and passion.

"But we have done things so badly here, we are such a good example of how not to deal with the epidemic, that we offer a valuable lesson to the world, a lesson that all governments ought to study. The great lesson for how not to do things is here." Once that has been done, Achmat recommends studying Brazil, the developing country where the disease has been dealt with most admirably. South Africa and Brazil are similar in many ways: the two countries exhibit a vast inequality between rich and poor, they are similarly affluent and dynamic compared to their neighbours and, in the early Nineties, were at almost exactly the same level in terms of incidence of Aids. He produces a chart showing the incidence of death per every 100,000 women aged 15 to 64 in Brazil, and one for the same group in South Africa. The Brazilian curve is as one would expect it to be: slowly ascending then becoming steeper after the age group hits 50. The South African curve is as high at peak child-bearing age, 20 to 35, as it is at 60.

Overall, the number of men and women dying in the 30 to 34 age group in South Africa is higher than any other. "We've done everything wrong and Brazil has done everything right," said Achmat, "from setting a clear example at leadership level, to combining prevention with treatment, to investing the necessary money, to displaying, as a society, a healthy attitude towards sex. What I mean is that Brazil does not have an inferiority complex about the fact that its people are having lots of sex. Unlike South Africa, where there is also lots of sex going on, but you see this hypocrisy and denial right from the top."

He calls this attitude "public piety and private permissiveness", whereas in Brazil, he said, permissiveness is both private and public. The risk of Aids is greater, he believes, in those countries where there is sexual licence, but no sexual freedom; where it is taboo to talk about sex, but women are treated abominably.

Achmat, whose militancy has in the past put him in danger of retribution from Muslim radicals, is appalled by what he considers to be the dangerous illogic of religions incapable of addressing themselves honestly to the question of sex. "The problem is mistaking morality for sex; in raising sex to the level of greatest immorality. This means we have ceded morality - which I understand to be about avoiding harm to others, loving your neighbour and so on - to political bigots who misuse religion so that sex becomes taboo, therefore precluding us from addressing ourselves - rationally, openly, practically - to the problems that sex brings us.

"We are battling every day for the Enlightenment again. The Enlightenment means democracy, reason, science, equality, respect for the individual. Every day we fight again that battle, as if it were something new."

For Achmat the great champion of the modern-day Enlightenment has been Nelson Mandela. "There is leadership for you. No other South African political figure has spoken out more openly and wisely on Aids. Back in 2003 he appeared on stage at a TAC rally wearing one of these 'HIV Positive' T-shirts. Do you know what that means coming from a man who was raised in the twenties and thirties in a traditional, rural, aristocratic home, who was away 27 years in prison, and who in many ways behaves like a 19th-century Victorian gentleman? And then his son dies of Aids and he goes and gives a press conference announcing the fact to the world, in order precisely to fight the taboo about sex and about Aids. And yet from our present leadership here in South Africa, while nearly a thousand die a day, nothing."

And yet, things are changing in South Africa. "There has been a sea change and the next ANC president will have no choice but to make Aids a high priority."

Far more money is also being dedicated to combating Aids. Yet it is not enough, said Achmat, who considers "obscene, phenomenally obscene" the disproportion between global spending on the so-called war on terror and funding for the far more clear and present danger represented by Aids and diseases that scythe down the poor like malaria and tuberculosis.

Achmat ends our four-hour encounter on a hopeful note, however, as befits a time when he appears to be on the threshold of a famous victory, of helping reverse the policies that have made South Africa such an Aids basket case, such a shameful example to the world. "I believe that the campaigning movement built up around Aids not only here but in the rest of Africa has created a degree of common purpose the likes of which we did not see even 50 years ago during the African independence movements. Out of the ashes of Aids we can, I believe, build stronger societies - as happened in Europe after the Second World War."

Continuing the analogy, Achmat makes the point that he made before the World Bank and is sure to continue to make with ever greater vigour in the coming years: that what is needed now in Aids-stricken Africa is the equivalent of the Marshall Plan. "We have the basic tools to get a Marshall Plan going in Africa. We have the people with us, Now what we need is the leadership and the resources."

By which he means, that rich countries must spend more money, that special taxes must be levied on the rich and the middle classes, that big companies must pay up, that scientists must work together and not in competition - as is the case now - to find an Aids vaccine, and that governments should give them incentives to do so.

Achmat argues that for the rich countries to pay now would represent a saving in the middle and long term. At a time when the problems of mass migration from poor countries to rich generate so many problems, for the rich countries to join actively in the war against Aids is a matter of urgent self-interest. The great injustice - one of the world's most grotesque injustices - is that a disease which is now merely chronic, and in large measure symptom-free, in Europe and the United States, continues to be mortal in Africa.

Progress has been made. But Achmat knows that victory remains distant, that the war will be long, that great perils lie in store and more dragons must be slain. But he himself has already risen from the ashes. Having scored triumphs in the toughest Aids battlefield of them all - South Africa - his atheist's faith tells him that, for all the suffering, it can be done.