E-drug: NYT - Never a lull in a South African's AIDS battle
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Never a Lull in a South African's AIDS Battles
By Sue Valentine
The New York Times, 14 October 2003
http://www.nytimes.com/2003/10/14/health/14AIDS.html
CAPE TOWN, Oct. 13. Zackie Achmat has always been a fighter. In
1976, as a young teenager, he was at the forefront of student
uprisings against apartheid. He has been shunned in his extended
family in a Muslim community for being open about his homosexuality
and has been active in helping to secure a nondiscrimination clause
for gays in the South African constitution of 1996.
For the last few years he and his organization, the Treatment Action
Campaign, fought the South African government to make drug
therapies accessible to people with AIDS who rely on public health
care.
Featured in numerous articles here, profiled in the United States and
elsewhere, Mr. Achmat was well known for those battles. And for the
fact that he had refused on principle to take antiretroviral therapy
unless the government changed its policy.
During that time, he suffered recurring bouts of diarrhea, pneumonia
and other infections. His friends and fellow activists had long urged
him to take antiretroviral drugs to allow his body to bounce back
against the virus.
Now, Mr. Achmat has relented, and the South African government
has agreed to roll out antiretroviral treatments. This summer,
surrounded by close friends, family and a handful of fellow treatment
campaign members, he took his first dose of pills. Combative as
always, he had stalled the start of this therapy for two weeks while he
waited for the national drug authority to allow his doctor to prescribe
generic versions of the drug rather than to use brand products, which
cost almost four times as much.
In the close comradeship that has developed among
treatment-campaign advocates, it is perhaps not surprising that Mr.
Achmat says he feels guilty about his decision to take the
life-prolonging drugs. He knows many people who need the
medicines but cannot afford them, and he expects that the
government will not act swiftly to fulfill its promise.
"I've wanted to take medicines for a long time, and to me it's a
genuine relief," Mr. Achmat said. "But taking the medicines now, even
when the government has made this commitment, I'll still feel guilty.
I'll feel as if there are many, many people who won't have access for
a long time. I'll worry about them, and I worry that this country still
hasn't woken up to the fact that we have people dying on our
doorsteps and we close our eyes to it."
The latest United Nations population report lists South Africa as one
of seven African countries with H.I.V. infection rates of more than 20
percent. Projections in the report indicate that by the year 2050,
without intervention, the South African population will be 9 percent
below the 44 million people in 2000.
Mr. Achmat, 41, discovered that he was infected with H.I.V. 12 years
ago, the result of unsafe sex, but he was relatively slow to develop
AIDS-related illnesses.
"I'm what they call a long-term nonprogressor," he said of the
illnesses that have troubled him only in the past two to three years.
He ascribes this largely to his healthful way of life.
"I've never smoked; I used to be a long-distance runner; and I've only
drunk at each New Year to celebrate the collapse of the Stalinist
states and the fall of the Berlin Wall," Mr. Achmat said. He said he
had thrived on the energy of the struggle against the government,
buoyed by his fellow activists. "I'm lucky I have supportive friends, but
the main thing I have is T.A.C.," he said, referring to the Treatment
Action Campaign. "After shouting at the health minister, I gained 20
CD4 cells."
Since he started treatment, Mr. Achmat said, he has been feeling
"lightheaded" and has been battling a headache, but is otherwise
well. What he most looks forward to as the antiretrovirals take effect
is getting his energy back. "I used to read 100 to 200 pages a day,"
he said. "Now I have one long interview or conversation and I feel
dead tired." "I'm hoping that my viral load will be completely
eliminated within the next six weeks to six months," he added. And he
expressed great optimism after a month of treatment. "I've had no
rash, my liver function is perfect, my lactic acids are normal and I've
had two headaches in a month," he said, referring to possible side
effects he could have experienced in the early stages of antiretroviral
therapy. "I can't believe it." Most encouraging, he said, is that he is
getting back his energy.
Speaking on a cellphone on his way to the airport recently, he said he
was amazed at how he was able to take part in meetings and take on
engagements that previously would have been too exhausting. He
said he planned to return to law school at the University of Cape
Town next year. Last week, Mr. Achmat received the 2003 Nelson
Mandela Award for Health and Human Rights on behalf of the
Treatment Action Campaign. Now he is off to Europe for two weeks
and is clearly not looking to slow down. So far, he says he has had no
problems adhering to his drug regimen. "I haven't missed a single
dose," he said. "Although I was two hours late with one dose, but
otherwise I've been fine." He was even upbeat about having a cold.
Sniffling on the phone he joked, "Now that I don't get opportunistic
infections, I can get the ordinary things again like a bit of flu."
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