A Rewarding Engagement the Treatment Action Campaign and the Politics of HIV AIDS

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2005 33: 511Politics SocietySteven Friedman and Shauna Mottiar

A Rewarding Engagement? The Treatment Action Campaign and the Politics of HIV/AIDS

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10.1177/0032329205280928POLITICS & SOCIETYSTEVEN FRIEDMAN and SHAUNA MOTTIAR

A Rewarding Engagement?The Treatment Action Campaign and the

Politics of HIV/AIDS

STEVEN FRIEDMANSHAUNA MOTTIAR

The current spread of democracy has not enabled the poor to use rights to winequity, raising questions about whether the poor and weak can use liberal demo-cratic freedoms to address inequality. An oft-cited model of success, however, is theTreatment Action Campaign (TAC)’s campaign to press the South African govern-ment into distributing anti-retroviral medication to people living with HIV/AIDS.This article finds that TAC’s strategy of using the rights and rules of constitutionaldemocracy to win gains may offer an exemplar for forms of collective action whichcan win substantive equality, but that the model remains of limited application.

Keywords: social movements; HIV/AIDS; South Africa, civil society; TreatmentAction Campaign

In early 2001, when many believed multinational corporations to be invinci-ble, a group of demonstrators were able to pressure international pharmaceuticalfirms to abandon their court action which sought to prevent the South Africangovernment from importing cheaper medicines.1 Before and after the case, thecompanies had responded to criticism of their pricing policies by reducingthe price of medication to southern countries. In August 2003, the South Africangovernment sanctioned a plan to distribute anti-retroviral medication (ARVs) topeople living with HIV/AIDS, a course of action it had resisted until then.2

The common thread between the two events was the pivotal role of the Treat-ment Action Campaign (TAC), which was responsible for the 2001 demonstra-

POLITICS & SOCIETY, Vol. 33 No. 4, December 2005 511-565DOI: 10.1177/0032329205280928© 2005 Sage Publications

511



tions and also led a campaign to win access to ARVs as part of its attempt to winadequate treatment for people infected by HIV and AIDS. This second victoryhelped confirm TAC’s iconic status internationally and at home. The organisationand its chair, Zackie Achmat, have received several international awards and werenominated for the Nobel Peace Prize.3 TAC has also been cited repeatedly as asuccessful social movement which has won gains for its constituency.

Is TAC a model for other social movements? Has it developed ways of winninggains which could be adopted by others seeking to champion demands for greatersocial equity? Does it offer an approach which enables the poor to claim the rightspromised by democratic citizenship? These questions have ramifications wellbeyond the—important—question of how people infected with HIV/AIDS can beheard and can so claim a respected place in society.

Unlike a previous wave of democratisation, the current international spread ofdemocracy has not brought reduced social inequality: the poor have been unableto use their democratic rights to win policies and programmes which might reduceinequality because classic forms of organisation such as trade unionism have beenrendered less effective by changes in the labour market which exclude many of thepoor from the formal workplace.4 There is, therefore, a pressing need for effectiveapproaches which will enable the poor and weak to use democratic freedoms towin greater equity. Given its reputation as a model, studying TAC’s experiencemay shed some light on possibilities for the effective use of democratic rights toachieve greater social equity in current circumstances.

This article is a modest attempt to address that need. It begins with a brieforganisational profile of TAC and discusses what participating in the movementmeans to those who are part of it. It then discusses the environment and strategicchoices which enabled TAC to win a government decision conceding the right ofpeople living with AIDS to government-supplied anti-retroviral medication, andconcludes by discussing whether TAC is a model for other social movements.

METHOD

The study relies largely on qualitative interviews with TAC activists and offi-cials: forty-three were conducted, and interviewees ranged from the nationalchairperson of TAC to grassroots participants. Interviews were conducted withnational leadership at the TAC Head Office as well as with officials and activists inWestern Cape, Gauteng, and KwaZulu Natal provinces. While the selection ofinterviewees is heavily weighted to metropolitan areas, it does encompass themajor centres of TAC activity. One of us also attended TAC’s national conference,branch meetings, and social functions. While some grassroots activists were waryof speaking to researchers after previous experiences with the media in whichthey felt that they were not quoted accurately, TAC and its officials were, in themain, extremely cooperative.

512 POLITICS & SOCIETY



Interviews were also sought with institutions and organisations which dealwith TAC—government, pharmaceutical companies, allies such as the Congressof SA Trade Unions (Cosatu), and other social movements—since we believedthat a more accurate picture would emerge if we researched how others saw TACas well as how it sees itself. Four such interviews were conducted but coopera-tion from government and pharmaceutical firms was extremely limited: only onecompany, Boehringer Ingelheim, agreed to see us; and two others, Pfizer andGlaxoSmithKline, refused but did not give reasons. Two senior Department ofHealth officials agreed to meet with us but repeatedly cancelled meetings.

Interview material was supplemented by documents as well as secondary lit-erature. Gaining access to documents was extremely easy since TAC operatesopenly, and we are unaware of any documentation which was withheld from us.Indeed, much of the material we required was available freely in electronic form.

WHAT IS TAC?

TAC may owe its prominence to a government failure to capitalise on anopportunity.

It was launched on December 10, 1998, International Human Rights Day,to “campaign for greater access to treatment for all South Africans, by raisingpublic awareness and understanding about issues surrounding the availability,affordability and use of HIV treatments.” It seeks affordable treatment for peopleliving with HIV and AIDS. Its two founders, Achmat and Mark Heywood, hadbeen active in the Marxist Workers’Tendency, a Trotskyite pressure group withinthe ANC which sought to remain in the movement while criticising it from a leftperspective. However, their purpose was not to build a new left-wing movementbut to respond directly to HIV/AIDS, South Africa’s most significant health chal-lenge (see appendix 2).5 While the virus had been spreading during the 1980s, ithad received relatively little attention in the political debate: the pressures of thesociety’s political transition focussed attentions elsewhere and influential sec-tions of black opinion were reluctant to focus on HIV/AIDS because, in theirview, to do so would give a victory to white racists who repeatedly cited the virusto support their claims of black sexual irresponsibility.6 While organisations ofpeople living with AIDS existed before TAC, these were mostly white groups andTAC was an attempt to develop a more grassroots and racially representativeAIDS activism.7

According to TAC, its goals are to “ensure access to affordable and qualitytreatment for people with HIV/AIDS,” to “prevent and eliminate new HIV infec-tions,” and to “improve the affordability and quality of health-care access for all.”TAC says it also “campaigns against the view that AIDS is a ‘death sentence.’”8

While, as noted above, TAC is seen to have led the campaign which pressuredthe Cabinet into approving the “rollout” of ARVs to people living with AIDS, itsfounders did not expect conflict with the government—rather, they anticipated

STEVEN FRIEDMAN and SHAUNA MOTTIAR 513



campaigning against pharmaceutical companies which they expected to pose themajor stumbling block to affordable medication for people living with the virus.9

This expectation seemed vindicated when the companies, organised into thePharmaceutical Manufacturers’ Association (PMA), challenged in court legisla-tion allowing the “parallel importation” of cheaper generic medicines, which,they claimed, infringed their intellectual property rights. TAC intervened as anamicus curiae (friend of the court) on behalf of people living with HIV and AIDS,and backed this with public demonstrations designed to embarrass the companies.It succeeded—the PMA withdrew the action and continued to reduce medicineprices. TAC expected that the government would respond to the legal victory bybeginning to dispense ARVs at public health facilities. Instead, it rejected the“rollout” of ARVs (either on principle or until lengthy “pilot programmes” wereundertaken to test them). Led by President Thabo Mbeki, it denied not only theefficacy of ARVs, which some in government branded “toxic,” but the linkbetween HIV and AIDS itself. AIDS “denialists”—those who denied the scien-tific consensus on the HIV/AIDS link—were given seats on official advisory pan-els, even though they were discredited everywhere else.10

TAC mobilised in response in alliance with the Congress of South AfricanTrade Unions, the country’s largest trade union federation and a formal ally of thegoverning African National Congress (ANC), as well as black opinion leaderssuch as former president Nelson Mandela and then-chair of the official MedicalResearch Council, Professor Malegapuru Makgoba (whose campaign for racialrepresentativeness in universities had won enthusiastic support from Mbeki).In July 2002, it won a breakthrough when the constitutional court, arbiter of theconstitution, declared the government’s failure to provide a comprehensive pro-gramme to prevent mother-to-child transmission of HIV “unreasonable andunconstitutional” and ordered the government to supply the ARV nevirapine toprevent transmission of the virus by mothers to newly born children.11 This wasfollowed by the much greater victory, the August 2003 decision by the nationalCabinet to sanction the distribution of ARVs to people living with HIV/AIDSrather than purely to mothers.

TAC employs a multistrategy approach to campaigning, and its methods rangefrom civil disobedience and street demonstrations through action in the courts(the AIDS Law project at the Johannesburg-based University of the Witwaters-rand works closely with TAC) to measured pamphlets spelling out scientific argu-ments. In TAC’s own understanding, it maintains its visibility “through posters,pamphlets, meetings, street activism and letter writing.”12 TAC is not only a cam-paigning organisation: it also runs programmes which provide important servicesto its members. Perhaps the most important are the treatment project, which pro-vided medication for a limited number of TAC and “community” members,13 andthe treatment literacy campaign which offers advice to people undergoing oradministering treatment.14




Both, however, have a political purpose as well as a “service” dimension. Theattempts to equip people living with HIV and AIDS with information tend toinclude, alongside practical advice on how to cope with HIV/AIDS and how totake treatment, content which may raise consciousness as well as provide helpfulpractical information on coping with the virus.15 The treatment project was and isalso a way for TAC to show sceptics, including those in the government, that ARVprogrammes can be implemented effectively, despite repeated claims that patientswill not take their medication in the required manner. It has also created structuresto buttress the treatment project—preparation workshops and a network of coun-cillors who undertake home visits. It argues that this support is essential if an ARVprogramme is to be effective and has criticised the government for not beginningthis process, which it insists is essential to the ARV “rollout.” The exercise is,therefore, a campaigning tool, and a demonstration of the role TAC could play inthe “rollout,” as well as a service. TAC has also combined service provision withcivil disobedience—when it imported generics, ignoring the patents held by phar-maceutical companies.16 So, even where TAC is providing a service, an attempt towin policy change is crucial to its operation.

The treatment campaign would seem to threaten conflict in TAC because onlysome members receive treatment. However, members are said to understand thatonly some can receive treatment, and TAC activists stress that those chosen“would be the most likely to be successfully treated given our limits.”17 The can-didates are also chosen from lists put forward by the branches and the supportgroups affiliated to them18 and by clear criteria which are available to TACmembers.

Finances and Internal Organisation

Social movements are seen by some analysts and intellectuals active in themas new forms of organisation. We will return to this point. But how new is TAC’sstructure?

It is in many ways a conventional membership organisation, although im-portant aspects of its internal structure are unconventional. Thus there seems noclear-cut distinction between members—who usually do not pay dues but do fillin membership forms, allowing TAC membership to be quantified—and “sup-porters,” “volunteers,” or “activists.”19 Indeed, one official insists that “‘volun-teers’ and members are really the same thing.”20 The primary means of becominga member is to join a TAC branch,21 and officials and activists usually seem morecomfortable quantifying branches than members (one activist put the member-ship at almost four times its actual size). And, while some branches do charge asmall membership fee,22 this does not seem to be the norm. It may, therefore, bemore accurate to describe all people active in TAC as “participants” rather thandraw a clear distinction between members and supporters. Membership doesbecome relevant in the election of office bearers although even here there is diver-




gence from the norm: while members do elect its national executive committee,social sectors are also represented—children, youth, faith-based organisations,health care professionals, and labour.23 Thus Cosatu is automatically representedon the TAC National Executive.24 In KwaZulu Natal Province, clinic staff, includ-ing doctors and nurses, as well as local councillors, are encouraged to attend TACmeetings.25 While the recruitment of individuals as members is an important routeto participation in TAC, it cannot be seen as an entirely conventional membershiporganisation.

Membership in early 2004 was said to be around 8,000;26 this had risen to9,500 by midyear, although TAC acknowledges that some people listed as mem-bers have died.27 This is a very small percentage of the 5 million people estimatedto be living with HIV and AIDS, although the fact that TAC draws some member-ship from people living with a virus and that some members lose their lives is, inthe view of its leadership, one reason for its limited size.28 An activist suggestsalso that the stigma of being identified as HIV positive is a deterrent to member-ship: “[S]ome people who are not HIV positive will avoid hanging around withme or joining TAC because they are afraid that they will be assumed by their com-munity to be HIV positive.”29 TAC activists point out that the numbers participat-ing in its marches—which they estimate at between 8,000 and 15,000—indicatean ability to mobilise well in excess of its membership.30 TAC officials insist thatits strength is not based on numbers—a view strongly endorsed by activists inother social movements who insist that influence stems from assets other than thesize of membership.31 But TAC leaders recognise that the size of its base does con-strain it by ensuring that it cannot undertake some campaigns and cannot winissues by organised strength alone.32

TAC has grown in size, scope of activities, and funding. Unlike most socialmovements, it has a substantial full-time staff, administration, and donor-fundedprogrammes—features more often associated with nongovernmental organisa-tions (NGOs). It employs forty people and has a budget of R18 million (someUS$3 million)—roughly double the income for the 2002-2003 financial year.33

Since it does not charge membership fees, all revenue is sourced from donations.In the 2002-2003 financial year, the last for which audited statements have beenpublished, 98 percent of income was derived from grants from ten donor organi-sations—the rest from individual donations to, for example, the treatment cam-paign.34 The largest donors were the church aid programme Bread for the Worldand Atlantic Philanthropies, a U.S.-based private foundation.35 That several gov-ernments are donors despite TAC’s opposition to government policy and its civildisobedience campaign suggests a growing “respectability,” but official donormisgivings have not disappeared—“[S]ome are nervous of us because they see usas too critical of government.”36 Funding is donated for both running costs andspecific activities. The largest donation, from Bread for the World, is for generalexpenses: the only condition is a stated preference that some be used on work-




shops.37 TAC does not accept donations from the South African government orpharmaceutical companies38 or from USAID because “it is seen to promote theinterests of the US government.”39

The bulk of TAC activity remains concentrated in the provinces which housethe country’s three largest urban centres—Gauteng, Western Cape, and KwaZuluNatal. Within those provinces, the metropolitan areas are the prime focus of mem-bership. But TAC does have active branches in smaller towns in KwaZulu Nataland Western Cape particularly, and is seeking to build a presence in provinceswhich are further removed from the major urban centres.40 The Eastern Cape ruraltown Lusikisi is, for example, the site of an active branch.

Who Governs TAC? Internal Decision Making

Participation in social movements, like that in civil society organisations, ismeant to offer participants a voice: acquiring the right to speak in a way whichcould lead to realisation of people’s interests could be the most important ratio-nale for participating in movements. Movements offer voice when they are able toinfluence their social environments for, if they do not, the voices of their partici-pants are not heard; they must also offer participants a say in the organisation toensure that, if it does influence the environment, it is doing so on their behalf.41

The internal governance of social movements is, therefore, an important indicatorof the extent to which they do offer participants a voice.

Despite its unconventional approach to membership, TAC has a formal struc-ture which provides for internal representative democracy. The basic unit is thebranch. Each province in which it is active also has a provincial executive commit-tee (PEC), and the organisation has a national executive committee (NEC) whichis its prime decision-making structure. National leadership is nominated at branchlevel and elected at a national congress every two years where four national officebearers are elected in a ballot supervised by the Independent Electoral Commis-sion (IEC), which also oversees elections for all three spheres of government:chair, deputy chair, secretary, and treasurer. At TAC’s last conference, in August2003, the chair and treasurer were elected unopposed while elections for deputychair and secretary were contested.42 Despite the ambiguities about membership,participation at branch meetings is largely restricted to members. An innovation isthe district, which was introduced because “the branches began to take on moreand more tasks and there was just too much burden on the provincial office tooversee them all.” Districts have their own coordinator and administration; theyalso aim to accommodate the long physical distances between many branches andthe provincial office. They coordinate and lead all branches in their area.43 Thethree provinces in which interviews were conducted have all set up district officesbut not all are yet fully operative.44

While perspectives differ on the respective roles of the various levels, there isbroad agreement within TAC that major strategic decisions are initiated by the




national leadership.45 What is less clear is whether branches have a significantinfluence. National proposals are passed to the provincial level and then to the dis-tricts, which are meant to confer with branches and send responses to the pro-vincial level, which communicates them to the national office. National is theultimate decision-making authority although some compromise between its viewand that of other levels does seem evident. Thus the NEC amended a district pro-posal that volunteers be paid: “[A]fter some haggling between provinces andnational,” it decided to pay a low fee “which is still a point of contention amongvolunteers now.”46

In theory provinces are able to take strategic decisions, but in practice thisseems limited. Thus Western Cape decided to hold a demonstration disrupting aspeech by then–Deputy President Jacob Zuma—one of whose responsibilitieswas the government response to HIV/AIDS—in Cape Town by blowing whistles.

At the last minute we had to call our plans off because of an enraged call from Zackie(Achmat) who claimed that we had to wait for the civil disobedience campaign. We toldhim we felt this was the right time and he said quite angrily that the national office wouldannounce when the right time was—we can’t be sure how he found out about it but therewas one person who didn’t agree with our plans and so perhaps he said something. We hadto inform our members that they could not whistle, toyi toyi or disrupt Zuma’s speech—this caused a bit of a set back for us, it ruined the spirit and made people question how muchauthority we really had at the Western Cape office.47

This is clearly an example of the national level countermanding a provincial deci-sion. But the fact that national had to “find out” about the plan suggests that West-ern Cape was assuming that it did not have to tell national what it was doing. Andrelations with the national office are said to be “fine” after this incident, suggest-ing that the conflict has been managed. But there clearly are tensions between thenational leadership and provinces:

National has directed that all the treatment literacy campaigns be run in the same way in allthe provinces—but we here in Gauteng have some ideas of our own and are constantlyvoicing our need to do things our way.48

At present, these do not seem to be a serious source of conflict. But, if inter-nal democracy proves less effective in substance than it is in form, they could be-come so.

Finances are tightly controlled at the national level, a practice justified on thegrounds that it guards against wastage and corruption.49 Strict financial control isexercised—down to monitoring and commenting unfavourably on the cost ofcatering.50 This concern for tight financial controls has not entirely prevented mis-appropriation of funds but has, TAC officials say, enabled them to detect it—twoprovincial officials and one in an outside administrative facility created to overseespending have been dismissed in the past five years for misappropriating money




(while one national official was dismissed for receiving financial inducements).51

There are concerns that financial control may become more difficult as the budgetcontinues to grow, but there is no sign of a weakening yet—TAC is also trainingofficials in financial management. Whatever the merits of national control, strongprotections against corruption are a strategic necessity for TAC, both because ofits dependence on donations and because a movement premised on retaining the“moral high ground” (see below) cannot afford financial scandal. As a means ofretaining trust, financial information is publicly available on the TAC website.52

The national is meant to be the highest decision-making level of the organisa-tion, and the civil disobedience campaign was the result of a resolution by TAC’snational conference. The question is whether members enjoy a say in decisions.TAC KwaZulu Natal Coordinator Thabo Cele implies that they do: “Strategiesand tactics are suggested by the national office—provinces and branches wouldthen be consulted. Responses and suggestions would then go back to the nationaloffice from the provinces and branches before the final decision is taken.”53 Thecivil disobedience campaign was “thoroughly discussed by all PECs” eventhough the final decision came from the national office. In at least one case, a stra-tegic decision by national leadership was overturned by branch members.54 Con-cerns by branch members that they would be beaten by police or arrested did notalter the decision to embark on civil disobedience but

the PEC, after consulting national, told us to assure members that TAC would be there toassist should they be arrested and that if they were afraid or unhappy to participate they didnot have to and it would not affect their membership.55

Some TAC participants insist that there is also effective communication frombranches to the national level: “Recommendations are usually made at all branchmeetings and sent on to the provincial office and then to the national office ensur-ing that there is an awareness at national level of what is happening at branchlevel.”56 To ensure that TAC leaders stay in touch with other levels of the organisa-tion, each province is allocated a national representative to attend provincial anddistrict meetings. Provinces also send representatives to the NEC.57

Not everyone in TAC, however, shares the view that upward communication iseffective. One activist says her branch has better contact with the national than theprovincial level which “does not provide us with much input—probably becauseof structural problems.”58 Another says, “It seems that our link with the provincialoffice is only strong during a crisis.” He adds that national leadership’s attempt tostay in touch with members is not very effective:

I was once invited to a TAC meeting in Durban just because I happened to know someone innational leadership: the rest of the members of my branch did not even know about it. Ourbranch only found out about the civil disobedience campaign after it was decided upon.




As a result, the branch made decisions autonomously from the province ornational office in accordance with its branch constitution.59 “Communicationbetween our branch and the province is bad—I always e-mail them all our minutesbut they never respond.”60

Some informants insist that this situation has improved significantly: theyreport improved responses from the provincial office to branches. In particular,the formation of a youth task team with representatives from all branches is saidto have helped branches to form stronger links with the provincial office: “[C]on-cerns are well articulated.”61 More generally, complaints of a lack of liaison are aminority view: “TAC is a democratic organisation—it is not as if Zackie [Achmat]says something and we all follow. Branches are given the opportunity to input.”62

Or, “[T]he PEC takes branch meeting resolutions very seriously—June was de-clared Youth Month as a direct result of the call from youth branch members.”63

Similarly, issues raised in treatment literacy workshops are said to be effectivelyconveyed to the NEC—this is also seen as an effective way of channelling grass-roots concerns:

People tend to ask a lot of questions, and we make sure that we give them clarity whereverthere is confusion—all the feedback from people at workshops is recorded as recommen-dations and filed at the provincial office, and is the material with which I write my monthlyreports to the national office.64

An activist suggests that communication and participation are uneven: “Relation-ships between various levels of TAC are never fixed—sometimes TAC works topdown and other times bottom up.”65

Overromantic views of democracy within TAC would, therefore, be inappro-priate. There are structural constraints to some expressions of democracy becausesome TAC strategies require technical knowledge unavailable to grassroots mem-bers who lack formal education. In some cases, concerns for desirable goals suchas financial probity may also create constraints to internal democracy. In this con-text it is almost inevitable that at times a divide will emerge between the smallgroup of national officials, whose formal education, political histories, or bothgive them an in-built advantage in addressing technical and strategic issues, andthe grassroots. In this context, rhetoric claiming that strategy is powered by thegrassroots would deserve scepticism, and it is to the credit of TAC’s nationalleadership that it did not make these claims.

However, it would be equally misleading to reject TAC’s constitutional struc-tures as a fig leaf for control by a small group of leaders. Members are free tospeak—interviewees were happy to talk openly, including those who offeredfrank criticism of the leadership, and this speaks to a high degree of tolerancewithin TAC. Interviewees agreed that members were free to speak. Those con-trols which do exist seem consistent with a democratic organisation’s reasonabledesire to ensure that policy is conveyed accurately: “Should a TAC member say




something or behave in a way that is contrary to what TAC is standing for, mem-bers of the PEC will be responsible for having a talk with that person to find outthe reasons.”66 There is no disciplinary procedure for people who hold dissentingviews: “[W]e have no policy on holding specific views—TAC has a culture ofspeaking openly.”67 Certainly, the reverence with which grassroots members talkof Achmat could raise concerns of a personality cult, but there is no evidence thateither he or the TAC leadership encourages this. And, of course, the fact that par-ticipants in TAC express strong loyalty to Achmat may simply mean that he haswon the affection of the grassroots. Most importantly, the fact that TAC does havefunctioning democratic structures is in itself an important guarantee that mem-bers retain a voice since they build in mechanisms which force leadership torespond to membership, even if this happens in practice less often than it could.

Some features of TAC’s structure, such as the fuzziness of membership and theautomatic representation of sectors at the national level, could pose obstacles todemocracy but there is no sign that this has happened yet. In a context in whichsome analysts and activists exalt the looseness of social movement organisation(see below), it is important to stress that democratic structures are not impositionsby bureaucrats but means by which participants gain a say in their organisation. InTAC, the structures ensure that it remains a democratic organisation. But structureis only a necessary condition for members to exercise voice. Historical disad-vantage is a substantial barrier to the exercise of voice in TAC, and, as some ofits leaders acknowledge, it could do more to ensure a voice for its grassrootsmembership.

THE MEANING OF BELONGING

This brief organisational profile, of course, does not describe what it means tobelong to TAC: what political loyalties it requires, the motives of those who join it,and its effect on them. This section discusses these issues.

Political Loyalties

TAC is not affiliated to a political party and members are said to support a vari-ety of parties.68 “TAC is a political movement, but not a party political move-ment.”69 At least one branch reports maintaining contact with several parties.70

According to one interviewee, tension between ANC and opposition supporterssurfaced in a KwaZulu Natal branch: the ANC supporters were reluctant to takeARVs, reflecting government policy at the time. TAC members also arrived atbranch meetings wearing party T-shirts.71 This mirrors similar conflicts in theearly days of the trade union movement:72 once movements begin to recruit mem-bers on the strength of a common interest, a membership with diverse politicalloyalties is likely—and may become a key challenge for the organisation sinceleaders may have strong political loyalties which are not shared by all members.




In TAC, ANC members are numerically dominant—as they probably are in mostmembership organisations given the size of the ANC’s electoral majority.73

Heywood, now treasurer, says TAC is “neither anti-government nor anti-ANC.”74

It is prepared to oppose both fiercely but does appreciate that “if there is a partycomposed of the poor, it is the ANC.”75 Frequent statements by Achmat that he is a“loyal member of the ANC” elicit criticism from activists in other social move-ments who reject governing party macroeconomic policy.76 Senior officialsacknowledge that while TAC has endorsed the role in the ARV “rollout” of theANC-governed Western Cape government, taking the same stance would havebeen very difficult—perhaps impossible—if the province was ruled by the oppo-sition Democratic Alliance.77 So, despite its independence and diversity, TAC hasa political identity which ensures a relationship with the government and ANCunlike that of most social movements.

Its relationship with the ANC is more complex than its critics might suggest.Achmat has called for the democratisation of the ANC which, he argues, largelyignores civil society. And, in an interview before South Africa’s 2004 generalelection, he suggested, “The ANC would like TAC to endorse a boycott of elec-tions so that we can lose legitimacy.”78 Some of its leaders, then, see a link withthe ANC as a part of their identity which they seem eager to preserve whether ornot the governing party welcomes the association. But substantial ANC supportwithin TAC did not dissuade it from launching a civil disobedience campaign inwhich, among other actions, it attempted to charge the ministers of health andtrade and industry with culpable homicide. TAC’s approach to the ANC is not,therefore, straightforward loyalty.

To social movement activist Ashwin Desai, this mixture of sympathy andopposition is a legacy of Achmat and Heywood’s days in the Marxist Workers’Tendency. He suggests that this is an inappropriate stance for social movements,which should work entirely outside the party political terrain.79 But, given that adegree of internal democracy is available to TAC members, it is highly unlikelythat two leaders would be able to shape the direction of the organisation unlesstheir preferences were broadly consistent with membership sentiment. The ANCis the expression of the political identity of many TAC members—but one whichdoes not impel them into loyalty to it when it is seen to deny or obstruct treat-ment to people living with HIV/AIDS. The closest analogy is to TAC’s allyCosatu which is loyal to the ANC but independently pursues its interests whenthese conflict with ANC policy and practice—although the analogy has clear lim-its since Cosatu is a formal ANC ally while TAC is not.

TAC’s location, albeit in ambiguous fashion, in the ANC tradition also gives itan important asset: it enables it to use the imagery of the ANC’s anti-apartheidstruggle as an important “discursive tool”80 in its attempt to achieve legitimacyand moral support. It has referred, for example, to its civil disobedience campaignas a “Defiance Campaign,” evoking a celebrated ANC campaign against apart-




heid laws in 1952. While some other social movements have also sought to evokethe images of anti-apartheid struggle, TAC’s refusal to break with the ANC obvi-ously gives the imagery greater salience when it uses it. Also, of course, its politi-cal location makes tacit support within the government more possible for TACthan for many other movements.

Interests and Identities

Why do people join TAC? Because they are HIV positive and rely on collectiveaction to claim medication? Or because they are socially aware people who feelstrongly about the claims of people living with HIV and AIDS? It would be mis-leading to classify TAC as an interest-based organisation or one flowing out ofsocial concern because it is clearly both.

Discovering accurately how many people join because they are HIV positive,and how many for other reasons, is not possible since it is an article of faith withinTAC that people should not be required to reveal their HIV status (although theyare encouraged to do so). Estimates of the relative proportion of people livingwith HIV and AIDS and those who are active for other reasons therefore rangebetween 50-5081 to 70 percent HIV positive.82 And, of course, it is possible forpeople to join for both reasons—Achmat is both HIV positive and a veteran leftactivist. Members or supporters who are not HIV positive are active not only as aresult of a broad social commitment but, in some cases, because people in theirlives—friends, family members—have been infected.83 Common sense mightsuggest that people at the grassroots are more likely to join because they are HIVpositive, while senior leaders are more likely to be motivated by a social cause.But a crude distinction between social activists concentrated at the top and HIVpositive people at the bottom does not bare scrutiny. Not only are several senioroffice bearers HIV positive, but grassroots activists join for a variety of reasons:motives for participation offered by KwaZulu Natal branch members includedparents and children who are infected with the virus and a public-spirited desire tospread awareness in their residential areas.84 That said, there is a divergence, againanalogous to that of the trade union movement (in its formative years), betweenpeople at the grassroots joining for functional reasons and middle-class activistswho join to pursue a social agenda. Ensuring that the gap between them does notcreate destructive tensions is a key TAC challenge.

Clearly, the main reason for participating in TAC remains interest rather thanidentity: people join because they wish to see people living with HIV and AIDSreceive treatment, whether they do so because they need the medication or iden-tify with others who do. While Achmat’s identity as a gay man of Muslim back-ground is often commented on—and TAC might remember with respect andaffection Simon Nkoli, a gay human rights activists who succumbed to AIDS andis cited as one of its “catalysts”—TAC is not primarily a vehicle for gays and lesbi-ans, who seem to make up only a fraction of participants.85 About the nearest we




are likely to come to an identity-based rationale for TAC activities, then, is that itis more likely to attract people who identify with a broadly left-wing perspective,at least in the sense that they believe that social action to secure state provision ofnecessities is desirable. But in the main, interest in treatment, or identification andempathy with those who need it, is the spur rather than religious, political, orsocial identities.

Interviewees repeatedly stressed that more was at stake for people at the grass-roots than the hope of receiving medication. Many noted the sense of hope, effi-cacy, and self-worth which people drew from TAC.

TAC approaches HIV differently. It talks and teaches positive living, that this illness is not asin—life is not wasted or less valuable, it must go on. TAC is an organisation for the people,it works directly with people—look how closely it works with support groups like ours,people who come to us are the poorest of the poor, those with no resources, education,information—that is why they come to TAC meetings, as well as in the hope of gettingtreatment.86

TAC also seeks to play a role in eradicating the stigma of HIV/AIDS and to “pro-vide vital information about HIV which the ordinary person has trouble access-ing.”87 People join TAC, in one activist’s view, not only “because it is vocal aboutan important issue concerning them” but also because “it is a forum to share theexperience and pain of living with HIV.”88 TAC’s biggest success has been that ithas gone some way to ending discrimination about HIV/AIDS. “People are notafraid to be open about their HIV status any more.”89 “I would be dead by now if itwasn’t for TAC—they gave me the courage to accept my status and be open aboutit.”90 To some extent, living with HIV and AIDS can itself define the identity ofparticipants, giving TAC an identity dimension even as it pursues a cause shapedby a common interest.

Given that TAC’s key concern is to win effective treatment for people too poorto be able to afford it from private sources, it is perhaps inevitable that its grass-roots branch membership will be composed largely of poor, black people whosesocial circumstances and lack of access to the resources which make politicalinfluence possible set them apart from a middle-class activist leadership. Accord-ing to Achmat, “The demographics of TAC are 80 percent unemployed, 70 per-cent women—the group most affected by HIV, domestic violence and violence inschools—70 percent in the 14-24 age group and 90 percent African.”91 So TACdoes speak for some of the society’s most marginalized people who do not shareany of the advantages available to middle-class activists and who therefore maybe unable to shape the organisation’s strategy. This raises two dangers—that theconcerns of the grassroots are not informing the agenda of the leadership and thatTAC is in danger of conflict as grassroots leaders feel that their route to an effec-tive role in the organisation is blocked. Again there is an analogy with the forma-tive period of the trade union movement: initially, talented worker leaders, who




had no difficulty operating effectively in the workplace, found it difficult, giventheir limited formal education, to graduate into leadership positions which re-quired a grasp of technicalities usually available only to people with more school-ing (and, often, familiarity with English).

The first issue is dealt with in our discussion of decision making. The second,TAC officials and activists insist, is acknowledged as a problem, and significantefforts are being made to ensure that grassroots leaders are empowered to take onthe task of national leadership too. There is, Heywood acknowledges, “a tensionbetween the profile of the leadership and the base.” Effective grassroots leaders,he notes, “are often quiet at NEC meetings but active on the ground.” But he addsthat an attack on him by Health Minister Manto Tshabalala-Msimang, whoreferred to him as a “white man” and accused him of manipulating black people,92

reminded TAC leadership of the need to “ensure that grassroots activists led theorganisation at the top.”93 He says that TAC has sought to empower people to risein the ranks through workshops and training courses—“[W]e can’t simply pro-mote people for being loyal.” Another technique to empower TAC members is the“parallel hiring method” in which people are promoted in staff jobs and someoneis hired alongside them to train them until they can take over. TAC has a leadershipprogramme which involves five workshops a year dealing with social and politi-cal issues. It also constantly sends rising activists on courses to enhance theirskills. Several of its national leaders have emerged from the grassroots.

Deputy Chair Sipho Mthathi, herself a graduate of the grassroots, whileacknowledging different layers of leadership within TAC, insists that there is noconflict between them: the real conflict in TAC, she argues, is within individualactivists as well as between them over where to locate TAC’s work in relation towider social concerns. She adds that the new TAC leadership is still trying toshape their political views and create a space for themselves in the new society.TAC gave them this space.94 This also creates the possibility, of course, of TACadopting differing political strategies in the future if this is the preference of itsnewly emerging leadership. Later generations of union leaders, emerging fromthe grassroots, did adopt more overtly political positions than the first generationof largely middle-class leaders.

Gender in TAC

Like most or all South African institutions and organisations, TAC is still farfrom being able to maintain that it has achieved full gender equality or somethingapproximating it.

Most TAC members are women—one source estimates the proportion at 60-70percent.95 This is not surprising, given evidence that women are far more likely tobe infected by HIV than men:96 a TAC official notes that statistics show thatwomen aged between fifteen and thirty are more vulnerable to the virus than anyother group.97 Organisers also say that women are more active in branches: one




interviewee notes that while attendance at branch meetings differs from branch tobranch in numbers and gender distribution, “overall I would say that about 50-60percent are women,”98 who are said to attend branch meetings in greater numbersthan men and to be more active in TAC activities.99 One speculates that men arereluctant to participate because they are more likely to fear the stigma of beingknown to be HIV positive.100 Women are also subject to domestic abuse and vio-lence compounded by the advent of HIV, and this is said to give them an addedincentive to participate in TAC.101 But, while some office bearers insist that genderbalance has been achieved in TAC with a roughly equal distribution among officebearers and staff,102 an interviewee estimates that only about one third of officebearers and about half of staff members are women.103

Measured simply by how many women occupy senior positions, TAC hasmade significant progress. Formally, its secretariat consists of four people—threemen were elected at its last conference and one woman. But one of the menresigned and was replaced by a woman, so the split is exactly equal. In practice,the secretariat also includes senior staff members, and, on this measure, TAC isrun by four women and three men. Most people in provincial management posi-tions are women.104 But its public face remains predominantly male—Mthathi,the most senior woman in the organisation, does not yet have the profile ofAchmat, Heywood, and other men who lead TAC. One woman activist suggeststhat this is a consequence of both “the patriarchal system and the fact that womendon’t seem very keen to step into leadership roles.”105

TAC’s leadership is concerned to promote gender equity—current ratiosbetween men and women are an improvement on the past and a result of a nationalstrategy to address the problem expressed in a request by Achmat and the nationalexecutive committee to “balance the gender make up.”106 While this concern is notexpressed in a formal gender policy, “TAC is very sensitive to gender. We are adiverse organisation and our structures should reflect this—TAC does empowerwomen and give them leadership positions—in recruiting staff we also take thisinto account.”107 Its leaders insist also that it is learning to handle gender withgreater sensitivity. Thus, several years ago, an incident in which a male volunteerstruck a female colleague was handled “inappropriately”—the man was given toolight a punishment, and the woman was “not handled with sufficient dignity.” But“we learned from our mistake”—subsequently, a senior national office bearer wasdismissed, partly for sexual harassment. TAC has also sought to educate malemembers about women’s rights.108 And despite the continued imbalance, the per-ception that TAC “gives women a voice” is cited as an important reason for partic-ipating.109 Given the centrality of gender issues to AIDS, TAC treatment literacyworkshops do address topics of particular concern to women such as violenceagainst them, sex and sexuality (gay and lesbian as well as “straight”), issues ofreproduction in the context of HIV/AIDS, family planning, Pap smears, abortion,social security programmes such as the child support grant, the disability grant




and basic income grant, as well as sexually transmitted illnesses.110 Achmat andHeywood are thus concerned to stress TAC’s role in giving some of the politicallyweakest sections of society, including grassroots women, a voice.

Clearly, the gender prejudices which inhibit women from playing a moreprominent role in the organisation were not invented by TAC. Its leaders do seemset on challenging them. But, despite advances, it clearly has some way to go if itseeks to become a vehicle for gender equality. TAC is providing opportunities forwomen to lead attempts to tackle HIV and AIDS at the grassroots, and it offersgrowing openings for participation in national leadership. There is considerablepotential for it to become a publicly acknowledged vehicle of women’s participa-tion in society, and its leaders are not closed to this possibility. But it is not yet anorganisation in which women are clearly playing a public leadership role at thenational level.

A Source of Power?

A key function of social movements is said to be the vehicle they offer the poorfor exercising some degree of power, albeit in a limited sphere.111 Does TACempower the poor and marginalized, enabling them to claim their rights? Does itenhance the deepening of democracy and the redistribution of resources?

There is more to this than whether grassroots people enjoy a say in TAC. Asimportant is whether it engages in activities which give people, particularly themost powerless, a new sense of their ability to become active citizens. TAC lead-ers are convinced that it does: “We are reconstituting civil society in places likeOrange Farm [an informal settlement]: our members are not used to thinking ofthemselves as people with agency and power. Participation in TAC makes themaware of what they can do.”112 TAC has also become a vehicle for grassroots initia-tives which suggest willingness by people outside the activist circle to take initia-tive, such as the Thatnusizo Support Group in Inanda, Durban, which initiallyconsisted only of three people who had all lost children to AIDS. They attractedsupport by knocking on neighbours’ doors and discussing HIV.113 TAC’s role infighting the stigma of HIV/AIDS and giving people living with it a sense of effi-cacy is itself an important contribution to changing roles in society. And basicinformation on the virus and how to cope with it helps participants take control ofa crucial aspect of their lives.

Certainly, the level of grassroots participation in TAC does suggest that it isdoing far more than providing a vehicle for people concerned to find medicalrelief from a deadly condition—although even that may be a contribution toempowering its members since it enhances their technical knowledge of the virus,enabling them to be more active citizens: “If they go to a clinic with herpes orthrush they know what to ask for.”114 Its workshops and the educative functionsthey play, its mass mobilisation campaigns and the opportunities they offer forparticipation, as well as the discussion at the branch level of strategic options are,




in the view of many interviewees, offering grassroots TAC members an opportu-nity to become active citizens rather than passive subjects.115 Branch treatment lit-eracy programmes “teach people to engage as citizens, not victims.”116

We have empowered people—branch members used to just keep quiet in meetings but arebeginning to participate actively—it started small with ideas for T-shirt designs but then itgrew with ideas on how to deal with local clinics which did not deal adequately with oppor-tunistic infections.117

In this way, TAC implicitly strengthens democratisation by ensuring not only thatpeople are able to claim their rights but also that they are better able to participateas democratic citizens.

Winning victories is also said to “facilitate empowerment” of members—including gains in the courts. Thus the court order mandating ARVs to preventmother-to-child transmission and the cabinet decision to agree to ARV “rollout”are said to enhance members’ belief that their actions can make a difference.118

Winning gains is paramount to TAC: “We do not just want to have a voice, wewant to win our demands.”119 At TAC as well as in the trade union movement dur-ing the 1970s and 1980s, gains are a means by which grassroots people becomemore aware of their capacity to change their world.

There does, however, seem to be a widespread view among TAC activists that itneeds to deepen its roots in the wider society: “[W]e are working to make TACmore visible in the communities—this way we can take an active role encourag-ing people to access treatment when government makes it available.”120 “TACneeds to work on permeating itself more effectively. Many rural areas have noteven heard of TAC.”121 There are plans to launch door-to-door campaigns bybranches “to destigmatise the HIV issue and promote people going for treat-ment.”122 Treatment literacy is also an area in which strengthening this link is seento be appropriate: “We are trying to encourage the building of relationshipsbetween the local community and TAC practitioners. This year we are going towiden our target beyond just TAC members.”123 The People’s Health Summit wasalso meant to “give communities a voice”124 and so, presumably, broaden partici-pation in the campaign for change. Similarly, grassroots members could play agreater role: “We would like our branches to be capacitated enough to monitorclinics in their areas for capacity, treatment and medication.”125 TAC is also tryingto ensure that its branches can pursue local advocacy.126

Clearly, TAC is pursuing a redistributive agenda, albeit one which some of itssocial movement critics feel is not thoroughgoing enough. It has, with its allies,pressed multinational companies to make medication available at lower prices orto give up their right to exclusive supply in exchange for a royalty.127 It has alsoprompted the government to agree to use its resources to provide ARVs to peoplewho cannot afford them. TAC, despite its focus on an issue not automatically




associated with poverty eradication, is working, with some success, toward theredistribution of social power and resources.

BEYOND RACE?

Is TAC able to transcend the politics of race? Race is a key divide in South Afri-can society. And, while left social movement activists might wish to insist that, inthe struggle for justice, common interests override racial identity, that is not theview of some black activists who feel that social movements are dominated bywhite left intellectuals. Whatever the merits of this complaint, it does point to aparticular reality: that, given historic disparities, many of the middle-class profes-sionals who gravitate to the top of social movement are white, while the grassrootsare overwhelmingly or exclusively black.

As noted above, the possibility that this could be a source of division withinTAC occurred to Minister Tshabalala-Msimang, whose attack on Heywood was,of course, meant to imply that a white leader was manipulating black followers. Itappears to have occurred also to Thandoxolo Doro, national organiser of TAC’srival, the National Association of People Living with AIDS (NAPWA), who, at ameeting in March 2004, is said to have attacked Heywood and a white member ofthe AIDS Consortium, the network which brings together all the sources of AIDSactivism in South Africa, declaring to the cheers of NAPWA members that “weare sick of white people sitting at the front of the meeting; it causes us pain,” andtelling Heywood, “[W]e are sick of you white racists taking advantage of blackpeople and people with HIV/AIDS.” After the meeting, NAPWA members re-portedly danced, led by NAPWA Director Nkululeko Nxesi, singing “MarkHeywood the white racist has succeeded in dividing black people—that was hisagenda all the time.” An intervention to stop this by Communist Party activistMazibuko Jara, chair of the AIDS Consortium, led to a new chant that Jara was the“new black bourgeoisie.” In response afterwards, Heywood charged that “thesimilar language used by the Minister and Nxesi and Doro, with whom she hasregular contact, is no coincidence.” And a subsequent statement by the consor-tium questioned NAPWA’s motives: “These NAPWA representatives are knownto have financial discrepancies and questionable business activities within theirown organisations.”128 Heywood notes that there is a certain irony to this: TACwas originally launched because NAPWA was seen as “conservative and largelywhite.” TAC, he adds, played a role in the emergence of the black leadershipwhich was later to attack it.129 Whether or not NAPWA was acting on behalf of theminister or creating a diversion to distract attention from its business dealings, thepossibility that people may have questionable motives for invoking race does notundermine its salience—indeed, it could be argued that its power lies precisely inthe reality that people can use it so effectively to hide questionable motives.

Given this background, it is significant that the attempt to introduce racial divi-sion into TAC seems to have failed. Not only does Heywood insist that black




members have enthusiastically supported him against these attacks.130 In not oneof our interviews with TAC officials and activists at all levels of the organisationdid race emerge as an issue, either overtly or in the code which South Africanstend to use to express racial sentiments in a nonracial way (in this case, complaintsof excessive influence by “middle-class people” might have acted as a surrogate).

This does not necessarily mean that TAC has defied the laws of South Africanpolitical gravity by “transcending race.” It is conceivable that, if circumstancesdid emerge in which grassroots frustration could be linked to the prominent roleof white activists, racial sentiments which had been invisible might surface. But,thus far, like the union movement and a range of activist organisations, TAC’sexperience does seem to show that people in a society with South Africa’s historyof racial division can cooperate in search of a common interest in social equity.

But this does not mean that TAC can afford to assume that it is operating in anenvironment in which “colour-blindness” is possible. An approach which did nottake seriously a history of racial disadvantage and simply hired “the best personfor the job” could block off opportunities for black leadership by privilegingwhites whose access to formal education and other resources gives them a domi-nant position. If that was allowed to continue unfettered, black frustration andensuing racial tension would be highly likely. TAC is aware of this—hence thecommitment to develop grassroots leadership and the recognition that race mustplay a role in appointments.131 Thus, rather than claiming that TAC has “tran-scended” race, it might be more accurate to say that it is managing it fairly effec-tively thus far. Continued success is likely to depend largely on continuing torecognise the need to nurture black leadership.

ANATOMY OF A SUCCESS

While being part of TAC clearly makes an impact on its participants, the move-ment’s significance, of course, lies in its ability to win change for people livingwith HIV and AIDS. How has it achieved this?

Recasting the Debate

Ironically, perhaps the clearest sign of TAC’s success is that it has made thefight for recognition of people living with HIV/AIDS, and thus for the provisionof ARVs at public expense, seem easy.

Sceptics thus doubt the claim that TAC’s experience is a potential model forother social movements and an indication that citizens’ organisations can wingains in liberal democracies in general, and in post-apartheid South Africa in par-ticular. Winning medication for people suffering from a deadly virus is, it is sug-gested, a poor example of a successful campaign to challenge structural inequal-ity since it appeals to the moral sensitivities of just about everyone—includinginterests who support inequalities in other areas. Shifting government attitudes,




they add, was made easier by TAC’s refusal to distance itself from the governingparty; the fact that much of its constituency are poor and black, and thus key tothe ANC’s support base; and the reality that disbursing ARVs did not challengecore government policies. While TAC’s methods may be ingenious, this view sug-gests, it took advantage of assets and opportunities not available to movementstackling structural inequalities whose campaigns inevitably place them in irrec-oncilable conflict with powerful interests in the ANC and the society.132

This analysis appears to confuse effects and causes. The fact that people livingwith HIV and AIDS came to be seen as persons deserving of sympathy demand-ing a basic human right was the result of the strategy of TAC and its allies, not anasset which they inherited. As noted above, HIV/AIDS was not a popular issueamong South African policy makers—it was seen as at best a diversion from thepressing tasks of creating a democracy on the ashes of minority rule, at worst as anacknowledgment of white bigotry. South Africa is also a socially conservativesociety with pressing development needs occasioned both by the demand oforganised black interest groups for racial redress and by the acknowledged needto address severe social inequalities. AIDS could well have been seen as a symp-tom of its victims’ inability to control their sexual impulses and thus a conse-quence of social deviance which ought not to be rewarded by the public purse—or, at best, as a luxury which a society with pressing challenges could not afford.That some key early campaigners, including Achmat, were gay men was, ofcourse, likely to increase this possibility. The fact that AIDS activist GuguDlamini was beaten to death by a mob enraged by her open acknowledgment ofher HIV status is eloquent testimony to the depths of potential resistance.

And, as noted elsewhere in this article, TAC’s campaign has affected the inter-ests of the powerful in business and government. It is hardly impossible to imag-ine it being demonised in much the same way as demands for a universal BasicIncome Grant (BIG) has been—a widespread view in the mainstream policydebate dismisses the BIG as wasteful, while media reports and middle-class opin-ion repeatedly claim, for example, that women fall pregnant purely to accesssocial grants. The fact that, despite government AIDS denialism, there is broadconsensus in the national policy debate (including among social and fiscal conser-vatives) that people living with HIV and AIDS are deserving of sympathy andsupport is a key achievement of TAC and other activists.

Relating to the Political Environment

TAC was able to achieve this shift, and the policy change which it pro-duced, partly because of the way in which it was able to relate to the politicalenvironment—the opportunities and constraints which face social movements aredetermined not only by their own organising and strategic efforts but also by anexternal environment which can both open and close possibilities.




A popular formulation of this reality is that of social movement theorist SidneyTarrow, who proposes the notion of a “political opportunity structure,” which heexplains as “consistent—but not necessarily formal, permanent or national—dimensions of the political environment which either encourage or discouragepeople from using collective action.” The most salient changes in opportunitystructure result from the opening of access to power, shifts in ruling alignments,the availability of influential allies, and cleavages in and among elites. State struc-tures create stable opportunities, but it is changing opportunities within stateswhich provide the openings that “actors can use to create new movements.”133

This helps us understand the circumstances in which social movements mightflourish and those in which they might wane.

The key change in the political opportunity structure facing TAC is democrati-sation since 1994. This opened up opportunities by removing the threat of repres-sion from some types of collective action—and by creating potential opportuni-ties for influence which did not exist previously, such as use of the constitutionalcourt or engagement with government. Collective action did not first become pos-sible in 1994—indeed, increasing space had opened up as the apartheid system’spower waned in the 1980s. But it is trite to point out that, as the society liberalised,the costs of collective action declined.

In the decade before 1994, the key constraint TAC might have faced was notstate repression but pressures from within the anti-apartheid struggle. “Therecould have been a TAC without the transition. But our space to operate and ourrole would have depended on ANC politics at the time.”134 While issue-basedactivity did form part of anti-apartheid activity, there were expectations that it bepursued in a manner which could be seen to advance the fight against the system.It is therefore likely that TAC would have been expected to link its activity to thewider problem of apartheid. Also, strategy would have been affected: even if itcould be demonstrated that opportunities for influence existed within an apart-heid state, TAC would have faced pressure not to bestow legitimacy on the system.This does not necessarily mean it would have been prevented from taking oppor-tunities presented by it: the union movement did this throughout the “struggle”period. But it would have been required to adopt an adversarial attitude to the stateeven if, for tactical reasons, it used some of its institutions. In the event, formingsomething like TAC did not arise as a possibility during the anti-apartheid “strug-gle” period because, in the heat of the battle against apartheid, attentions werefocussed elsewhere.

As implied earlier, however, TAC activists were able to use the experience ofthe anti-apartheid struggle as an asset. “Many of us have activist backgrounds andwe are doing old things in a new environment.”135 Even use of the courts is not anew strategy since anti-apartheid activism did use the law and the courts to seekspace to operate. This may have helped TAC to see the constitutional court, whichis interpreting a rights-based constitution and is thus a much more fertile source of




support, as a strategic resource: “We have taken advantage of the Bill of Rights towin gains.”136 Its victory on mother-to-child transmission is seen as a “break-through” which has “forced the government’s hand” by establishing a legal prece-dent.137 The court is seen as a continuing resource to be used if the promised ARV“rollout” does not materialise: “[T]he government is afraid of the constitutionalcourt.”138 Use of the court is, like many other TAC strategies, a case in which tac-tics forged in the fight against apartheid are used in more hospitable circum-stances after its demise. While a social movement activist accuses TAC of over-reliance on the law, echoing criticisms that using the courts detracts from popularmobilisation, he acknowledges that “TAC has managed to find a balance betweenthe legal (in the courts) and the masses in the streets.”139 Using international soli-darity, broad alliances and civil disobedience also show continuities with tacticsunder apartheid. Unlike some other social movements, TAC was able to use its ac-tivists’experience to identify strategic levers which new circumstances presented.

An entirely new opportunity structure is obviously opened by the presence ofpotential allies within the government despite considerable conflict with it overARVs and AIDS (this would not have been impossible in the later stages of apart-heid but was obviously far less likely). TAC has allies as well as opponents withinthe ANC and the government,140 a point to which we will return. Another keyasset, the support of people who are strategically placed in society albeit not ingovernment such as Mandela, Anglican Archbishop Njongonkulu Ndungane,and Makgoba, are also products of a post-apartheid opportunity structure.

Perhaps TAC’s greatest political opportunity, however, was the strong rightsambience which has existed since the political transition began in the mid-1990s.The peculiar circumstances of the transition made rights an unlikely point of con-sensus in a society with no experience of protecting or respecting them: majorityleadership had won freedom partly by effectively using the language of rightswhile minority leaders saw an entrenched rights regime as a crucial protectionagainst majority rule.141 This created an opportunity for groups whose demandsmight have been unpalatable to social conservatives but which could not beopposed without violating the rights consensus—women’s and gay and lesbiandemands particularly. The ANC is particularly sensitive to being accused of lackof sympathy for rights—since apartheid was synonymous with the denial ofrights, and the key stated project of the new political class is to create a societyfundamentally different from apartheid, rights-based demands are particularlypotent. This potential asset was effectively used by TAC and other AIDS cam-paigners to legitimise their demands.

Democratisation has, however, also created new strategic challenges for socialmovements. Not only has apartheid’s disappearance reduced incentives for col-lective action by citizens (by, of course, removing a key reason for mobilisa-tion). Support for campaigns by most citizens can no longer be assumed: winningand retaining public opinion matter in a way which they did not during the anti-




apartheid struggle when broad support could be more easily assumed. The legiti-macy of the government and the popularity of the ruling party are also new re-alities which activists tackling government policy forget at their peril: “A majortactical error would be to lose support among our members as other social move-ments have done when they are seen to threaten democratically elected lead-ers.”142 TAC seems unusual among social movements in its awareness of this issueand appreciation of the need to change strategic calculations to accommodate theenvironment created by democratisation. This is best demonstrated by its civildisobedience campaign undertaken in 2003 in response to the government’s fail-ure to sign an agreement at the National Economic Development and LabourCouncil (Nedlac)143 agreeing to an AIDS treatment plan.

To Defy or Not?

“Civil disobedience was a difficult decision,” Mthathi recalls,

because it is historically a tool that was used against government—but not a governmentmost people support. There was some internal debate as to how it would work for us. Therewere fears that it would make us politically vulnerable if we seemed anti-government.144

The campaign also prompted tensions between the “middle-class” component ofTAC and the grassroots.145 A key TAC ally, Cosatu, did not participate. TAC’sunderstanding of this decision was that “[t]hey felt it would leave a bad impres-sion with the international community and may affect voting in the next elec-tion.”146 Cosatu’s view was that it could not participate because “[w]e felt that ourmembers would see this as an attempt to overthrow the government. It also placedthem at risk if they participated.”147 Both within TAC, therefore, and for a key ally,decisions which would have been straightforward before democracy’s adventbecame complicated under democratic conditions.

The decision to undertake civil disobedience was taken ultimately becauseTAC leadership judged that the campaign could be justified and conducted in away which would not lose it the moral high ground. Part of this was demonstratingthat the decision to disobey was not taken lightly:

We were forced to enter into a civil disobedience campaign because we had exhausted allother means—it was an extreme step and we did not take it lightly. How can you have civildisobedience against a legitimate government? We recognise the legitimacy of the stateand are fully prepared to take the consequences of breaking the law. We decided to renamethe civil disobedience campaign a mass protest to accommodate Cosatu. We also held offour first planned civil disobedience at the request of [then-]deputy president Zuma in thehope that a Nedlac meeting would resolve the dispute. TAC has worked through the HumanRights Commission, Gender Commission and the courts and, given that, civil disobediencewas seen as a good strategy to embarrass the government and make a moral statement.148




Similarly, “It was seen as the final resort. Lobbying and picketing had achievedonly so much—[later] the campaign was suspended to give the government timeto decide what to do.”149 It was essential that the campaign be conducted in a man-ner which would show that TAC behaved nonviolently and that its activists wereprepared to accept the consequences of defying a legitimate legal order. Anyonewho wished to opt out could, and people aged under 18 had to have informed con-sent.150 Later, the campaign was called off to allow the government to respond.The methods used were also consistent with TAC’s concern to build bridges byseeking perhaps unlikely sources of support: “[W]e found ourselves engagingwith police officers on HIV issues in their families and communities.”151

The calculation appears to have been vindicated: TAC credits the campaignwith achieving the cabinet decision to “roll out” ARVs (although the evidence insupport of this is inconclusive).

The campaign was certainly very successful—it gave the people a voice and made themfeel as though their message was being heard, it was an outlet for people’s grief atdeaths that had affected them and it was a symbolic statement—it brought allies out ofthe woodwork.152

“It was a definite success in that it gave TAC a voice.”153 More than 600 peopleparticipated.154

The disobedience campaign did TAC little harm and perhaps much goodbecause it showed that a mobilisation campaign which formally broke the lawcould advance its interests in the new environment provided it was sensitive topublic opinion and the norms of the new constitutional order. It does seem to showtoo that, if the need to retain the support of a key set of allies and to win a measureof public support is taken seriously, social movements can win significant gainsunder democratic conditions without sacrificing the popular mobilisation whichis their lifeblood.

TAC and the Government

While the relationship between TAC and the government has often been con-flict-ridden, the way in which the movement has managed this interface may be acrucial element in its success.

Where a political system is irrevocably hostile to social movements and theirdemands, the relationship will be adversarial—as were relations between theapartheid state and resistance organisations. In these circumstances, even wheremovements are willing to use the levers provided by the system to win incremen-tal gains, this is unlikely to lead to a cooperative engagement with government orthe state: it may equally well produce what students of the labour movement—aprime example of this phenomenon—have called “militant abstentionism.”155




Some current social movement approaches seem to exhibit something of thisflavour. The state is seen not as an opponent but an enemy,156 the system not as asource of opportunity and rights to participate but of inequity.157 TAC’s approach,however, assumes a more complicated relationship in which both cooperationand conflict are means of engagement—in which it is possible for both to be em-ployed at once. And behind this lies an assumption that “we can win gains fromthis system—far-reaching reform is possible.”158

This is particularly so since the Cabinet’s decision to allow an ARV “rollout.”Ensuring that it is implemented is repeatedly stated as a key goal by TAC activists:“TAC’s current goal is to assist government in making the rollout a success.”159

The main programmes for 2004 are making sure the ARV rollout is a success, that there areeducation campaigns promoting prevention of HIV, that there are literacy campaigns aboutHIV and that enough support groups for HIV-affected people have been established.160

Much TAC activity is devoted to this task. Site visits are planned to hospitalsearmarked for “rollout” to see if they are equipped with staff and equipment tosustain it. Branches’ capacity is being strengthened to ensure that they can play arole in the “rollout.” A further goal is to ensure that people living with AIDS areaware of the ARV programmes and how best to make use of them. A further planis to recruit treatment practitioners from TAC branches who will be based at“rollout” sites to look at the quality and level of information provided to people inthe area on ARV treatment and access to it, and to liase with “community struc-tures in the area such as schools and churches” to provide information and pro-mote openness about HIV status and to attempt to remove stigma in the hope thatpeople will come forward to be treated. They will also make people wanting treat-ment aware of their rights and obligations created by the “rollout.”

TAC’s statements on the “rollout” have repeatedly insisted that it sees itself asan enthusiastic government partner in this venture. One TAC official notes that, byensuring that people know where to access ARVs and how to use them, TAC willbe providing a service to the government.161 Another talks of plans to establish anAIDS forum of NGOs, local government, and provincial government to “worktogether to make rollout a success.”162 But it would be misleading to see this asstraightforward enthusiasm for cooperation. While one critic suggests that “join-ing with government to provide ARVs” will cost TAC its independence and turn itinto “effectively a parallel structure to the state,”163 TAC and senior governmentleaders are well aware that the “rollout” is not the unfolding of a voluntary govern-ment strategy but a reluctant response to pressure: “[T]here seems to be no realpolitical will from government on HIV treatment.”164 Certainly, some in the ANCand in government favour a “rollout” and did so when official policy was opposedto it, but the circumstances in which it became a reality mean that there is con-siderable resistance from within government to implementing the policy change.




TAC activists believe this is most evident in the attitude of the health minister andsome provincial MECs (ministers) for health.165

Nor has the government displayed any great enthusiasm for a working partner-ship with TAC. It was initially excluded from the SA National AIDS Council(SANAC) established by the government to advise it on AIDS. Now, severalSANAC members are leaders or sympathisers of TAC but only because the gov-ernment no longer appoints members but allows sectors to choose their represen-tatives.166 (As a result, Tshabalala-Msimang is said to want to close down SANACbecause it is now too sympathetic to TAC; a view in government suggests thatTAC has “monopolised” SANAC).167 It was—not surprisingly, in the view of TACleaders—excluded from the government task team established to direct the “roll-out”: “We did send a response to their findings—needless to say we did not re-ceive a reply.”168

TAC was not part of the task team because it was a centralised plan from the department ofhealth. Government still wants control over everything on the HIV/AIDS issue and its rela-tionship with TAC is still conflictual. TAC did try to engage with the task team but to noavail.169

Given this, TAC’s intention to make the rollout succeed is less an attempt atpartnership than a determination to hold the government to its stated intentions.This could entail further campaigns, confrontation, and court action.170 “We willalways have to put pressure on government to carry out its promises—if there isno rollout as promised, we will explore litigation, civil disobedience, interna-tional mobilisation and embarrassing the government.”171 It might be accurate,therefore, to see it not as an abandonment of mobilisation for change but as anintention to mobilise on a new terrain. TAC leaders acknowledge, as many move-ments which have campaigned successfully for policy changes know, that whereconcessions are reluctantly made to campaigns by governments, ensuring that theauthorities do what they say they will do is as much a challenge, if not more of one,than winning the concession. Cele notes,

In the longer term TAC must have a role in making sure the ARV plan is initiated and sus-tained. If you look at the 2001 court case on nevirapine you can see that although thingshappened after that, they happened very slowly—TAC needs to make sure that there aren’ttoo many delays and that the programme is expanded beyond urban areas.172

That said, its strategy on the “rollout” does indicate an approach to engage-ment with the government unusual in South African social movements. TAC’sprimary goal is not to help the government but to ensure ARVs for people livingwith AIDS. But while this may entail a continuation of campaigning, it cannot beonly that: the exercise will entail significant elements of cooperation as well asconflict, for no “rollout” will be possible without that. And, when authorities do




respond to the campaigning, or simply act on their own initiative, to further the“rollout,” TAC’s activities become an important resource to them. Just as the Min-istry of Social Development has discovered that mobilising civil society organisa-tions can be an effective way of ensuring that people access the social grants towhich the law entitles them, so might a politician concerned to ensure effective“rollout” come to see TAC as a resource.

This has two important implications. The first is that making sure that conces-sions won by campaigns translate into concrete gains poses significant challengesto social movements and civil society organisations concerned to win gains ratherthan to act only as vehicles of protest or resistance. Having committed themselvesto securing a realisation of stated goals, they develop a stake in effective govern-ment implementation. The delicate strategic challenge of knowing how to com-bine cooperation and conflict, partnership and challenge, poses far more compli-cated dilemmas than the politics of winning the concession.

Second, social movement activism can be an important resource for govern-ments—even if they do not endorse Achmat’s view that “criticism is the best formof loyalty.”173 But this is only, of course, if they share a desire to achieve the goalschampioned by the movements—in particular if they share a desire to tackle inter-national economic inequalities—and are able to acknowledge that independentactivism is not only a threat but also an asset. It is worth recalling here that oneof TAC’s most significant triumphs was helping the government beat back theattempt by pharmaceutical firms to overturn a law allowing the importation ofcheaper generic drugs. There may be some government leaders and officials whosee TAC as a useful partner as well as a sometime adversary. But the lack ofresponse from the task team shows that this is hardly a universal view. And to theextent that it is not, the government does seem to be depriving itself of an impor-tant strategic resource. There is also evidence that the government vastly exagger-ates the threat posed to it by social movements—a senior politician is said to havetold TAC activists that it feared being overthrown by TAC’s campaign!174 Thegovernment, suggests an activist, “sees TAC as political competition.”175 Thismay well reflect a wider government fear of left and “populist” movements whichcauses it to overstate their potential power.176 While this may make it possible formovements’demands to be taken seriously even when they have little support, it isa substantial constraint to cooperation.

It is also important that, while the offer to “help” government does not elimi-nate the adversarial features of the relationship between the two, TAC’s desire tosee the “rollout” work is genuine, for it gains little if government fails and much ifit succeeds. The incrementalism which TAC pursues, does, therefore, create a realand perceived interest in strengthening government which is hardly universal tosocial movements. Mthathi observes,

TAC’s relationship with government will always be difficult. We are dealing with a life anddeath issue—it is urgent and there are no perfect solutions. But we would like to be engag-




ing more constructively: we will never compromise our principles and we require that it betransparent. But it is a result of our lack of engagement with government that we have hadto resort to other methods to make them listen to us.177

Far from seeing the pursuit of treatment for people living with AIDS as a means ofexposing the weaknesses of the system, TAC tends to see government unwilling-ness to see the potential of partnership as a regrettable constraint to the search fortreatment, not a political opportunity. As long as TAC relies on government deliv-ery to achieve its goals, it and the government will remain, to a degree, mutuallydependant, whatever the degree of conflict between them.

As noted above, TAC does not see the government as a monolith and does haveallies within it—even though Mthathi suggests that it is important to recognisethat, without President Mbeki’s personal support for a policy, “nothing will hap-pen.” But within that constraint, it does enjoy better relations with some seniorpoliticians and officials than others and has sought to lobby sympathetic cabinetmembers, even during periods of open conflict with the government.178 Severalinterviewees suggested that relations with their provincial health departmentswere good, “but this is not the case in all provinces.”179 KwaZulu Natal’s then-premier held an AIDS Indaba (consultation or discussion) which TAC was invitedto address.180 In some cases, provincial health departments have attended to prob-lems brought to their notice by TAC.181 Other examples of provincial govern-ments seeking TAC’s help are also cited. In some, this is explicitly contrasted witha tense relationship with national government.182 This is further evidence of astrategy based on using every possibility for engagement with the government,whether the mode is conflict, conversation, cooperation, or all of these simulta-neously. The strategy clearly presents challenges: “[O]n the one hand we areoffering help to the minister of health and on the other we are saying that sheis mad.”183 But influence does seem to depend on finding the balance, not onrefusing to seek it.

TAC’s mode of engagement with government, in which cooperation and con-flict are, in a sense, deeply intertwined, is not simply a strategy born of con-venience. It also reflects an approach which recognises that democratic gov-ernments, while they enjoy access to power which could be used against thegrassroots, are also elected by the majority of voters and so cannot simply be dis-missed as “enemies of the people.” TAC’s approach does appear to recognise thatalliances with democratic government are possible and that cooperation and con-frontation can be complementary strategies. The assumption that a democraticgovernment is always hostile to popular aspirations neglects its need to getreelected—a reality which creates opportunities for influence for movements ableto win popular support.

In sum, TAC has managed its relationship with government so as to makeuniform opposition unlikely—by differentiating between allies and opponentsin government and by seeking to strengthen the former while confronting the lat-




ter. It has also constantly offered itself as a resource to government where theirinterests coincide, opening to government decision makers with an interest inaddressing the HIV/AIDS challenge the possibility that TAC, while sometimes anopponent, can also be a vital resource.

The Politics of the Moral High Ground

TAC’s senior leadership readily acknowledges that it has not won major gainsbecause of organised strength in numbers. While it has a larger membership and amore organised structure than many other social movements, its leadership andactivists in other movements insist that its power—and that of other social move-ments—lies elsewhere. But where? Often, the claim that other sources of strengthare more important to social movements than numbers lacks a clear statement ofwhere that strength might lie.

Achmat, however, is specific on TAC’s prime source of strength—morality.

TAC is not a numbers game. It is more about the ability to create a moral consensus. Thebutton we were aiming to push (in planning civil disobedience) was that the governmentwas morally weak. Morality is usually left to the churches but we all have a duty to bemoral. The left needs to give a sense of morality to politics.184

Morality is thus both a desirable principle and an important strategic weapon. The“politics of the moral high ground” is a key resource for TAC because winning themoral argument gains a movement and its cause substantial support and weakensthe case of its opponents, in this case the government and pharmaceutical compa-nies. A company executive notes, “Whatever we might feel about their campaign,TAC and other activist organisations did persuade us to see the need for a middleground between our need for returns on investment and the poor’s need for medi-cation.”185 While he insists that the companies were persuaded by the argument,not embarrassed into making concessions, and the government has resolutelyinsisted that the “rollout” was not a change in policy,186 TAC activists and mostanalysts assume that in both cases, moral embarrassment played a significant rolein winning change.

The realisation that morality is a strategic resource can be missed in assess-ments of the strategic resources of social movements and civil society organisa-tions. Analyses which assume an irreconcilable conflict between those who haveand those who do not, those who wield power and those over whom they wield it,imply that the weak can gain power only by forcing the powerful to concede it.Even if a compromise is considered possible, redistributive politics can be seenpurely as a matter of strategic calculation, as a “game” in which actors use theirstrategic resources to wield power over their opponents.187 This does not automat-ically exclude the possibility that the powerful may be induced to give groundbecause they have been persuaded that their policy is morally untenable—a key




tenet of the Gandhian perspective. But it tends to obscure it and to encourage amode of thinking which sees redistributive gains purely as a consequence of theeffective use of power by the powerless, or the powerful making concessions tohead off worse outcomes, or both. TAC’s experience suggests that the ability topersuade a range of audiences that the actions of a power holder are immoral isitself a vital source of power.

At first glance, this is trite: all movements which make redistributive demandsseek to portray the denial of these demands as immoral. The difference, however,lies in the way in which morality is understood and, therefore, the uses to which itis put. If redistribution can be gained only by rallying the powerless to seize powerfrom the powerful, movements might see morality as a convenient “weapon”which can rally their constituency to their cause (since other social interests areassumed to be beyond moral appeal): in this case, morality would seek to per-suade poor people living with HIV and AIDS that they ought to support TACbecause the government for which they vote is behaving “immorally.” But in thisview, morality is a tactic aimed at a specific audience and is not central to themovement’s manner of operating.

TAC’s objective has been far more ambitious—to create a “moral consensus”behind its demands.188 This assumes that it is possible to win support for a demandamong a variety of constituencies, including some which may be seen as hostileto redistribution, by using moral argument. Thus a government could be mor-ally weak because many of the important constituencies on which it relies—international business or key domestic constituencies across the political andracial divides—are persuaded that its conduct or position on a particular issue isimmoral. Being seen as immoral may also be damaging not because it creates anobstacle to a strategic goal but because human beings prefer not to feel that theiractions are immoral—why else would authoritarians insist on surrounding them-selves with people who continually assure them that they are moral? The TACapproach advocated by Achmat assumes, therefore, that it is possible for a smallorganisation or movement with limited organisational power to compensate forthese constraints by appealing to a sense of compassion and fairness which is heldto cross many of the social barriers which are often assumed to impede a commonmorality. Since morality in this view is an indispensable strategic resource, it mustbecome a permanent and indispensable element of the movement’s campaign, nota tactic to be used or discarded depending on circumstance—or deployed toappeal to some constituencies but not others. Paradoxically, then, morality may bemost effective as a strategy only when it is not seen as a strategy, but as an indis-pensable element of a struggle for rights or entitlements.

This perspective has important implications. If morality is an integral part ofhow a social movement operates, then it needs to become an essential feature ofall activity—from financial management and commitment to internal democracyto the way in which campaigns are designed—since losing the moral high ground




would be to lose one of the movement’s reasons for existence. This means accept-ing constraints which do not apply when morality is seen only as a useful strategicdevice for occasional use. One example is Achmat’s decision not to take ARVswhile other people did not have access to them, a decision which threatened at onestage to cost him his life. In his view this is one of a number of cases which demon-strated “a distinct tension between morality and strategy.”189 Not taking medi-cation obviously weakens the activist who does not take it, but the decision wastaken despite this to make a moral point (although this does not seem to have beenfollowed as a consistent point of principle: a key reason why TAC introduced itsnational treatment project which provides a limited number of people with ARVswas “to prolong the life of TAC activists and take care of them”190).

The politics of the moral high ground requires that tactics be evaluated not onlyby whether they enhance the movement’s coercive power—its ability to force oth-ers to do what it wants them to do—but also by whether they will retain the “moralconsensus” which underpins TAC’s work. “How do we build a moral consensus?By knocking on doors, educating and drawing people in. Tactics which show mil-itancy but alienate people destroy that consensus.”191 As the debate over the civildisobedience campaign shows, this does not mean avoiding all militancy. But itdoes mean that action must be morally justifiable—and to far more people andconstituencies than the core of committed activists. Thus one activist notes thatTAC’s first step in fighting a campaign would be to communicate with govern-ment. “If this didn’t work we would consider litigation and, failing this, we wouldturn to demonstrations and protest.”192 Showing that all other avenues had beenexhausted and ensuring that Gandhian tactics were used—breaking the law in anopen and nonviolent manner and inviting arrest—are seen as essential means ofretaining the moral high ground.

Certainly, some issues are more amenable to the politics of the moral highground than others, and health issues are among them. Pharmaceutical executiveKevin McKenna observes,

Business is far more vulnerable to moral attack on medicines and health than any otherissue. Many people see making a profit out of illness as immoral, no matter how much weshow that without us people would not have effective medicine.193

But, given the constraints to building a moral consensus noted earlier, the TACapproach may be more replicable than this criticism acknowledges.

Certainly, the TAC experience shows only that the politics of the moral highground can be effective in winning single-issue demands, not wider redistribu-tive programmes. But there are few demands for greater equity on which moralappeals are likely to be ignored by everyone except a social movement’s constitu-ency. The moral high ground may, therefore, be a resource available to socialmovements on a very wide range of issues, as long as each is approached sepa-rately. This also implies a need for social movements to engage in strategic think-




ing on potential recruits to a moral consensus—and, more broadly, to analysepotential for recruiting allies beyond their normal constituency for particulardemands.

One important qualification is necessary. The rights-based consensus withinthe new South African policy elite was a crucial element in TAC’s success. It wasable to build a moral consensus because it understood that rights appeals in thepost-apartheid environment had a powerful salience. While other social move-ments sought to use the rights consensus as at best a bludgeon with which to beatthe new order—or ignored it altogether—TAC saw it as a means of building sup-port. While others saw it as best as a means of delegitimising the new order, TACmade gains by legitimating those aspects of that order’s moral self-understandingwhich opened up new possibilities for winning sympathy. This tactic could not beused in environments in which rights language was not so obvious a potentialsource of embarrassment—but South Africa’s is hardly the only governing elitevulnerable to claims of ignoring rights, suggesting that this approach may havemore general application.

Thinking Alliances

Allied to the politics of the moral high ground in TAC’s armoury is a stress onalliances as a means of pursuing its strategic agenda.

At first glance, there seems nothing exceptional in this: deciding that a cam-paign would be more effective if it is fought with others seems a fairly elementarystrategic step. But alliance politics is not simply a matter of gratefully acceptingthe support of those who happen to agree. It requires, firstly, rejection of a purismwhich insists on working only with natural allies: it assumes that common groundcan and should be found with those who differ as well as those who agree. Sec-ondly, it needs an acknowledgment that alliances—like morality—are rarely cost-free. Where it entails reaching out to those who have different interests or goals,the politics of alliances requires compromises. In TAC’s case, this is so even in thecase of a like-minded ally such as Cosatu, whose unwillingness to support civildisobedience disappointed some in TAC: “It was disappointing that Cosatu didnot support the civil disobedience campaign, but perhaps not surprising.”194 “Wealso have a relationship with Cosatu but we were hoping they would partner us.”195

“The drawback of this alliance is that there may be pressure on us to adopt differ-ent strategies than we see fit such as the civil disobedience campaign.”196 Never-theless, concessions were made to Cosatu to retain it as an ally. The campaignwas, according to Cosatu, called a “protest” in an attempt to dispel the impres-sion that it was a rebellion against government authority, and it was agreed thatCosatu’s failure to participate would not jeopardise the alliance,197 which contin-ues despite the reproaches against Cosatu: “The most important of TAC’s alliesare from the labour sector—Cosatu with its two million members.”198




The TAC-Cosatu alliance is, despite this tactical differences, a natural “fit,”given the similarity in approach and style of organisation, and given that Cosatu’smembers are affected by HIV/AIDS and it has a strong incentive to press for anARV “rollout.”199 TAC activists also cite predictable allies such as NGOs andcommunity-based organisations,200 the SA Council of Churches and SA NGOCoalition (SANGOCO), the Medical Research Council which is a “technicalally” whose role is to supply information,201 the SA Medical Association, andnursing unions. But one ally, the counselling group ACCT based in Soweto,turned out to be financially supported by a drug company.202 TAC’s view is that,since ACCT is a service organisation, it has no objection to it taking money fromthe drug companies and will work with it despite that.203 And there are allianceswhich required adjustment on each side—such as that with the Catholic Church,which is opposed to condoms, considered essential by TAC to curb the spread ofHIV/AIDS. In this case, the alliance acknowledges difference rather than tryingto end it, and seeks cooperation despite this. Alliance politics do not mean sup-pressing “controversial” opinions—Mthathi has insisted on raising the occupa-tion of Iraq in donor meetings,204 and Achmat called for the defeat of PresidentBush at meetings in the United States.205 But in some cases, it may be necessaryfor TAC to adjust its actions and strategies to maintain allies. Achmat insists thathis activist past taught “the development of united fronts despite differingviews.”206 Cooperation with international allies, discussed below, has surviveddespite clear differences. The concern to form alliances seems to have becomeingrained in TAC’s manner of operating: in Khayelitsha, outside Cape Town,local organisers plan to “engage the community” by seeking cooperation withyouth groups, religious organisations, schools, and business.207

The politics of alliances requires more than deciding which civil society orga-nisations are potential partners. It was noted earlier that some politicians and offi-cials were TAC allies, even when TAC was in conflict with the ANC and the gov-ernment: “[W]e have sympathy for our cause from some senior executives inAnglo American Corporation as well as half the cabinet.”208 These alliances mayrequire compromises to ensure that the ally is not forced to withdraw support. Themedia have been a substantial resource to TAC which “makes good use of themedia.” This enhances capacity to raise funds, gather support, and “counter anypropaganda.”209 The media are also seen as a potential support for the “rollout”:“We are working on educating the community, we plan to use the media.”210 Thecivil disobedience campaign “received a lot of media coverage both local andinternational and for the most part the media stayed on TAC’s side.”211 And asocial movement activist who is critical of TAC on several grounds says a positiveaspect of its performance has been its ability to use the media to highlight its con-cerns—which social movements campaigning against water and electricity cut-offs have failed to do. “TAC has managed to keep the media on its side—evenwhen they brought in those drugs illegally, they got media support for their




cause.”212 While the media are not a formal TAC ally, strategy presumably doesneed to take into account a need not to alienate them.

A penchant for alliances does not mean working with everyone on any terms.TAC, particularly in its initial phase, fought some heated battles within the spec-trum of AIDS organisations and activists gathered in the AIDS Consortium toestablish treatment as a key goal against those who favoured an exclusive stress onprevention. “We had to create a demand for treatment. There were some fiercefights with people in NAPWA and some of the academic specialists.”213 TAC isalso accused of refusing to work with other social movements because it fears thattheir militancy will jeopardise its attempts to build a winning coalition—eventhough they do see TAC as a social movement and support its campaign.214 TACinsists that it is not afraid of their militancy but believes that their tactics andapproach will not yield change. It insists that it, not they, mobilised some 3,000people to march in support of a Basic Income Grant.215 Almost by definition, alli-ances entail conflict and cooperation, a strategic appreciation of who, on anygiven issue, is an opponent as well as an ally.

TAC leadership seem to approach issues in a way which can best be describedas “thinking alliances.” This means that indispensable to the planning of any cam-paign is considering where support can be sought from significant constituencies,including unlikely ones. Thus, one rationale behind the proposed People’s HealthCampaign is the expectation that the middle class has a strong interest in healthreform and that the campaign will therefore attract mainstream support as well asinevitable opposition.216 Whether or not this judgment is vindicated, it demon-strates an approach which starts from the assumption that, without the support ofkey constituencies in the society, a campaign is likely to be pushed to the fringesof the policy debate. Chances of success, therefore, depend to a considerableextent on whether it can avoid relegation to the margins by attracting the supportof influential social groups. Absolutely indispensable to this is a refusal to assumethat a constituency is beyond the reach of a campaign unless thorough analysisindicates this—as well as the already mentioned avoidance of purism in selectingor rejecting allies. And this assumes a politics which does see the winning ofparticular issues and demands as desirable.

This propensity to “think alliances” is particularly important when we con-sider current constraints to redistributive politics. Mainstream development ap-proaches, by insisting that anti-poverty programmes be targeted at “the poorest ofthe poor” so that “the non-poor” do not benefit, politically isolate the poor by cre-ating conflicts over resources between them and the less poor. This prevents theformation of broad alliances in support of redistributive programmes.217 In a con-text in which the poor and marginalized lose potential influence when they areisolated from other social groups, strategies designed to strengthen the voice ofthe poor are likely to do this only if they can transcend isolation. The more cam-paigns for social equity are restricted to weak sections of society forced to act on




their own, the likelier it is that they will be ignored. Since none of the constituen-cies pressing for equity are majorities, only alliance formation can assemble thesocial coalitions necessary to win gains. In principle, at least, TAC, by “thinkingalliances,” is opening new potential frontiers for effective social action againstinequality by raising the possibility that, on most or perhaps even all issues, thosecampaigning for change can find allies and so make a seemingly unwinnablecampaign a success. While the “classic” days in which the poor, organised intotrade unions and labour parties, could win adoption and implementation of re-distributive social programmes by forming durable electoral alliances with othersegments of society218 may be over, issue-based alliances may be more possiblethan they seem. The TAC experience also suggests that social movements that donot “think alliances” are likely to remain isolated and weakened.

TAC’s advantage over many other social movements is its willingness to seealliances as a pragmatic strategic question rather than one of principle, opening itto possibilities which remain closed to others. This too has played a role in win-ning it gains in a potentially hostile environment.

Hands across the Sea: The International Dimension

As suggested above, TAC’s most strategically important alliance may wellhave been that with international allies.

International support seems to have been important in two ways. First, itplaced pressure on multinational pharmaceutical companies because their headoffices abroad feared being portrayed in public as irresponsible or unsympatheticto the poor.219 Second, it may well have raised the costs of refusing to endorse a“rollout” to a government concerned to win foreign approval: unsubstantiatedclaims suggest that pressure from northern governments played a major role inpromoting the Cabinet’s policy shift. Whether or not that is accurate, the fact thatTAC and other organisations ensured international opposition to government pol-icy on ARVs must, given the government’s sensitivity to international opinion,have played a role in winning the “rollout.” “A background in Trotskyite activismtaught an understanding of international solidarity,” according to Achmat.220

This dimension is important because, while globalisation is frequently seen asa constraint to collective action in pursuit of equity, it may be far more of a poten-tial resource than a fetter. The claim that states are now unable to chart their ownsocial and economic policy directions lacks compelling evidence.221 However,advances in communications technology have ensured that ideas and informationcan travel the globe more quickly than ever before, and one effect is to make possi-ble alliances between local and international civil society organisations which cancause considerable embarrassment to company executives. An environment inwhich a company official can be faced with immediate unfavourable publicity inAmerica and Europe because of actions in Africa is one which offers considerablescope for activists. International solidarity has also strengthened TAC by expos-




ing it to information which it has been able to use to campaign more effectively:“International solidarity has been important because through e-mail and Internetwe came to know about things like parallel importation and compulsory licensingwhen we came into contact with organisations like Consumer Progress and Tech-nology USA.”222 International solidarity has also been a pressure on the govern-ment which has faced campaigning at its embassies by TAC allies.223 A key fea-ture of international alliances in the era of electronic communication is that theycan be sustained without using significant resources—“[W]e don’t need a directpresence abroad to build international support.”224

TAC’s most consistent international ally has been the Belgian-based NGOMedicins sans Frontieres (MSF), which, with the activist group Act Up,

were putting [former U.S. President Bill] Clinton and then [SA President] Mbeki underpressure, not just about AIDS programmes but also about health issues in general. Alsoorganisations such as Gay Men’s Health Crisis and the Treatment Action Group actuallyran workshops for us, making the science of the virus user friendly.

MSF’s role was particularly significant because it runs continuing treatmentprogrammes in South Africa: “Organisations like MSF not only began to distrib-ute condoms but also began to run HIV programmes placing people on ARVs—this went a way to lifting the stigma of HIV/AIDS too.”225 International coordina-tor Njogu Morgan insists that this is not a “one way relationship”—TAC is able to“share our experiences and lessons and so strengthen what our international part-ners are doing.”226

But international alliances are also not cost-free. Just as the anti-apartheidresistance discovered in the early 1990s that its international allies felt that theywere entitled to a veto over strategic compromises, such as the African NationalCongress decision to lift sanctions in the early 1990s, so, it appears, did some TACallies.

On occasions our allies seem unaware of strategic realities here. When we agreed with twodrug companies on a formula which made cheaper medicine available while recognisingsome of their concerns we were accused of compromising unnecessarily. Our allies said weshould have taken them to the competition tribunal.227

TAC leadership insists, however, that it does not allow alliances to erode its auton-omy: “We are always careful in our contact with international organisations tostress that we are debating and involving ourselves in issues as equals and we arenot being told what to do.”228 Support for this claim is provided by the fact that,like the ANC in the 1990s, TAC has ignored its international allies’ strategic per-spective and has made the compromises they oppose. And, while at least onecross-national alliance did collapse as a result of strategic differences, mostcontinue despite them.




Currently, TAC is seeking to broaden its international base by giving priority tostrengthening a Pan-African network of AIDS treatment activists. Passing onexperience in coalition building is one key goal since it believes that, in manyother African countries, treatment activism is restricted to people living withHIV/AIDS and that this isolates it and renders it ineffective. One rationale for thisis a recognition of a need to share its experience and resources with activists else-where on the continent: “There is an emotional bond between us. This countrydoes owe a lot to others in Africa.”229 But solidarity, whatever its motive, doesalso enable pressure for treatment to take on a regional dimension, potentiallystrengthening TAC’s bargaining power. The network does not restrict itself toencouraging campaigning in particular countries; it engages the secretariat ofthe Southern African Development Community (SADC), as well as the AfricanUnion, potentially creating new momentum toward treatment in South Africa aswell as other countries. And the regional focus does concentrate on internationalequity issues such as global trade regulation and its effect on the availability ofanti-AIDS drugs. South African trade negotiator Xavier Carrim “says that wehave made his life easier.”230

This last observation raises the possibility implied by TAC’s role in deterringthe pharmaceutical companies from seeking legal protection against legislationallowing generics to be imported—that the activism of social movements can bean asset as well as a challenge to African governments, strengthening their abilityto press for a fairer international economic order. While there are few examples ofgovernments seeing independent activism as a resource, “it is too pessimistic tosay that activist-government cooperation is impossible,” Morgan insists.231 Activ-ists are, for example, engaging African parliamentarians on health policy. Pros-pects of a productive relationship depend significantly on the degree of democra-tisation in particular countries—prospects of a “constructive” relationship withAfrican governments are thus most pronounced in Kenya and Ghana.

In sum, international activism remains a key resource for TAC—one which haswon it significant gains. But cross-national activist networks, while they havewon gains on specific issues such as extending treatment for people infected withHIV/AIDS, have not managed yet to make substantial inroads into what are seenas structural inequities in the international system which militate against adequatetreatment for people living with AIDS in Africa. A campaign against the currentU.S. administration’s AIDS policy, which seeks to focus on AIDS within a muchwider context, may indicate that these issues are being pursued with increasedvigour.232

TAC and the Future: A One-Issue Movement?

This section has shown how TAC has been able to fight effectively for peopleliving with HIV/AIDS. But does it have a wider role? Do participants see it as a




vehicle for broad social change—or simply as a means of securing treatment forpeople living with HIV and AIDS?

Heywood insists that it is concerned “with the politics of health, not politicsper se.”233 Achmat is unequivocal: “We want to get medicine to people—we don’twant to cause a revolution.”234 Many activists and officials see TAC’s futurepurely as a participant in the fight for treatment for people living with HIV andAIDS,235 either by taking forward the fight for treatment or by, for example, “mak-ing sure that people who are HIV positive have access to their social grants so thatat least they can have sufficient nutrition.”236 “In the next 5 years or so, if therollout goes as planned, TAC will have a role as a social movement dealing withissues such as human rights related to HIV infected people, orphans and disabili-ties.”237 TAC is criticised by a social movement activist because it is said to refuseto place its campaign in the context of a wider critique of government macroeco-nomic policy.238 But this focus on immediate goals may accurately read the needsof many of its constituents, who see TAC as an instrument to win treatment, notbroader change. And it may read accurately a more general reality in social move-ments. Thus some activists note that the belief of some of their colleagues that par-ticipants in social movements share their left perspective overstates their “revolu-tionary” impulse. Most members of the movement, they suggest, simply seek theear of the government. Nor is to focus on HIV/AIDS alone necessarily to avoid theunequal distribution of power and resources: TAC leaders are convinced that theircampaign for treatment in itself addresses some of these inequalities—Heywooddescribes the 2000 initiative to import generic drugs in defiance of company pat-ents as “our first campaign on a structural issue.”239

But an expectation that TAC should play a broader role is also articulated bysections of the leadership. Mthati suggests that “the HIV/AIDS issue is an entrypoint for TAC, current problems with HIV/AIDS are symptoms of an ailing healthcare system. We want to ensure a better society and equality.”240 Achmat strikes asimilar note:

TAC is not a single issue campaign—we also deal with issues of governance, corporategovernance and domestic violence—our concern is wider than HIV treatment. We are aim-ing to reorder the health sector. We need to build a culture of complaint, we need to startasking for solutions, we need communities to become more active. We have a progressivesocial democratic vision and shouldn’t hide it.241

Similarly, “We could not win our demands if we were a single issue campaign.HIV/AIDS raises all sorts of other issues and we would not make headway if wewere ignoring them.” Nor is explicit political engagement ruled out. Thus, if theANC were to split, TAC might find itself in an alliance with that section which“offers alternatives.”242

Thus leadership notes that TAC has committed itself to a People’s Health Cam-paign: “TAC needs to start focusing on an improvement in public health care in




general.”243 Part of this intention is linked to its immediate concerns: “[R]oll outcan only really work in a good health care system.”244 But it is also an attempt toidentify with a wider agenda for change. TAC has thus also joined a trade unioncampaign to oppose importation of textiles.245 It organised, with the Basic IncomeGrant Coalition (a COSATU-led initiative to win social grants for all citizens), thefirst march for a BIG.246 Some activists believe its focus needs to be widened todeal with social security,247 partly because there are reportedly cases in which illpeople have been denied social grants.248 It needs, KwaZulu Natal Deputy ChairGugu Mpongose suggests, to mobilise people to claim grants and monitor accessto them.249 The idea that TAC may become part of a broader social justice coali-tion—presumably comprising sectoral, interest, and issue-based organisationsthat might pursue their particular concerns while uniting on broader issues—isalso articulated by some of its leaders.250 And some officials share a vision of awider role:

We are not just advocating HIV treatment. We are concerned with healthcare in general,our role now is to assist clinics, ease the burden on healthcare workers and then start to lookinto issues such as wages for health care workers, the brain drain, hospital services, nurses’attitudes.251

The perspective of TAC activists and officials shows that the dividing linebetween a campaign which aims to change the structure of society and one whichseeks only to win immediate gains is far more complicated than a simple distinc-tion between movements fighting for structural change and “single-issue organi-sations” content with the ordering of society might suggest. Single-issue cam-paigns may challenge the ordering of society if their goals entail a redistributionof power and resources. It could be argued that embarking on these campaigns,winning gains, and then building on these is the most feasible way to achievestructural change.252 But, as TAC leadership is well aware, the fight for treatmentfor people living with AIDS will not in itself end the poverty and powerlessness ofmany TAC participants. Whether an organisation such as TAC is capable of play-ing a role in addressing these wider inequalities is still far from clear—to its lead-ership as well as to those of us who observe it. And, while TAC is led by peoplewho harbour a vision of social change which goes well beyond treatment for peo-ple infected by AIDS, it does seem likely that, for the foreseeable future, thedemands on its time and resources placed by HIV/AIDS alone are likely to be sogreat that active engagement in a wider agenda may remain a sporadic and sec-ondary concern. TAC will continue to face pressures from outside its ranks forinvolvement in other issues. But it is also likely to continue to speak for those whoparticipate because they want progress on treatment for people living with AIDS.Ensuring that it does not lose its focus on the needs and expectations of its mem-bers will be a continuing challenge as its perceived mobilising ability makes it adesirable ally for those seeking support for other campaigns.




A NEW WAY OF DOING THINGS?

Is TAC a model for “new social movements”? That depends on whether it canbe seen as “new”—or, indeed, a social movement. For, if it is, in the eyes of some,the most successful of these movements, it is also different from most others.Activists in other movements say that the chief divide lies in its failure to situate itscampaign in a critique of government macroeconomic policy.253 Its frequent useof the law is also seen as distinguishing. It is criticised because it “seems to workwithin the corridors of power—it tries to be part of the [ANC] alliance. It is oftenin top level closed door meetings which may demobilise [its] base.”254 It is seen torely too heavily on “a bureaucracy of full time personnel who could become thedecision makers”255 and to distance itself from other social movements: “Theyseem to see us as wild troublemakers—they need to recognise that we could worktogether.”256

But the difference may be more fundamental than differing attitudes and posi-tions—it may lie in the reality that TAC, unlike many other movements, engageswith the post-apartheid system and accepts that rights can be won within it. To usethe law implies that it is not inherently biased against the poor and can offer themgains. To lobby politicians implies that those who demand equity can find alliesin mainstream politics. To help the “rollout,” albeit in a way which may requireconfrontation, implies that the government can, with prodding, meet the needs ofpoor people living with HIV/AIDS.

Many social movement intellectuals would, however, be more inclined to en-dorse this view:

The post-apartheid state is primarily the guardian and protector of . . . dominant economicinterests and the guarantor of capitalist property relations. . . . [L]iberals view the state as anagent of a democratic social order with no inherent bias toward any class or group. They failto understand the elementary truism that the state in a capitalist society is not neutral inrelation to different classes. This misconception is the fount from which all sorts of reform-ist illusions arise.257

Logically, then, “It seems increasingly unlikely that open confrontation withthe repressive power of the post-apartheid state can be avoided.”258 In this view,engaging with the state is futile since the problem is not that poor people havefailed to assemble the power they need to influence it, but that it can never be influ-enced by the poor.

TAC’s strategy of engaging with and winning incremental gains from the statesets it off from many other social movements, even if it is not unique.259 It alsocategorises it clearly as a civil society association, one which “interact[s] with thestate but [doesn’t] want to take it over.”260 This describes a form of engagementwith the democratic state which is held to enrich democracy since citizens claimthe right to be heard through their associations. It also describes TAC’s approachto democratic government. There is no contradiction between being a social




movement and operating in civil society—“When civil society networks joinforces on a scale and over a time-span significant enough to force through morefundamental change, they can be classified as social movements.”261 And so webest understand TAC as a social movement which chooses to operate in civilsociety.

This notion of a social movement as a type of civil society association whichrelies on mobilisation is not what many champions of “new social movements”have in mind. For them, social movements are defined by more than that theymobilise people. Two broad criteria are said to distinguish them—their agendaand mode of operation. On their agenda, one study emphasises that they seek afar-reaching restructuring of society.262 Similarly, a concept document written toguide the project to which this study contributed defines social movements as“politically and/or socially directed collectives . . . focused on changing one ormore elements of the social, political and economic system.”263 Another defini-tion sees them as “[p]urposive collective actions whose outcome in victory, as indefeat, transforms the values and institutions of society.”264

The movements may be seen as vehicles of fundamental change: activistTrevor Ngwane thus talks of the need to “fight with your own national bourgeoi-sie.”265 Alternatively, intellectuals may see them as attempts not to overthrow theexisting order but to create an alternative within it.266 Neither view, however, seesmovements as a means of winning gains from the state by engaging with it inthat mixture of conflict and cooperation employed by TAC as it operates in civilsociety.

The weakness of defining social movements by their aims is revealed when weapply it to TAC. It is unclear why, beyond the rhetoric of its leaders, a movementseeking subsidised electricity for the poor is pressing for structural change whileone which fights for free AIDS medication for the poor is not. Defining socialmovements by how radical they are seen to be is arbitrary. If TAC is a social move-ment because it seeks to change the distribution of resources in society, then so ismost of civil society. If social movements are distinguished by something otherthan their reliance on mobilisation, the distinction must lie in something morefundamental than the details of their demands.

Social movements are therefore distinguished by some from civil society orga-nisations in their mode of action.

This movement . . . is about creating new forms of organisation. It is about creating andenacting horizontal networks instead of top-down structures like states, parties or corpora-tions . . . it does not seek to solicit hegemony as a part of civil society. . . . Instead, it seeks to“reinvent daily life as a whole.”267

For others, refusal to engage in mainstream politics is vital: “Social move-ments . . . result from protests against predominant social structures. This implies




a natural opposition to established politics”;268 “[T]he vote is meaningless unlesswe can run our own economy.”269

Added to this is a suggestion that new forms of action are being employed—so new that they are defined only in the negative. Social movements are thus notan advocacy network, not a labour movement—indeed, not anything the authoris willing to define.270 Another view is more descriptive, talking of “largely atom-ized and prolonged mobilisation with episodic collective action, and openand fleeting struggles without clear leadership, ideology or structured organi-zation.”271 Others talk of multiple, hybrid forms of action. But, while definitionis often vague, the consensus is that social movements offer a new form ofactivism—one in which the rules of civil society engagement do not apply.272

If this is what defines social movements, TAC does not fit since its strategiesare entirely consistent with that of civil society organisation as understood here. Ittoo seeks to engage with the state without taking it over and employs the methodsof civil society engagement—lobbying and coalition building, public protest andlegal action. Organisations which mobilise people are firmly within civil societyif they also engage with the state to win concessions. Nor is civil disobedienceincompatible with operating in civil society: nonviolently breaking the law andaccepting state sanctions in order to draw public attention to a perceived injusticeare compatible with the loyalty to the state and willingness to respect its rulesassociated with civil society. But if we understand social movements as associa-tions which mobilise people, TAC clearly qualifies. Thus its activists want it to beseen as a social movement since they associate the term with advocacy and areadamant that TAC will always remain “a campaigning organisation.”273 TAC is,clearly, a social movement. What sets it off from many others is that it is hard tosee in which way it is “new.”

Much more is at stake than definitions. The stress on “new” social movementsassumes that “classic” democratic modes of engagement with the state cannotnow deliver gains for the poor, and that something new is needed. But if the mostsuccessful of the “new” movements is not “new,” then TAC demonstrates thatmobilising in the traditional way in civil society can yield real gains for the poorand marginalized and that no new approach is needed. While its stress on themoral high ground, its use of alliances, and its tactical flexibility are all importantassets which may provide useful pointers to more effective action for equity in thecurrent environment, none suggests that a significantly new form of activism hasemerged in TAC. The lesson of TAC’s experience, then, is that it remains possibleto use the rights guaranteed and institutions created by liberal democracy to winadvances for the poor and weak. The claim that a new form of action is needed isnot vindicated by TAC’s record.

But this too must be qualified. TAC’s experience has much to teach about howsocial movements or civil society organisations can win single-issue battles. Itcannot point to strategies for more fundamental change because that has not yet




been its goal. Whether this approach can win the sustained policy changes andprogrammes which will enable the poor and marginalized to claim their place asfull citizens remains untested. But, by suggesting that the possibility of winningallies across divides is greater than we may think, that “globalisation” providesunprecedented opportunities for cross-national action, and that the politics of themoral high ground and its assumption that all human beings have a moral senseand are vulnerable to shame can be effective, it has held out the possibility thatorganisations of the poor which apply these lessons can make an impact on thestructure of inequality as well as its symptoms.

APPENDIX 1:INTERVIEWS

Achmat, Zackie. TAC Chairperson. February 19, 2004.Berold, Ralph. TAC Human Resource Manager. February 19, 2004.Cele, Thabo. TAC KwaZulu-Natal (KZN) Coordinator. December 3, 2003.Claasen, Mario. TAC Clinics Programme Coordinator. February 19, 2004.Dabula, Nomfundo. TAC Western Cape Provincial Treatment Literacy Coordinator. Feb-

ruary 18, 2004.Desai, Ashwin. Researcher and activist. May 19, 2004.Geffen, Nathan. TAC National Manager. February 19, 2004.Geffen, Nathan. June 14, 2004 (phone).Heywood, Mark. TAC Treasurer. March 29, 2004.Heywood, Mark. June 14, 2004 (phone).Khumalo, Nomvula. Treasurer, TAC KZN Provincial Executive Committee. December 3,

2003.Khumalo, Nonkosi. TAC National Treatment Project Coordinator. February 19, 2004.Khwaza, Ntombozuko. TAC Western Cape Provincial Treatment Project Coordinator.

February 18, 2004.Kunene, Xolani. TAC Gauteng Provincial Organiser. March 24, 2004.Majali, Thembeka. TAC Western Cape Provincial Coordinator. February 18, 2004.Mambo, Rosemary. Coordinator, Thatnusizo Support Group, Inanda. January 28, 2004.Mbali, Mandisa. TAC University of KZN Durban Coordinator. December 8, 2003.McKenna, Kevin. Boehringer Ingelheim. April 28, 2004.McKinley, Dale. Anti-Privatisation Forum. May 25, 2004.Mkhutyukelwa, Bongi. Treatment Literacy Coordinator, TAC KZN Province. January 28,

2004.Morgan, Njogu. TAC International Coordinator. April 1, 2004.Mpolokeng, Jacqui. HIV/AIDS Coordinator, COSATU. May 17, 2004.Mpongose, Gugu. Deputy Chairperson, TAC KZN PEC, and provincial representative to

the TAC NEC. December 12, 2003.Mthathi, Sipho. TAC Deputy Chair and National Treatment Literacy Coordinator. Febru-

ary 19, 2004.Mthathi, Sipho. June 15, 2004 (phone).Mthethwa, Nkosi. Chair, TAC KZN PEC. December 3, 2003.Mvinjelwa Nondumiso. TAC Western Cape Provincial Administrator. February 18, 2004.Mvotho, Bulelani. TAC Khayelitsha District Organiser. February 18, 2004.Ncala, Johanna. TAC Gauteng Treatment Literacy Coordinator. March 24, 2004.




Ndlovu, Zodwa. TAC volunteer, Umlazi Branch. January 28, 2004.Nkala, Sfiso. TAC KZN Organiser. December 3, 2003.Pillay, Kimendhri. TAC University of KZN Durban Branch. December 8, 2003.Pithouse, Kathleen. Chair, TAC University of KZN Durban Branch. December 4, 2003.Political analyst. June 29, 2004.Ramothwala, Pholokgolo. TAC Gauteng Provincial Coordinator. March 19, 2004.TAC activist. December 12, 2003.TAC grassroots activists. January 28, 2004.TAC KZN branch members. December 12, 2003.TAC Tongaat branch member. December 12, 2003.TAC Verulam volunteer. December 12, 2003.TAC volunteer. December 12, 2003.Wilson, Dawn. TAC Financial Manager. April 1, 2004.Xaba, Zakhele. Secretary, TAC PEC KZN. December 2, 2003.

APPENDIX 2:HIV/AIDS IN SOUTH AFRICA

The South African HIV/AIDS epidemic dates back to at least the 1980s. While it was,as elsewhere, initially associated with gay men—who have been prominent AIDS activ-ists—it has primarily affected heterosexuals, and early incidences were noticed on themines, which reply on a male migrant workforce, as well as in other economic sectors. Theepidemic has grown steadily since then and may not yet have reached its peak.

Current statistics according to a national HIV antenatal sero-prevalence survey con-ducted in 2002 indicates that 5.3 million South Africans were HIV positive by the end of2002. This is an increase from the 2001 figure of 4.74 million.274 Most people living withthe virus are women. Table 1 indicates a steady rise in the number of HIV positive antenatalpatients presenting in South African clinics during the period 1994-2002, by province.275

Table 1HIV Prevalence by Province, 1994-2002

Estimated % HIV Positive

Province 1994 1995 1996 1997 1998 1999 2000 2001 2002

KwaZulu-Natal 14.4 18.2 19.9 26.8 32.5 32.5 36.2 33.5 36.5Mpumalanga 12.1 18.3 15.8 22.6 30.0 27.3 29.7 29.2 28.6Gauteng 6.4 12.0 15.5 17.1 22.5 23.9 29.4 29.8 31.6Free State 9.2 11.0 17.5 19.6 22.8 27.9 27.9 30.1 28.8North West 6.7 8.3 25.1 18.1 21.3 23.0 22.9 25.2 26.2Eastern Cape 4.5 6.0 8.1 12.6 15.9 18.0 20.2 21.7 23.6Northern Province 3.0 4.9 7.9 8.2 11.5 11.4 13.2 14.5 15.6Northern Cape 1.83 5.3 6.6 8.6 9.9 10.1 11.2 15.9 15.1Western Cape 1.2 1.7 3.09 6.3 5.2 7.1 8.7 8.6 12.4

Because HIV/AIDS is prevalent among young adults (25-29 years),276 there has been adistinct rise in the number of orphans and child- and pensioner-headed households. It alsohas inevitable negative economic and social impacts. A study predicts that by 2010 ,the




level of GDP will be 17 percent lower in a “with HIV/AIDS” as opposed to a “without HIV/AIDS” scenario.277

After the first universal franchise elections in 1994, the ANC-led government endorsedan AIDS plan. But by 1996 it became clear that the plan was failing, with HIV levels havingnearly doubled from 7.6 percent in 1994 to 14.2 percent in 1996.278The problem was com-pounded by government refusal to make medication available to HIV-positive pregnantwomen to prevent mother-to-child transmission (MTCT) on the grounds that it had yet toundergo the requisite testing in South Africa to ascertain its safety for public consump-tion. In May 2000 the Department of Health initiated its HIV/AIDS Strategic Plan whichfocussed more on prevention and management than on treatment programmes. In July2002, the government established a Task Team to investigate the treatment, care, and sup-port for those infected and affected by HIV/AIDS. Following its report in August 2003which included the option of anti-retroviral therapy, the Cabinet instructed the Depart-ment of Health to develop an operational plan on an anti-retroviral programme by the endof September 2003. Despite a standing commitment to prevention, the plan set forth aschedule for the roll-out of anti-retroviral therapy in public hospitals.279

This decision was delayed by a government view questioning the relationship betweenHIV and AIDS and the effectiveness and appropriateness of anti-retrovirals. While a “roll-out” of anti-retrovirals has now been agreed, identified sites, comprising hospitals in eachprovince, are not fully capacitated to handle the burdens on staff, medication, and equip-ment. There is also said to be continued resistance from national and some provincialgovernments.

NOTES

1. Treatment Action Campaign, “An Explanation of the Medicines Act and the Implica-tions of the Court Victory,” Treatment Action Campaign statement, April 24, 2001, http://www.tac.org.za.

2. Treatment Action Campaign, “TAC Welcomes Cabinet Statement Committing to Anti-retroviral Treatment Rollout,” TAC News Service, August 8, 2003, [email protected].

3. Treatment Action Campaign, “TAC Responds to American Friends Service Commit-tee Nobel Peace Prize Nomination,” TAC News Service, December 2, 2003, [email protected].

4. See Steven Friedman, “Equity in the Age of Informality: Labour Markets and Re-distributive Politics in South Africa,” Transformation 50 (2002): 31-55.

5. For an account of the epidemic and its political context, see Peris Jones, “‘A Test ofGovernance’: Rights-Based Struggles and the Politics of HIV/AIDS Policy in SouthAfrica,” Political Geography 24, no. 4 (May 2005): 419-47.

6. In the 1980s, HIV/AIDS became a significant problem on the mines. But the NationalUnion of Mineworkers resisted discussing the issue on the grounds that right-wing whiteson the mines continually focussed on it, claiming that it was evidence of black sexualproclivities.

7. Mark Heywood, TAC Treasurer, interview, March 29, 2004, Johannesburg, SouthAfrica.

8. Treatment Action Campaign, “About TAC,” http://www.tac.org.za.9. Heywood, interview.




10. Perhaps the clearest exposition of the government position is a widely publicisedanonymous African National Congress paper, “Castro Hlongwane, Caravans, Cats, Geese,Foot and Mouth Statistics: HIV/AIDS and the Struggle for Humanisation of the African,”http://www.virusmyth.net/aids/data/ancdoc.htm, released in 2002. It is not signed but iswidely believed to have been authored by a former deputy cabinet minister, Peter Mokaba,who, ironically, died of AIDS.

11. Minister of Health and Others v. Treatment Action Campaign and Others, Consti-tutional Court CCT8/02 2002 (5) SA 721 (CC), 2002 (10) BCLR 1033 (CC), http://www.concourt.gov.za/judgment.php?case_id=11915.

12. Treatment Action Campaign, “About TAC.”13. Ntombozuko Khwaza, TAC W Cape Provincial Treatment Project Coordinator,

interview, February 18, 2004, Muizenberg, South Africa.14. Treatment Action Campaign, “Treatment Literacy,” http://www.tac.org.za;

Nomfundo Dabula, TAC W Cape Provincial Treatment Literacy Coordinator, interview,February 18, 2004, Muizenberg, South Africa; and TAC volunteer, interview, December12, 2003, Durban, South Africa.

15. Bongi Mkhutyukelwa, Treatment Literacy Coordinator, TAC KZN Province, inter-view, January 28, 2004, Durban, South Africa.

16. “Activists Import Generic AIDS Drugs to South Africa,” Reuters Health Informa-tion, February 1, 2002, http://www.hivandhepatitis.com/recent/pricing/020102c.html.

17. Khwaza, interview.18. Syndi Blose, TAC Treatment Project Coordinator, KwaZulu Natal, interview, Janu-

ary 28, 2004, Durban, South Africa.19. Nondumiso Mvinjelwa, TAC Western Cape Provincial Administrator, interview,

February 18, 2004, Khayelitsha, South Africa; Gugu Mpongose. Deputy Chairperson,TAC KZN Provincial Executive Committee, and KZN provincial representative to theTAC NEC, interview, December 12, 2003, TAC KZN office, Durban, South Africa; andSfiso Nkala, TAC KZN Organiser, interview, December 3, 2003, TAC KZN office, Durban,South Africa.

20. Ralph Berold, TAC Human Resource Manager, interview, February 19, 2004,Muizenberg, South Africa.

21. Thabo Cele, TAC KwaZulu-Natal Coordinator, interview, December 3, 2003, TACKZN office, Durban, South Africa.

22. Observation of TAC University of KwaZulu Natal TAC branch meeting, October15, 2003 Durban, South Africa.

23. Cele, interview24. Jacqui Mpolokeng, HIV/AIDS Coordinator, COSATU, interview, May 17, 2004,

Johannesburg, South Africa.25. Nkala, interview.26. Zackie Achmat, TAC Chairperson, interview, February 19, 2004, Muizenberg,

South Africa; and Nathan Geffen, TAC National Manager, interview, February 19, 2004Muizenberg, South Africa. A communication from TAC in early January gave a member-ship of 7,698 but with the rider that it had increased since this count by an unspecifiedamount. Rukia Cornelius, personal communication to Shauna Mottiar, January 6, 2004.

27. Geffen, personal communication, July 23, 2004.28. Achmat, interview.29. Mpongose, interview.30. Geffen, interview.




31. Ashwin Desai, researcher and activist, interview, May 19, 2004, Durban, SouthAfrica; and Dale McKinley, Anti-Privatisation Forum, interview, May 25, 2004, Johannes-burg, South Africa.

32. Sipho Mthathi, TAC Deputy Chairperson and South Africa National Treatment Lit-eracy Coordinator, interview, February 19, 2004, Muizenberg, South Africa.

33. Heywood, interview.34. Nonkosi Khumalo, TAC National Treatment Project Coordinator, interview, Febru-

ary 19, 2004, Muizenberg, South Africa.35. Other donors of grants were (in order of size of donation): Medicins sans Frontieres,

Rockefeller Foundation, South African Development Fund, Kaiser Foundation, UNAIDS,an anonymous international pop star, AIDS Foundation of SA, and Oxfam. TreatmentAction Campaign, “TAC Audit for Year Ending February 2003,” http://www.tac.org.za/audit/audit4/audit.pdf.

36. Geffen, interview.37. Dawn Wilson, TAC Financial Manager, interview, April 1, 2004.38. Treatment Action Campaign, “TAC Audit for Year Ending February 2003.”39. Geffen, interview.40. Heywood, interview; and Geffen, interview.41. See for example James S. Fishkin, The Voice of the People: Public Opinion and

Democracy (New Haven, Conn.: Yale University, 1997); and Carole Pateman, Participa-tion and Democratic Theory (Cambridge: Cambridge University Press, 1976).

42. Treatment Action Campaign, Report of the Second TAC National Congress, August1-3, 2003, Coastlands Conference Centre Durban, South Africa, http://www.tac.org.za/Documents/SecondNationalCongressReport.pdf.

43. Bulelani Mvotho, TAC Khayelitsha District Organiser, interview, February 18,2004, Khayelitsha, South Africa; Zakhele Xaba, Secretary, TAC PEC KZN, interview,December 2, 2003, Pietermaritzburg, South Africa; and Thembeka Majali, TAC WesternCape Provincial Coordinator, interview, February 18, 2004, Hout Bay, South Africa.

44. KwaZulu Natal has four districts, Gauteng six, and Western Cape nine. Interview,TAC officials, Muizenberg, South Africa.

45. “Decisions about tactics and strategy are generally made at national level and thentaken to provincial and district or branch level.” Xaba, interview.

46. Mvotho, interview.47. The toyi-toyi is a dance used by South African demonstrators. Mvotho, interview.48. Pholokgolo Ramothwala, TAC Gauteng Provincial Coordinator, interview, March

18, 2004, Johannesburg, South Africa.49. Wilson, interview.50. Mkhutyukelwa, interview.51. Wilson, interview.52. Wilson, interview.53. Cele, interview.54. Geffen, personal communication.55. Mvotho, interview.56. Nkala, interview.57. Cele, interview.58. Kathleen Pithouse, Chair, TAC University of KZN Durban Branch, interview,

December 4, 2003, Durban, South Africa.59. Zodwa Ndlovu, TAC volunteer, Umlazi Branch, interview, January 28, 2004,

Umlazi, South Africa.




60. Kimendhri Pillay, TAC UND Branch Secretary, interview, December 8, 2003,Durban, South Africa.

61. Kimendhri Pillay, personal communication, July 22, 2004; and Kathleen Pithouse,personal communication, July 22, 2004.

62. Mandisa Mbali, TAC UKZN Durban Coordinator, interview, December 8, 2003,Durban, South Africa.

63. Ramothwala, interview.64. Mkhutyukelwa, interview.65. Ramothwala, interview.66. Xaba, interview.67. Berold, interview.68. Mthathi, interview.69. Heywood, personal communication, July 9, 2004.70. Mvotho, interview.71. TAC Tongaat branch member, interview, December 12, 2003, Durban, South

Africa.72. Steven Friedman, Building Tomorrow Today: African Workers in Trade Unions

(Johannesburg, South Africa: Ravan, 1985).73. Mthathi, interview.74. Heywood, interview.75. Heywood, personal communication, July 9, 2004.76. Desai, interview; and McKinley, interview.77. Geffen, interview.78. Achmat, interview.79. Desai, interview.80. Jones, “‘A Test of Governance.’”81. Geffen, interview.82. Ramothwala, interview.83. For example, “The reason I participate in TAC is because I have 2 sisters who are ill”

(Nomvula Khumalo, Treasurer, TAC KZN PEC, interview, December 3, 2003, Durban,South Africa); “I participate in TAC because I believe in the need for social service—I alsoknow someone who died of AIDS and I am angry about it because, given the appropriatetreatment, it need not have happened” (Pithouse, interview); and “I joined TAC because Iam a parent affected by AIDS—I am a trained councillor and received further training fromTAC” (Verulam volunteer, interview, December 12 2003, Verulam, South Africa).

84. KZN branch members, interview, December 12, 2003.85. Heywood, interview. In a similar vein, he mentions Gugu Dlamini, who was mur-

dered because she openly declared her HIV positive status.86. Grassroots activists, interviews, January 28, 2004, Durban, South Africa.87. Mvotho, interview.88. Mvinjelwa, interview.89. Nkosi Mthethwa, Chair, TAC KZN PEC, interview, December 3, 2003, Durban,

South Africa.90. Activist, interview.91. Achmat, interview.92. The minister said people “come with busses and go to commissions where they wait

for the white man to tell them what to do. . . . Our Africans say: Let us wait for the whiteman to deploy us; to say to us: toyi-toyi (protest) here.” http://www.massiveeffort.org/showstory.asp?id=1227.

93. Heywood, interview.




94. Follow-up phone interviews with Heywood, Mthathi, and Geffen, June 2004.95. Mbali, interview.96. South Africa Department of Health, National HIV and Syphilis Sero-prevalence

Survey of Women Attending Public Antenatal Clinics in South Africa—2001, SummaryReport (PretoriaSouth Africa Department of Health, : 2002); and Nelson Mandela/HSRCStudy of HIV/AIDS, South African National HIV Prevalence, Behavioural Risks and MassMedia Household Survey 2002, cited by Jenni Fredriksson and Steve Berry, “South Africa:HIV/AIDS Statistics,” http://www.avert.org/safricastats.htm.

97. Majali, interview.98. Cele, interview.99. Majali, interview; Xaba, interview; Nkala, interview; Pithouse, interview; and

Kunene, interview.100. Mvotho, interview.101. Mvotho, interview.102. Mthethwa, interview; and Cele, interview.103. Xaba, interview.104. Geffen, personal communication.105. Mbali, interview.106. Mthethwa, interview; and Xaba, interview.107. Berold, interview.108. Geffen, personal communication.109. Pillay, interview.110. Mkhutyukelwa, interview.111. See, for example, Ashwin Desai, We Are the Poors: Community Struggles in Post-

Apartheid South Africa (New York: Monthly Review Press, 2002).112. Heywood, interview.113. Rosemary Mambo, Coordinator of Thatnusizo Support Group in Inanda Durban,

interview, January 28, 2004, Durban, South Africa.114. Geffen, interview.115. See Mahmood Mamdani, Citizen and Subject: Contemporary Africa and the Poli-

tics of Late Colonialism (Kampala, Uganda: Fountain, 1995).116. Heywood, interview.117. Kunene, interview.118. Mvotho, interview.119. Geffen, interview.120. Mvotho, interview.121. Mthethwa, interview.122. Dabula, interview.123. Mkhutyukelwa, interview.124. Mthathi, interview.125. Cele, interview.126. Geffen, interview.127. Kevin McKenna, Boehringer Ingelheim, interview, April 28, 2004, Johannesburg,

South Africa.128. Treatment Action Campaign, “Condemn the Threats by NAPWA Against AIDS

Activists” TAC News Service, March 30, 2004, [email protected]. Heywood, personal communication, July 10, 2004.130. Heywood, interview.131. Berold, interview.




132. This view was expressed forcefully in discussions between members of the re-search team participating in the social movements study convened by the Centre for CivilSociety, University of KwaZulu Natal, of which this study was a part.

133. Sidney Tarrow, Power in Movement (Cambridge: Cambridge University Press,1994), 18.

134. Heywood, interview.135. Heywood, interview.136. Heywood, interview.137. Mbali, interview.138. Geffen, interview.139. Desai, interview.140. Mthathi, interview; and Heywood, interview.141. Doreen Atkinson, “Insuring the Future? The Bill of Rights,” in The Small Miracle:

South Africa’s Negotiated Settlement, ed. Steven Friedman and Doreen Atkinson (Johan-nesburg: Ravan, 1995), 121-47.

142. Achmat, interview. For a critique of failure to grasp this point, see Kerry Chanceand Mandisa Mbali, “Chance/Mbali on Limits to Invoking ‘False Consciousness,’” July 2,2004, [email protected].

143. Nedlac was established by statute in 1995 as a forum at which government, labour,business and “community organisations” can consider economic, labour, and social policy.

144. Mthathi, interview.145. Heywood, interview.146. Nkala, interview.147. Mpolokeng, interview.148. The Commissions were established by the constitution. Achmat, interview.149. Mpongose, interview.150. Achmat, interview.151. Achmat, interview.152. Mbali, interview.153. Mpongose, interview.154. Achmat, interview.155. See, for example, Sakhela Buhlungu, “Trade Union Organization and Capacity in

the 1990s: Continuities, Changes and Challenges for PPWAWU,” in Trade Unions andDemocratization in South Africa, 1985-1997, ed. Glenn Adler and Eddie Webster (NewYork: St Martin’s, 2000), 90; see also Karl von Holdt, Transition from Below: ForgingTrade Unionism and Workplace Change in South Africa (Pietermaritzburg, South Africa:University of Natal, 2003).

156. Trevor Ngwane, “Interview: Sparks in the Township,” New Left Review 22 (July-August 2003), http://www.newleftreview.net/NLR25603.shtml.

157. Salim Vally, “The Political Economy of State Repression in South Africa,” CCS-lDigest 1, no. 1169 (March 15, 2004), [email protected].

158. Heywood, interview.159. Mvinjelwa, interview.160. Majali, interview.161. Mario Claasen, TAC Clinics Programme Coordinator, interview, February 19,

2004, Muizenberg, South Africa.162. Ncala, interview.163. Desai, interview.164. Majali, interview.165. Geffen, interview.




166. Heywood, personal communication, July 9, 2004.167. Government official, discussion, Pretoria, South Africa, July 19, 2004.168. Majali, interview.169. Claasen, interview.170. Achmat, interview; and Geffen, interview.171. Mthathi, interview.172. Cele, interview. The ruling upheld TAC’s view that the ARV nevirapine should be

available to prevent mother-to-child transmission of HIV.173. Achmat, interview.174. Geffen, interview.175. Kunene, interview.176. Political analyst, interview, June 2004.177. Mthathi, interview.178. Mthathi, interview.179. Xaba, interview. Also, Mpongose, interview; Mkhutyukelwa, interview; and

Ramothwala, interview.180. Nkala, interview.181. Ramothwala, interview.182. Kunene, interview.183. Geffen, interview.184. Achmat, interview.185. McKenna, interview.186. Before the Cabinet announcement, the government repeatedly insisted that it was

not opposed to distributing ARVs, but was “piloting” their use in public health facilities.187. For an analysis which blends both perspectives, see Adam Przeworski, Capitalism

and Social Democracy (Cambridge: Cambridge University Press, 1987).188. Achmat, interview.189. Achmat, interview.190. Khumalo, interview.191. Achmat, interview.192. Mthethwa, interview.193. McKenna, interview.194. Geffen, interview.195. Kunene, interview.196. Nkala, interview.197. Mpolokeng, interview.198. Nkala, interview.199. Mpolokeng, interview.200. Xaba, interview.201. Mthethwa, interview.202. Kunene, interview.203. Heywood, personal communication, July 9, 2004.204. Heywood, interview.205. Paul Schindler “South African AIDS Activists Share Their Experience and Hope,”

Gay City News, in CCS-l Digest 1, no. 1019 (November 17, 2003), [email protected].

206. Achmat, interview.207. Mvotho, interview.208. Geffen, interview.209. Mbali, interview.




210. Kunene, interview.211. Geffen, interview.212. Desai, interview.213. Heywood, interview.214. Desai, interview.215. Geffen, personal communication.216. Achmat, interview.217. Friedman, “Equity in the Age of Informality.”218. Przeworski, Capitalism and Social Democracy.219. McKenna, interview.220. Achmat, interview.221. See Steven Friedman, “Democracy, Inequality and the Reconstitution of Poli-

tics,” in Democratic Governance and Social Inequality, ed. Joseph S. Tulchin with AmeliaBrown (Boulder, Colo.: Lynne Rienner, 2002), 13-40.

222. Achmat, interview.223. Nkala, interview.224. Njogu Morgan, TAC International Coordinator, interview, April 1, 2004, Johan-

nesburg, South Africa.225. Achmat, interview.226. Morgan, interview.227. Morgan, interview.228. Achmat, interview.229. Morgan, interview.230. Morgan, interview.231. Morgan, interview.232. Treatment Action Campaign, “Invest in Health Not War,” TAC News Service, June

14, 2004, [email protected]. Heywood, interview.234. Achmat, interview.235. For example, Mandisa Mbali, TAC UKZN Durban Coordinator, interview,

December 8, 2003, Durban, South Africa; Mpongose, interview; and Johanna Ncala, TACGauteng Treatment Literacy Coordinator, interview, March 24, 2004, Johannesburg, SouthAfrica.

236. Dudu Dlamini, TAC Gauteng Treatment Project Coordinator, interview, March24, 2004, Johannesburg, South Africa.

237. Zakhele Xaba, Secretary, TAC PEC KwaZulu Natal, interview, December 2, 2003,Pietermaritzburg, South Africa.

238. “We link GEAR and its neo-liberal stance (e.g. privatisation) to the problemswe are highlighting. TAC never makes any mention of the macroeconomic framework”(McKinley, interview).

239. Heywood, interview.240. Mthathi, interview.241. Achmat, interview.242. Heywood, interview.243. Cele, interview.244. Mthathi, interview.245. Treatment Action Campaign, “TAC Newsletter: Meeting in JHB, US/SACU,

SACTWU, TAC Ad, Letter to Dr. Zokufa, ALP Jobs, Health Systems Workshop, Malan,Trad. Healing,” TAC News Service February 20, 2004, [email protected].




246. Treatment Action Campaign, “News 2002,” http://www.tac.org.za/newsletter/news_2002.htm.

247. Nkala, interview.248. Mbali, interview.249. Mpongose, interview.250. Heywood, interview.251. Xolani Kunene, TAC Gauteng Provincial Organiser, interview, March 24, 2004,

Johannesburg, South Africa.252. Friedman “Building Tomorrow Today.”253. Desai, interview; and McKinley, interview.254. McKinley, interview.255. Desai, interview.256. McKinley, interview.257. Vally, “The Political Economy of State Repression.”258. Desai, “We Are the Poors,” 147.259. Adam Habib, “State-Civil Society Relations in Post-Apartheid South Africa,” SA

Labour Bulletin 27, no. 6 (December 2003): 18.260. Naomi Chazan, “Discussion—Governability and Compliance during the Transi-

tion,” in Governability during the Transition, ed. Riaan de Villiers (Johannesburg, SouthAfrica: Centre for Policy Studies, 1993), 14.

261. Michael Edwards, Civil Society (Oxford: Polity, 2004), 33. See also Habib, “State-Civil Society Relations.”

262. Cyrus Zirakzadeh, Social Movements in Politics: A Comparative Study (NewYork: Longman, 1997).

263. Adam Habib, Richard Ballard, and Imraan Valodia, Project concept paper, 2.264. Manuel Castells, The Power of Identity, vol. 2 of The Information Age: Economy,

Society and Culture (Malden, Mass.: Blackwell, 1997), 3.265. Ngwane, “Interview.”266. Desai “We Are the Poors.” See also “Finding Ferial’s Rebellion,” June 29, 2004,

[email protected]. Ashwin Desai, “Between the Broken and the Built,” interview with Holley Wren

Spaulding, http://www.nu.ac.za/ccs. Cited in Ebrahim Fakir, “Institutional Restructuring,State-Civil Society Relationships and Social Movements,” Development Update 5, no. 1(April 2004): 143.

268. Cited in Michael Sachs, “‘We Don’t Want the Fucking Vote’: Social Movementsand Demagogues in South Africa’s Young Democracy,” SA Labour Bulletin 27, no. 6(December 2003): 24.

269. Ashwin Desai quoted in Paul Kingsnorth, One No, Many Yesses: A Journey to theHeart of the Global Resistance Movement ( New York: Free Press, 2003), 121. Cited inSachs, “‘We Don’t Want the Fucking Vote.’”

270. See Peter Waterman, “The International Call of Social Movements,” SA LabourBulletin 27, no. 6 (December 2003): 28.

271. Cited in Fakir, “Institutional Restructuring,” 143.272. Jacklyn Cock, “Local Social Movements: Some Questions from the ‘Back Alleys’

of South Africa,” SA Labour Bulletin 27, no. 6 (December 2003): 21.273. Morgan, interview; Mthathi, interview; and Heywood, interview.274. Directorate Health Systems Research, South Africa Department of Health, Na-

tional HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa 2002 (Pretoria:South Africa Department of Health, 2002).




275. Health Economics and HIV/AIDS Research Division (HEARD), University ofNatal, HIV/AIDS Statistics (Durban, South Africa: University of Natal, 2003).

276. T. Barnett and A. Whiteside, Aids in the Twenty-first Century: Disease and Global-isation (Hampshire, UK: Palgrave Macmillan, 2002), 121.

277. Policy Project for Bureau for Africa, Office of Sustainable Development, U.S.Agency for International Development HIV/AIDS in Southern Africa: Background, Pro-jections, Impact and Interventions: Policy Project, 2001), 35.

278. V. Van der Vliet, “South Africa Divided against AIDS: A Crisis of Leadership,” inAIDS and South Africa: The Social Expression of a Pandemic, ed. A. D. Kauffman andD. L. Lindauer (New York: Macmillan, 2004).

279. South African Government Operational Plan for Comprehensive HIV and AIDSCare, Management and Treatment for SA, 19 November 2003, http://www.info.gov.za/issues/hiv/careplan.htm

Steven Friedman is senior research fellow at the Centre for Policy Studies and visit-ing professor of politics and international relations, Rhodes University. He hasedited two books on South Africa’s negotiated transition and is the author of a studythe South African labour movement. He has written many monographs, book chap-ters, and newspaper articles on democratisation and related issues. He is currentlystudying the relationship between inequality and democratic politics.

Shauna Mottiar is an independent researcher whose interests lie in the field of dem-ocratic consolidation in South Africa. She has worked on democratic elections,political parties, civil society, service delivery, and local government.




A Rewarding Engagement the Treatment Action Campaign and the Politics of HIV AIDS

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