HIV victim Zackie Achmat tells Margarette Driscoll why he is refusing drugs until South Africa provides care for its 4.7m Aids victims

Last month Zackie Achmat was named one of Time Magazine's heroes of the modern world. Nelson Mandela has paid tribute to his work. As founder of the Treatment Action Campaign (TAC), Achmat has fought a four-year battle to change the South African government's stance on treating the country's 4.7m victims of Aids and, at last, it seems he might have won.

A South African government report outlining a new treatment strategy and costs is on the verge of being released. At present, antiretroviral drugs are available only through private healthcare, putting them beyond the reach of poor South Africans, who are dying at a rate of 600 a day.

Achmat, their champion, is HIV-positive but refuses to take anti-Aids drugs - although he can afford them - until they are available to his compatriots. "There is nothing so special about me. I just don't want to live in a community where you have to buy life," he says.

The big battle has been over antiretroviral drugs, including AZT, which western experts believe could give an extra eight years of life to those infected with HIV. Thabo Mbeki's government initially refused to distribute the drugs, claiming they were too expensive. Mbeki also came under the influence of so-called HIV denialists who dispute the link between HIV and Aids, causing him to question the drugs' effectiveness.

Achmat, 41, took on the multinationals, forcing them to reduce their prices, and has worn down the government's resistance through a campaign of civil disobedience and international demonstrations. He was in London last week, speaking at a rally outside the South African embassy. The major breakthrough came last year when he recruited Mandela to the cause.

Though Achmat ignored Mandela's pleas to start taking medicines himself, the day the 84-year-old put on a TAC T-shirt with the slogan "HIV-positive" - deliberately ambiguous - was "the happiest day of my life". Since then Mandela has had two meetings with Mbeki and the TAC is hoping the treatment programme will begin within weeks.

The TAC was set up in 1998 following the death of Gugu Dlamini, 36, one of the first South Africans to announce that she was HIV-positive. She was stoned to death in a township near Durban. "The fear, the stigma that surrounded Aids was indescribable," says Achmat. "Now all our members wear the HIV-positive T shirts whether they are or not."

Achmat's career as a political activist started at 14 when he tried to burn his school down.He was arrested and turned 15 in prison. The incident shook what was already a rocky relationship with his devout Muslim family. "What offended my parents most about having a gay communist atheist for a son was that I'm an atheist, the worst thing you can be in Islam."

He left home at 16 and continued as a political activist and working as a cinema usher and political researcher. He was imprisoned several times and recruited into an ANC cell in 1981.

Nearly 10 years later, in the exuberant times that followed the fall of the Berlin Wall and the unbanning of the ANC, he was diagnosed HIV-positive. "The doctor gave me six months to live. What was the happiest time of my life suddenly became the worst."

He took the prediction seriously. "I watched every movie I'd ever wanted to see.

Every morning at 6am I'd go walking by the sea, waiting for my last sunrise. At the end of six months I realised I was feeling better than I ever have done, so I decided to get on with living."

He went back to political work. As far as HIV was concerned, he was "in denial".

It was another seven years before he went public. Then in 1998 he fell seriously ill with a classic HIV-related infection that left him covered in sores and unable to swallow.

Friends paid for antiretroviral drugs but the incident made him acutely aware of how close he had come to dying and how many people in his situation did die because they could not afford the right drugs. He swore he would not take them again until they were available to everyone.

The Aids situation in South Africa was already spiralling out of control. Despite safe-sex campaigns, HIV has spread rapidly; 3m-4m people will die of the disease before the end of the decade.

Achmat campaigned for Mbeki and was stunned by the president's unorthodox stand on Aids. "It's an irony," he says. "We have tried several times officially to meet him and made too many unofficial approaches to mention. Yet he has spent hours on the phone to or meeting Aids denialists.

"There's a degree of stubbornness involved and something like paranoia. For example, he denounced our organisation as in the pay of the drug companies and the CIA. Mbeki's supporters have developed the myth that we are trying to be a political party, not because there is any truth in that but because we have been most steadfast in opposing the government; in getting doctors, churches and trade unions to take a stand.

"What we are doing touches everyone. When we did get a meeting with the deputy president recently the cleaner put down her buckets and gave us a hug. At all levels of society people have been horrified by the government's stance."

The drug companies have also felt the power of Achmat's campaigning zeal. Through stunts like smuggling in generic drugs from Thailand and comparing the prices charged for brand names he has shamed some of them into lowering prices. He has lodged a complaint against GlaxoSmithKline - the company that wanted to pay its chief executive more than Pounds 20m if he failed at his job - with South Africa's competitions commission and is waiting to hear the result.

The price of antiretrovirals has already fallen from around 4,500 rand (Pounds 358) a month to between 500 and 1,200 rand, depending on the brand. "If we could get it down to 300 rand a month many more working people could afford it," says Achmat. "That's important, because we don't expect the government to do everything. The scale is just too big."

Money could certainly be diverted from treating people with Aids-related illnesses. In 2000 (the latest figure available) 24% - 624,000 - of hospital admissions were for Aids-related illnesses that Achmat believes could be avoided given the right medicines. Some 50%-80% of all childhood admissions to hospital are also for Aids-related illnesses, squeezing out children with other serious illnesses, such as asthma and diabetes.

Deaths from Aids are tearing the social fabric of South Africa apart, so much so that foreign employers such as Volkswagen and DaimlerChrysler have taken to buying drugs for their infected workers rather than lose them and have to train more. The country is losing teachers, social workers, builders and firefighters.

There is the simple human tragedy, too. Zodwa Ndlovu, a widow and TAC member in KwaZulu-Natal, lost her 24-year-old daughter to Aids. When her 18-year-old son was diagnosed he committed suicide rather than die the same way. "She has nothing," says Achmat, "no husband, no children, no grandchildren. What keeps her going is her work for us and the thought that other parents might not have to go through the same ."

The treatment report has already been delayed once: the TAC has been promised a meeting with the government next month to discuss treatment programmes, after which - if the government does not continue to drag its feet - Achmat can start taking medicines. Time is already running out: he falls prey to infections every couple of weeks. The TAC has already lost some 40 members this year and friends are constantly trying to persuade him into changing his mind.

"It is so hard," he says. "When my body feels weak it's like it is asking me to do something. Then I meet someone who is dying who says, 'Thank you ... because you don't have medicines either you are in solidarity with us'. But others say, 'Take the medicines because you are fighting for all of us and we don't want you to go'.

So I am in a dilemma because I don't want to die for Thabo Mbeki."

If his campaign succeeds, he will not only save himself but many others. A modern hero indeed.