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COPYRIGHT 2003 All rights reserved. Reproduced by permission of The Condé Nast Publications Inc.
Khayelitsha is a sprawling, ramshackle township on the outskirts of Cape Town, South Africa. Most of the settlement's residents live in huts that have been constructed with corrugated tin and insulated with cardboard, plastic tarps, and sheet metal. More than five hundred thousand people live in the township; half are unemployed, and the average monthly wage is less than a hundred dollars. The dominant language is Xhosa. Although Khayeli-tsha resembles a squatter's retreat, it was in fact designed by the apartheid government. In 1983, the white regime decided to purge blacks from settlements close to the heart of Cape Town. The authorities dumped the evicted residents in Khayelitsha, which means "Our New Home."Houses were laid out in a grid pattern to help the police control disgruntled inhabitants. Since then, many families have established roots in Khayelitsha, but the crowded, unsanitary neighborhoods have also become home to viruses and germs. Khayelitsha has long had one of the highest tuberculosis rates in the world, and in recent years it has been decimated by aids. About fifty thousand people are infected with H.I.V.
On a warm March morning, a man named Zackie Achmat walked through Khayelitsha's dusty streets. He wore a white sweatshirt bearing a large message in garish purple letters: "h.i.v. positive."It was a typically audacious gesture by Achmat, a former male prostitute who has become South Africa's most prominent aids activist. He is the chairman of the Treatment Action Campaign, or tac, a grassroots movement that works to secure life-saving aids medicines for poor South Africans. Achmat, who is forty-one years old, is the most important dissident in the country since Nelson Mandela. He looks nothing like his elegant predecessor, however. His skin is golden, reflecting his Malaysian heritage, and his wide, boyish face is incongruously framed by chic, horn-rimmed spectacles.
Achmat, who lives in Muizenberg, a pleasant coastal town twelve miles from Khayelitsha, received a mixed greeting from the locals. Some people shuffled by him, straining to avoid eye contact. For them, Achmat is an unwelcome reminder of an unstoppable and unspeakable menace. South Africa has five million H.I.V.-positive people, more than in any other country. (If the disease were as prevalent in the United States, more than thirty million citizens would have H.I.V.) A more common reaction to Achmat, however, was awe. People gaped and whispered as he passed by, as if he were a pop star. A few had the nerve to approach. "Zackie, thank you for all you've done,"one woman said. "Please keep fighting."
Achmat pumped his fist and nodded. "We will,"he said. "And we'll win!”
A few minutes later, Achmat came across a pair of teen-age girls walking arm in arm. One wore an "h.i.v. positive"shirt just like Achmat's, which had been given to her by the local tac branch.
"Khayelitsha fashion,"Achmat said. He then passed an older woman planting vegetables in a small garden patch. She, too, was wearing an "h.i.v. positive"shirt. Her face lit up when she saw him. "I have seen you only on television,"she said.
Achmat pointed to a "Wanted"poster that had been plastered to a nearby telephone pole by tac supporters. The poster featured head shots of the health minister and the trade minister, both of whom were high-ranking members of the African National Congress, or A.N.C. The government has refused to distribute drugs like AZT to the public, and, in response, tac was charging the officials with "culpable homicide."Such pugnacious rhetoric repelled some South Africans, but Achmat said it was justified.
Achmat's real adversary is not the A.N.C. bureaucracy but its leader, Thabo Mbeki. A cerebral, proud man credited with helping to negotiate South Africa's remarkable transition to democratic rule, Mbeki succeeded Nelson Mandela as President in 1999, with the goal of fostering an "African renaissance."He celebrated the idea that African solutions could be devised for African problems. Mbeki's insistence on self-reliance became corrosive, however, when he applied it to aids. He denounced Western antiretrovirals, which suppressed the H.I.V. virus, as "harmful to health."He even questioned the link between H.I.V. and aids. Mbeki's stance not only bewildered people outside South Africa; it alienated many of his supporters at home, including Achmat.
At 10 a.m., Achmat arrived at a small white bungalow. The building housed the aids ward of the local health clinic. He stepped inside reluctantly. "Too many sick people,"he muttered. "I hate missionary work."Once indoors, however, he chatted warmly with patients and staff. The Khayelitsha aids ward represents a triumph for Achmat. It is the first public clinic in South Africa to have begun offering antiretroviral therapy. The program is run by Doctors Without Borders, the international humanitarian organization; to save money, the clinic imports generic aids drugs from Brazil.
The H.I.V. clinic is led by Eric Goemaere, a Belgian doctor. When Goemaere came to South Africa, in 1999, he had hoped to set up a drug-therapy program in Johannesburg. He was rebuffed by government officials, who said that antiretroviral medicines weren't affordable. Goemaere packed his bags. On his way back to Belgium, he stopped in Cape Town to have dinner with Achmat, whom he knew only by reputation as a charismatic campaigner for aids treatment. Achmat immediately persuaded Goemaere to stay. He told Goemaere that a group of renegade A.N.C. officials in Khayelitsha had just staged a revolt and begun administering AZT to pregnant mothers, with the goal of reducing H.I.V. transmission to newborns. Goemaere agreed to meet with these A.N.C. officials, and soon took over the Khayelitsha program.
Three hundred and eighty men and women are now enrolled in an expanded antiretroviral program, and in ninety-two per cent of them, Goemaere said, the virus had been suppressed to the point of being undetectable. "The medicines are incredible,"he said. Despite claims by some American officials that Africans would not be able to stick to the complex drug regimens, the clinic's patients were even more fastidious than those in the United States.
Goemaere's program had also helped to alleviate the shame that many Africans felt about being infected. Most patients entered the aids ward without embarrassment, in full view of the community. "Much of the stigma around H.I.V. is because it has been seen as a disease of automatic death,"Goemaere said. "If we offer people hope that they can live with the disease, then the stigma begins to fade."He added that far more Khayelitsha residents were asking for H.I.V. tests. "This is the impact of treatment on prevention,"he said.
As word of Khayelitsha's "miracle clinic"has spread, infected South Africans from all across the country have attempted to gain entry. One young woman from Langa, a neighboring township, was so desperate for medicine that she assumed the identity of a cousin from Khayelitsha. Unsuspecting doctors admitted her into the program, but generally only Khayelitsha residents are eligible for antiretrovirals. Even with this limited scope, the clinic cannot meet the demand. Thousands of locals need antiretrovirals, and Khayelitsha's pilot program can afford to treat only a fraction of them.
"Does anybody have medicines here?"Achmat asked a group of patients crowded inside the clinic's small waiting room.
Out of twenty people, two patients raised their hands. One woman said that she had started antiretroviral therapy last year, after falling sick. She had since gained fourteen pounds and returned to work. "I'm feeling great,"she said. She then pulled back the lapel of her shirt to reveal dark bumps along her neck and shoulder; a rash is an occasional side effect of taking antiretrovirals.
"So will you stop taking the medicines?"Achmat asked.
"No way,"she said, wagging her finger. "Never!”
Achmat smiled. Although he is H.I.V.-positive himself and needs antiretroviral drugs, he does not take them. In 1999, Achmat began the world's first drug strike. "I will not take expensive treatment until all ordinary South Africans can get it on the public-health system,"he announced. "That probably means I will die a horrible death, even though medical science has made it unnecessary."Achmat has since fallen ill; his pledge, however reckless, has made him a hero to many poor South Africans.
Before Achmat left the clinic, he spoke with some nurses. "Why do you fight so much, Zackie?"one asked. They were referring to the images of Achmat in that week's newspapers depicting their normally cheery spokesman shouting "Murderer!"at the country's health minister, Manto Tshabalala-Msimang. For years, Achmat had managed to maintain warm ties with many A.N.C. officials even as he fought for change. In late March, he gave up, and tac launched a national civil-disobedience campaign against the A.N.C.--his own party. "It's really not nice at all,"he told the nurse. "But we have to get the government to give us the medicines.”
Achmat is...
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