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Schindler, Paul (2003) Bringing a Global Message to NYC: South African AIDS activists share their experience and hope. Centre for Civil Society : -.

Zackie Achmat, a South African who is a leading proponent of an international solution to the AIDS crisis, was in New York this week, just as his government at long last delivered on the demands that he and other activists have pushed for years that it develop a comprehensive treatment plan for its 4.5 million citizens living with HIV.

Yet, even as he and his colleague Nonkosi Khumalo recounted the success
of their activism and the example they hope South Africa will set for
the rest of the world, Achmat was blistering in his critique of the
failure of world leaders to confront the scourge of HIV. At the top of
his list was the American president.

"The greatest threat to public health in the world is George Bush
staying in power," he said, in a presentation at Columbia University's
School of Public Health on November 10. "George Bush is one of the prime
evils we face in relation to effective prevention and treatment worldwide."

Achmat's willingness to take on the U.S. president at one of America's
leading universities is not out of character for him; he has been
causing trouble for well over half of his 41 years. An HIV-positive gay
man born in a poor South African Muslim family, he joined the once
outlawed African National Congress (ANC) as a youth to fight for the end
of apartheid. At 14, when he had already lived on the street as a sex
worker to earn money for his education, he was arrested after a
partially successful effort to burn his school down to protest the
government's racist policies.

Between 1977 and 1981, he was jailed five times--in several cases under
"preventive detention" provisions of the law--and spent a total of about
two and a half years incarcerated. In 1981, he began a nine-year stint
living "underground"--away from the watchful eye of a crumbling regime,
but free to work as an organizer among trade unions and students.

The 1990s saw the realization of Achmat's dreams--and those of millions
of other non-white South Africans. Freed from years of imprisonment, the
ANC's leader Nelson Mandela rose to the presidency of post-apartheid
South Africa. Yet during the same years that saw the flowering of
democracy and the world's first constitution that guaranteed the
equality of gay men and lesbians, the full extent of the AIDS crisis in
South Africa became clear. Today, the nation has more cases of HIV than
any other in the world.

"It was a cruel irony that at the moment we won our political freedom,
we faced the HIV epidemic in which our sexual freedom and our right to
life was taken away," he told the audience at Columbia.

Achmat's gay and AIDS activism in time put him at odds with President
Thabo Mbeki, Mandela's ANC successor, who for several years openly
espoused the view held by a small band of dissident scientists that HIV
infection does not cause AIDS. Achmat helped found and still leads the
Treatment Action Campaign (TAC) to press the South African government,
in spite of Mbeki's denialism, to respond realistically to a crisis
which causes 600 deaths and 1,500 new infections every day. Another key
aim of TAC's work has been to overturn the resistance of pharmaceutical
giants and Western governments to the generic production of HIV
treatments still under patent protection.

"Intellectual property rights are at the cutting edge of public health
activism," he said at Columbia, in a statement which puts him squarely
at odds with the influential U.S. pharmaceutical lobby. Activism like
TAC's, supported internationally by groups like Health Gap and ACT UP,
are credited with loosening opposition within the Clinton administration
to generic drug production. Achmat's twice-a-day combination therapy
costs his insurance company $40 per month, as opposed to a price tag of
more than $650 prior to TAC's efforts. A drug purchase agreement
recently negotiated by the William Jefferson Clinton Foundation will
allow public health facilities in South Africa access to the same
treatment for $18 per month.

"People tend to get better when they leave office," Achmat said about
the former president's current efforts on AIDS.

In 1999, he began the world's first known drug strike, refusing any HIV
treatments until the South African government developed a comprehensive
plan for universal access. Achmat stuck with his strike despite
illnesses and a public plea last year from Mandela. But, this week, the
South African government, after years of international pressure and
civil disobedience by TAC members, announced its first formal treatment
program, which by next year will put funding at a level of $150 million.
The commitment, Achmat said, is significant, and will allow drug access
and treatment education founded in sound principles of public health to
be rolled out. Anticipating that the government's agreement was
forthcoming, and "unwilling to die for Mbeki," Achmat began drug
treatment himself ten weeks ago.

Achmat and Khumalo were in New York for a whirlwind series of meetings
that included visits to Gay Men's Health Crisis, the world's oldest and
largest AIDS services agency that has become increasingly active in
recent years in the global AIDS movement, to Doctors Without
Borders/Médecin Sans Frontières (MSF), which worked with TAC to develop
a pioneering initiative in community-based treatment efforts in
Khayelitsha, South Africa, and to a fundraiser at the home of Dr.
Mathilde Krim, the chair of the American Foundation For AIDS Research

The harsh verdict Achmat delivered about Bush this week reflects his
disillusionment with the president's plan, announced with great fanfare
in his January State of the Union Address, to provide $15 billion over
five years to fight AIDS in 14 African and Caribbean nations.

"I was enormously hopeful when a president regarded as mean and stingy
and conservative showed interest in this global problem," Achmat said in
an interview at MSF's New York office on November 12. "But we have not
seen a cent."

Achmat faults the president's plan on three counts--first, its emphasis
on abstinence-only education; second, its small contribution to the
Global Fund to fight AIDS, Tuberculosis and Malaria established by the
United Nations; and third, the lack of follow through by Bush on
actually appropriating the money.

As the Bush plan has been fleshed out in Congressional negotiations, at
least one third of the money will be reserved for abstinence-only
prevention programs, and the president aims to devote only $200 million
each year to the U.N. Global Fund, compared to the $2.5 billion that
Secretary General Kofi A. Annan has requested. As Capitol Hill
negotiators became increasingly alarmed by the gaping growth in the
federal deficit, the president has let it be known that he favors
reducing the first year installment on his plan from $3 billion to $2

Achmat charged that Bush's unwillingness to participate in the Global
Fund reflects his disdain for multilateral solutions reflected in his
foreign policy generally. Indeed, in September, U.N. AIDS released the
first comprehensive survey of global efforts to address the HIV
epidemic. More than 100 nations participated, but the U.S. did not.

Achmat reserved particular scorn, however, for the president's emphasis
on abstinence-only prevention efforts.

"For a South African youth with no job, no fees to go to school, no
access to a public swimming pool, abstinence is a joke," he said. "For a
young girl, a pair of earrings can be traded for sex, or sex can be
traded for the fees to go to school."

He added that campaigns based on the message "Be Faithful" targeting
African women put them at risk because the migratory pattern of work in
which so many men are engaged leads to informal policies of polygamy, in
which men have both a "town partner" and a rural wife, or engage in sex
with prostitutes.

"'Be faithful' is a disaster," Achmat said at Columbia. "'Be faithful'
kills. The most at-risk people in South Africa are faithful wives. We
have to say, 'Be faithful with a condom.'"

Achmat also addressed the issue of educating gay men, in South Africa
and in the U.S., and in doing so betrayed his willingness the flout
politically correct conventions to get his message across. He seemed
particularly delighted to do so in front a crowd as distinguished as the
senior faculty at Columbia's public health school.

"We all know that we gay men are very promiscuous," he said. "If you
insist on saying that reducing partners will reduce infection without
teaching the science, it is only a moral judgment."

Like U.S. AIDS activists of a decade ago, Achmat enjoys his ability to
shock an audience, but also understands that he can use that skill to
educate. When asked in an interview about his life as a Muslim in South
African society, as a freedom fighter, and as an advocate for universal
health care, he quickly added, "And as a fag."

When Achmat met in Washington with Ambassador Randall Tobias, the U.S.
State Department's Global AIDS Coordinator, he was wearing a TAC T-shirt
that read "HIV Stigma." Apparently eager to make his South African guest
feel comfortable, Tobias said he had never seen the slogan before, and
wanted one of the T-shirts. Achmat responded, "We'll give you one that
reads 'Drug Companies Have Blood on Their Hands,'" and then added that
he was taking generic Prozac.

Achmat's U.S. visit affords him another chance to spar with the Bush
administration, this time publicly. On Sunday, November 16, he is set to
appear on a panel in San Francisco sponsored by the American Public
Health Association that will also include Health and Human Services
Secretary Tommy Thompson. When a Columbia professor in the audience
suggested that he give the same speech in San Francisco that he gave on
Monday, Achmat said, "I am looking forward to meeting Tommy Thompson. I
will ask him to go to the demo at the White House," planned by AIDS
activists for November 24, one week in advance of World AIDS Day.

Asked when he next expected to visit the U.S., Achmat said he hoped to
return next October "to stump in swing states for whoever is running
against Bush."

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