Читать книгу Witness to AIDS - Edwin Cameron - Страница 6

1. Second chances

I knew that I had AIDS when I could no longer climb the stairs from the judges’ common room in the High Court to my chambers two floors above. For nearly three years, every morning after tea, I made a point of walking. Two flights, four landings, forty stairs. But on that day in late October 1997 I couldn’t. Each step seemed an insuperable effort. My energy seemed to have drained from my legs. I was perspiring grey exhaustion. My lungs felt waterlogged. My mouth rough and dry. No pain. Just overwhelming weariness.

And fear.

After twenty steps I paused on the midway landing to lean my forehead against the wall. The stairwell was quiet. I could hear myself panting. I grimaced. The thought – that thought – could no longer be postponed. I would have to see my doctor. This afternoon.

But already I knew what he would say. It was what somehow I had been waiting for – fearing, dreading, denying, as it encircled me, closing in, for twelve years. My mouth and lungs told me what I didn’t want to know, didn’t need to be told. I had AIDS.

Acquired immunodeficiency syndrome. An accumulation of rare afflictions of the human body. Uncommon lung infections. Unusual cancers. Disabling funguses. Running unbridled through the body – because the immune system no longer functions. Threatening debilitation and portending a lingering death.

I already knew a lot about AIDS. That it is caused by HIV – a rare kind of virus that destroys a type of white blood cell in the human body, the helper T or CD4+ T cells. These are vital to the body’s defences against disease. HIV targets them. Because it cannot replicate on its own, the virus enters the helper T cells – the very cells that produce the body’s defence mechanisms against disease – and cannibalises the cell mechanisms to reproduce itself. As HIV destroys more and more CD4 cells, the immune system becomes weaker, less able to ward off new infections. Each illness in turn weakens the body further and renders it less able to fight HIV – causing a terrible cycle of wasting illnesses that culminate in death.

All this I knew. In fact, I knew too much. I didn’t want to know more. Specifically I didn’t want to know that HIV had finally succeeded in getting the better of my own immune system. That I had reached the diagnostic point where I was not ‘just’ living with HIV (a last consoling defence) – but that I actually had AIDS. And that without immediate, expert intervention I faced near-certain death.

In that southern spring of 1997 there was much in my life that was good, that I wanted to build on. Apart from deeply supportive family relationships (and a new love affair, later to prove misguided), my work as a High Court judge was challenging and interesting. The Johannesburg High Court is South Africa’s busiest superior court. As a former human rights lawyer – one whose practice as an advocate did not focus on commercial cases – I wanted to meet the challenge of getting on top of the intricate contractual and company law problems and insolvencies the court roll presented each day. Most of all I was determined to keep up. Every judge in Johannesburg works under remorseless pressure. I didn’t want to let anyone down. But even more I didn’t want to admit to myself – couldn’t afford to admit to myself, still less to colleagues – that I was desperately ill.

So as increasing tiredness took hold of me, as my body stopped digesting food and I lost appetite and weight, as I felt more and more shortness of breath, my response was to stretch my working hours, to cut out alcohol and late evenings to conserve energy, to bury myself in books and files so that I could stay abreast. To stop work would be to admit defeat. And admitting defeat meant death.

That week the judge-president (the senior judge in the division, who allocates the work) nominated me to a two-judge panel whose purpose was to decide appeals from the magistrates’ decisions. Our case-load involved appeals against convictions and sentences in criminal cases (drugs, rapes, assault, robbery, murder) as well as civil appeals (car crashes, contractual clashes, disputes between landlords and tenants). The long and demanding case lists required advance preparation over weekends and in the evenings. The senior colleague sitting with me was a wine connoisseur, a refined and courteous man who treated both agreement and disagreement with cordiality.

The previous day one of our cases had already brought disagreement. For some reason this collegial difference triggered an especial attentiveness in me. A young man had submitted a false insurance claim for a stolen car and its contents. This made him guilty of the criminal offence of fraud. When he was arrested, the insurance company was busy processing his claim for his Opel Kadett. A second claim for the belongings he claimed he had left inside it – compact disc player, speaker and discs, golf clubs, gym kit and sunglasses – had already been paid out to him in insurance benefits. His conduct undoubtedly constituted a serious misdemeanour.

A prisons’ social worker recommended a soft option – instead of jail the young man should be house-arrested and made to undergo counselling and perform community service. In favour of this was his clean record. On being caught out he owned up and pleaded guilty. He didn’t waste the court’s time. And, importantly, since his crime he had managed to get another job and was repaying the insurance company what it had paid out to him. At his trial he offered a belated apology.

The magistrate disregarded the prison worker’s recommendation. He sentenced the young man to twelve months’ jail. Was this justifiable? For us as judges hearing the appeal, it was a borderline case. We could intervene only if the sentencing magistrate’s reasons contained an error, or if the sentence imposed was shockingly heavy. As it happened, the magistrate had gone wrong in some of his reasoning. So technically we were entitled to intervene, and impose a new sentence. But the real question was not technical: it was – jail or community service? My colleague and I both hesitated. Before hearing the appeal, we talked it through carefully. He tended to think we should confirm the magistrate’s sentence. This sort of fraud was serious. And insurance scams were mounting, costing honest consumers hundreds of millions in extra premiums. The courts needed to send a clear message to middle-class offenders – those who used paper, and the opportunities their relative affluence in a poor society offered them, to commit crime. Jail was not only for street thieves and housebreakers and robbers. ‘White collar’ crimes could and sometimes rightly should also land you in jail.

Despite this, my own initial inclination was that the jail sentence was unjustifiably harsh. Both of us were open to persuasion, and each felt that he could persuade the other. During argument the young man’s advocate urged us to set aside the jail sentence. His opponent from the state prosecution office defended it. After the arguments my sense that we should use our appellate powers to intervene clarified and firmed within me. I thought that the young man should get a crucial second chance. That evening I worked late to type up a draft judgment setting out the reasons why. Sitting at my laptop in my study at home I could hear my own breathing. My chest felt heavy, my breath short. But I had to finish the draft. Later, I fell into a damp, unrefreshing sleep. In the morning I handed my draft reasons to my colleague. When I saw him at tea just before my standstill in the stairwell, he promised to think it through.

Thoughts about this case, and others, were close to my mind. But as I leaned against the landing wall they threatened to recede beyond reach. I did not want to be falling ill. Not think myself ill. Not face death. Not face telling my colleagues – or having colleagues suspect, conclude – that I had AIDS.

My doctor’s receptionist fitted me in immediately after court that day. While I sat in the waiting room she brought me a mug of tea. Though it had cooled by the time I took it into the consultation room, I winced painfully as I took the first sip. My doctor picked this up immediately. He looked concerned. ‘That’s a sure sign of thrush right through your oesophagus, Edwin,’ he said. ‘It’s what’s making it so difficult for you to swallow. And it’s also why you’ve lost so much weight. Apart from what the virus is doing to your body, your system just can’t absorb food anymore,’ he explained.

I smiled grimly at my doctor. David Johnson is a spry man who wears crisply ironed shirts and serves his practice and his patients with energetic determination. I had been in his care for six years, and had come to depend on his sympathetic professionalism. Over the previous months he had been tracking my CD4 and viral load counts with increasing regularity to measure my immune system and the virus’s rampaging progress. It was already clear to both of us that my immune system was declining. But it was a stop-start process. For a long time my immune system had been mostly heading downwards. But occasionally it would show an upward spurt. Until that afternoon it had not seemed irreversibly clear that I would fall ill with AIDS or when I would. And once I did, the most difficult question confronted us: what to do about it?

The year before, in July 1996, New York City AIDS clinician Dr David Ho made a dramatic announcement at a conference in Vancouver. Trials across North America had shown what was previously unthinkable – that the virus could be stopped in its tracks. The first AIDS case was formally diagnosed in June 1981. For more than a decade and a half, repeated hopes that modern medicine could beat the disease proved false. Those infected with HIV, with virtually no exceptions, went on to develop AIDS. And almost everyone who developed AIDS died. It was a simple, grim, inevitable prognosis.

That inevitability medical science now seemed to have overcome. For the first time, it seemed that doctors could deal with the disease – by administering a closely monitored package of antiretroviral drugs. Previous attempts to treat AIDS with one or even two antiretrovirals had failed. The virus soon found a way around them, emerging stronger and more resilient. But new types of anti-HIV drugs were constantly being developed – particularly a new class that stopped HIV from breaking up the proteins it needs to produce new viral particles. And Ho and his colleagues now realised that using more drugs of different types in combination with each other was the key. Triple (or in some cases quadruple) therapy, with drugs chosen for their different angles of attack on the virus’s means of replicating, were now proving dramatically successful in keeping it at bay. ‘Highly active antiretroviral therapy’ (HAART) was medicine’s best answer yet to AIDS – and it looked extremely promising. Doctors were talking about ‘long-term viral suppression’. And if patients kept taking the right drugs in the right combinations, it looked as though it might even be permanent.

At first some doctors went so far as to hope that over time the new drugs would eliminate the virus from the body completely by stopping viral replication. That would go beyond treatment. It would be a cure. But such hopes proved to be over-optimistic. In the face of the drug onslaught, the virus craftily recedes into the nooks and crannies of the body (the lymph nodes, the testes, the brain membrane), into ‘viral reservoirs’, where current forms of treatment cannot reach it. When the patient stops taking the drug combinations, the virus in most cases emerges, rampant once more.

Even so, talk of long-term viral suppression was an astounding breakthrough. For the first time in the fifteen-year struggle with AIDS, medical science offered patients the hope of escaping what had previously been certain suffering and eventual death. After Ho’s experimental results were released, other doctors adopted his breakthrough methods. For nearly a year and a half, doctors had been administering different antiretroviral drug combinations to tens of thousands of sick and dying patients throughout North America and Western Europe.

The results were astounding. In the rich world, deaths from AIDS plummeted downwards. AIDS illnesses – those that were bringing my own life to a standstill – had almost been eliminated. Once treatment stopped the virus from replicating, ravaged immune systems recovered. And the body, once more healthy, could fight off opportunistic infections.

‘Lazarus’ stories from the wealthy world reached us in South Africa – dramatic, first-hand accounts of patients in the very last stages of their battle with AIDS, who were saved from their deathbeds and restored to life. In the bright December sunshine of Perth, Western Australia, where I addressed a conference on HIV at the end of 1999, Graham Lovelock, one of the organisers, told me his story. At the end of November 1995 he had been admitted to hospital with dwindling health and a poor prognosis. He seemed beyond hope. Every drug had been tried and his body was at the limit of its fight against the virus’s effects. His family and friends had virtually resigned themselves to his imminent death; he did not himself expect to leave hospital again. But a doctor at the hospital managed to get him onto an early trial of the new drugs. In due course he arose from his bed, not dead, but very much alive and more or less restored to health.

The stories from Sydney, Los Angeles, New York, London and Munich were the same. Flushed with excitement, Time magazine made Dr David Ho its ‘man of the year’ for 1996. The end of the first phase of the struggle with AIDS had been reached: there was a way to manage it medically over the long term.

But the good news had a dismal side to it. In 1997 the drugs were unimaginably expensive. Drug companies protected their intellectual property rights – their right to stop competing companies and poor nations from using the knowledge needed to produce and distribute the drugs – with ferocious zeal. Their commercial interests – and, they claimed, their ability to carry out further expensive life-saving research – depended on the huge profits that patent exclusivity brought them. And Western governments, particularly the United States, supported them. While patent exclusivity lasted, the companies charged as much as they could for the drugs.

In wealthy countries, the public health services were simply buying the drugs for AIDS patients at the astronomical prices. But in Africa – where the huge majority of the world’s people with AIDS and HIV live – prices were a death-delivering obstacle. Only the miniscule number of people with AIDS who could afford to pay the cost of combination therapy from their own pockets stood to benefit from the new treatment. The breakthrough was perfected just as the epidemic was starting to show its most catastrophic effects in central and southern Africa. Yet the benefits of treatment were denied to those most desperately in need.

In this setting my own position was one of exceptional privilege. My job as a High Court judge paid well. At the end of 1997 my High Court job was paying me pre-tax just less than R30 000 per month [the equivalent of roughly US$4 000]. This was much less than leading lawyers earned in private practice. But it was about eight times the average salary of employees in the business sector – and almost thirty times the average monthly income of all South Africans taken together. This put me in an income bracket beyond the dreams of most of Africa’s 700 million people – and also of most of the continent’s thirty million people living with AIDS and HIV.

So I had choices – the choices that relative affluence conferred. The question was how to exercise them. Apart from my visits to Dr Johnson I was – with his conditional support – seeing a homoeopath. Sensibly, although disavowing the primacy of conventional Western medicine, she recognised that homoeopathic treatment could have limits. She made few promises. ‘I can keep you free from infections. And I will certainly try to keep your immune system as healthy as possible. But if the virus becomes too strong for my remedies, you will have to turn back to conventional medical treatment.’ For ordinary infections, she gave me remedies free from antibiotics that not only seemed to heal but also comforted. In the six years I’d been seeing her, I felt I had benefited.

But my panting breath and my clogged throat showed that homoeopathy had not managed to stop the virus from running rampant through my body. So the big decision was whether I should start with antiretroviral drug treatment. I was what AIDS specialists called ‘treatment-naive’. My body had never been exposed to any AIDS drugs, and seldom to any antibiotics – I was an ideal candidate for successful treatment.

At my last meeting with Dr Johnson, in September, my CD4 count had for the first time dipped below 200 – a clear sign of imminent AIDS. (The CD4 count of a normally healthy person is well over 800.) At this time Dr Johnson warned me: ‘If you want to carry on seeing how long you can manage without starting on the antiretroviral drugs, that’s fine. But as your doctor my formal advice to you has to be that you should start medication now.’ He treated me as a well-informed patient with the ability to make my own choices – and wanted me to have maximum freedom. So he gave me all the facts I could possibly need to make an informed choice. (Sometimes he gave me too many. He had the alertness of a puppy, and its eagerness. Sometimes I couldn’t deal with it. I wanted him to stop showing me how up-to-date he was. ‘I am not here as a judge or lawyer or policy-maker. I am a patient! I want solace and guidance – not expositions of virological learning or the latest treatment breakthroughs!’)

Given my doctor’s on-the-record advice, why was I so reluctant to start treatment, especially when it was showing such promise? One reason was the side effects I knew that I could expect. The drugs are immensely powerful. They have to be. Powerful enough to reach into the abstruse corners of the body’s genetic mechanisms, where HIV replicates, to put a stop to its machinations. So powerful that in doing so they unavoidably affect other body functions – upsetting the digestive system, causing painful nerve abreactions (tingling, numbness) and redistribution of body fat. Rare toxic reactions, some even fatal – when patients or their damaged livers just cannot tolerate the force of the drugs – gave me additional pause.

I also feared something starker: that the drugs wouldn’t work for me. Dr Johnson told me that his colleagues in rich countries were reporting success rates of about 70 per cent. Wonderful. But this also meant that for almost one-third of those starting on treatment in 1997 the drugs did not work. What if I was amongst them? Reported success rates on antiretroviral therapies are now well over 90 per cent – partly because many of the first patients who started on combination therapy in the mid-1990s had in desperation tried each of the drugs one by one, making the adaptive virus wary and resilient to any further onslaught. In Africa that problem barely existed. But in 1997 doctors didn’t fully appreciate the importance of ‘drug naivety’. So the thought of treatment failure chilled me, dragging me from exhausted sleep at four in the morning to blinking wakefulness in the dark. What if this was it?

To postpone starting on the drugs delayed constructive action. But it seemed to keep hope alive. And, until now, apart from increasing tiredness, I wasn’t actually showing any symptoms. I relied on the grinding treadmill of work in the Johannesburg High Court as an ally. As I grew more tired, I worked harder to try to keep up. And that, I reasoned, was why I was getting more tired. The self-deception was neat (denial comes in many forms). As long as it wasn’t AIDS.

But on the stairwell on Tuesday morning 21 October 1997 this reasoning fell apart. I was critically short of breath. And even though I had stayed up late working on my draft judgment the night before, this, I knew, was not from overwork. Dr Johnson asked me to take my shirt off. I sat with my legs dangling uncomfortably over the edge of his high examination table. Carefully pressing his stethoscope to the front and back of my chest, he listened to my breathing. ‘You don’t need to listen,’ I tried to keep it light. ‘I can tell you that it’s PCP.’ In Africa the main killer of AIDS patients is tuberculosis. In the 1980s, among the gay men of North America, it was PCP – pneumocystis carinii pneumonia. An ordinary fungus, commonly found in the lungs of humans and mammals, causes it. Most toddlers in most families have been exposed to pneumocystis. To healthy adults it can do no harm, lurking in the lungs without causing any noticeable trouble.

But to malnourished youngsters – and to adults suffering from immune debilitation – it can be fatal. The latent, harmless infection flares up into a rare type of pneumonia that before AIDS was virtually unknown. Unless treated, the pneumonia is lethal. The website of the United States Centers for Disease Control (CDC) still intones with simple bluntness that in such cases ‘increasing pulmonary involvement leads to death’.

But PCP is difficult to diagnose – especially in an otherwise healthy, strong adult. Although my body’s increasingly unsuccessful struggle with the virus had wasted away 10 kg, I still had 85 kg left – leaving even my tall, 193 cm frame hardly skeletal. Certainly I was thin – ‘overworked’ of course – but I by no means seemed AIDS-wasted. No one seemed to think I had AIDS. Only the previous week in a lift crowded with judges on their way to court a colleague, burly herself, had commented how thin I was. ‘Are you dieting?’ she challenged as I stuttered. She would have been appalled to know the truth. Just as appalled as I felt as Dr Johnson rubbed his stethoscope bup-bup-bup over my chest. He looked worried but uncertain. ‘It seems like PCP, Edwin,’ he said. ‘But we’d better send you for X-rays.’

After court the next afternoon I found myself in the waiting room of a radiology practice in one of Johannesburg’s smart private clinics. I’d spoken to no one about my incipient diagnosis. As the registrar called the cases and my colleague and I disposed of appeal after appeal, I tried to still my panic every time the thought came up. My life seemed to be fracturing in two. In one, I was a working part of the justice administration in newly democratic South Africa – an extraordinary privilege for anyone – even more so for a white person privileged by apartheid, who had thought that democracy would never happen. Judges faced enormous challenges. A fearsome crime wave was beginning to make the public, black and white, sceptical about the principles underlying our ambitious constitution. Were the new rights benefiting only criminals? Despite the clamour, President Mandela’s government, and that of his successor President Mbeki, remained true to their commitment to constitutionalism. Judges and the constitution were at the centre of this debate. It was hard not to feel some significance in our work – and a sense of promise. I wanted desperately to continue, not to be sick.

But the other part of my life was washing away beneath my feet, eroded by microbes and attacked by fungi coursing through my veins and wasting my muscles and bodily reserves, leaving me tired and panicked and isolated in the waiting room. The radiologist’s assistant called me in. I stripped off my jacket and shirt and donned a flimsy examination gown for her to take the X-rays. Her brisk efficiency as she manipulated the heavy X-ray negatives made me feel even more isolated. ‘Dr Jacobs will see you in about twenty minutes to discuss his assessment,’ she promised.

But twenty minutes passed, and then thirty. Once more in my suit, I waited in the corridor outside the viewing room. I had never been more conscious of my breathing. As the doctors walked in and out, one in particular glanced several times at me. But still I was not called in. Eventually my mobile phone rang. It was Dave Johnson. ‘The radiologist has just phoned. He’s sitting with your X-rays. But he can’t believe what they tell him. He’s scared of giving you a wrong diagnosis. He says they seem to show PCP. But he can’t believe it. He says you don’t look like you have AIDS. So he phoned me first to check whether you are at risk.’ Dr Johnson suggested that I bring the X-rays to his home that night to double-check.

I felt helplessness mixed with despair. If the radiologist was thinking media stereotypes, of course I didn’t ‘look’ like someone with AIDS. I was not in bed. I was not emaciated or entubed. I was fresh from a long working day in court – still in a suit. My medical insurance details at reception must have revealed my judicial status. And judges don’t get AIDS. (Nor are they gay.) In any event, Dr Jacobs’ practice didn’t look as though many black or gay patients – those most ‘at risk’ – frequented it.

At last he called me in. He spread out the X-rays on his light table. Both lungs shone bright with the tell-tale signs of PCP. He pointed out its white spots crowding both organs. His manner was kindly, respectful. My doctor would prescribe highly effective antibiotics, he reassured me. This usually cleared the infection within ten or fourteen days. I should come back then for a further check.

That evening I took the X-rays to Dave Johnson’s home. He held them up to his study lamp. ‘Yes, that’s what I thought, Edwin,’ he said. I had AIDS. On the way home I stopped at the pharmacy to pick up the fourteen-day course of bactrim he had prescribed. And faced a long, hard evening alone at home.

People sometimes say that they couldn’t go on living if they knew that they had HIV. Or that they’d ‘just’ kill themselves if they ever got AIDS. It’s a stupid and unreflective thought. I know, because I used to think it myself. I used to tell myself that I could not carry on living if I were ever diagnosed with full-blown AIDS. Then, I fancied, life could surely not be worth continuing. So I would take the simple course. I would just allow PCP – or whatever horrific opportunistic infection arrived to herald AIDS – to take its course, and let my too solid flesh melt, thaw and resolve itself into a dew. Without treatment PCP would make quick despatch of me.

Reality is less poetic. Or it was for me. Impending death did not arrive gracefully in the form of sensible choices. It was fetid, frightening, intrusive, oppressive. Too often I had seen friends and comrades die of AIDS. Had seen how day by day, week by week, they would redefine wellness, adjusting it downwards each time, but never losing its goal, no matter how wasted, disabled or physically dysfunctional they became. Getting better always seems to remain attainable, even when from the outside it was plain that it no longer was. I had seen too many friends choose life, right until the end, even when they knew – must have known? – that it was receding from them, no longer an option, that it was death only that awaited them.

Like them, I now experienced no existential hesitation. I just wanted to keep on living. I wanted my health back. Urgently. I wanted to breathe easily, freely again. I could not let diagnoses of PCP and all that they seemed to imply get in the way. And I had plenty to distract me. My imprudently chosen lover seemed to want to play a game of chase. Perhaps my inner commotion was more palpable to those closest to me than I had thought. To them I spoke about HIV. And to some I even mentioned PCP – or just ‘a chest infection’. But the accompanying diagnosis and its implications I did not reveal. The word AIDS was too big, too frightening, too fraught with implication. Too final.

My sister Jeanie, who for forty years had nurtured and protected me, worried over the phone. She listened carefully to what I described of my visits to Dave and the radiologist, and urged me to get into bed. I refused. How could I? There was court work to be done. The judge-president had included me on the roster of duties for the rest of the year. And I had meetings to attend. And committees to run. I was needed. Thank goodness. When Jeanie offered to travel the 60 km from Pretoria to Johannesburg to bring me meals, I assured her that it wasn’t necessary.

To accept sympathy and support means acknowledging weakness and dependency. I wasn’t ready for this. AIDS had to wait. Months before, Judge-President Eloff had circulated a court roll posting me to a six-week out-of-town session of the High Court. The circuit was due to begin on Monday in Vereeniging, an industrial riverside town ninety minutes’ drive from Johannesburg. I had already arranged for two young lawyers – promising black practitioners at the Johannesburg Bar – to join me on the bench as assessors. For them the work would bring good exposure. For me (like most white South Africans, miserably only bilingual in a country where people generally speak four or more languages) their assistance in understanding issues and clarifying meaning would be indispensable. While I would determine legal questions alone, on factual issues we would vote together – and in case of disagreement their vote could prevail.

Both had set aside time – and perhaps turned away briefs – to perform this public service on the Bench with me. So cancelling the Vereeniging circuit seemed unthinkable . . . Of course it was. Apart from anything, getting into bed and acknowledging how sick I was would cause talk. And that was unthinkable . . .

On the Monday we started the daily drive to the Vereeniging circuit court. I was relieved to have an agreeable young clerk do the driving while I leaned back into the passenger seat, willing the antibiotics to work as quickly as possible. Some of the cases on our roll came from Sharpeville, a township adjoining Vereeniging with intense historical associations. Twice in thirty years the name focused world attention on the excesses of apartheid – first when white police killed some sixty unarmed protesters at the Sharpeville police station in March 1960; and a second time twenty-five years later when a judge sentenced six township activists to death in December 1985 for the murder of a local councillor serving in apartheid structures.

When the first Sharpeville disaster happened I was five weeks from my seventh birthday – newly arrived with my older sisters Laura and Jean at a children’s home in Queenstown in the Eastern Cape province. Some of the other children were orphans, others had been abandoned. Most were from impoverished broken homes, their parents unable to care for them. My older siblings and I fell into the last category. After a succession of moves from city to town and back to city, as my alcoholic father drank his way out of job after job, our fragmented family finally fell apart. My mother, sad and angry and not coping at all, finally gave up on the marriage and divorced him a second time. Well-meaning church friends persuaded her that it was best to send us 700 km away to the children’s home.

If news of the Sharpeville massacre reached us there – and it surely did, for the Eastern Cape was alive with resistance to apartheid rule – it had to contend with other issues to make a mark on my boyish perceptions. There was talk of attacks by ‘Poqo’, the ‘pure’ armed resistance wing of the Pan Africanist Congress, a breakaway faction from the African National Congress. We were told that attacks were imminent. I imagined black warriors like those depicted in the stilted history books the older children used, streaming over the hilltops surrounding Queenstown.

The intervening twenty-five years transformed not only my circumstances but my consciousness. Queenstown seemed very far away. But the journey from the children’s home had left me with an intense, central, motivating awareness. There were many poor, deprived children in South Africa. Many intelligent, ambitious children, willing to work and to strive. Many who yearned for escape, release, transcendence from constricting material circumstance and poverty.

What made me different from most of them was my skin colour. What made me different was that the country was structured to privilege me while systematically disadvantaging others. What saved me from poverty was that I was white. After nearly five years in the children’s home, and a series of further schools in various parts of the country, my mother, despite her own poverty, managed at last to secure me a place in a first-rate government high school for boys. Set on a hill overlooking Pretoria’s most affluent suburbs, Sir Herbert Baker’s early twentieth century buildings were designed to epitomise the grace and dignity and scholarship appropriate to questing male adolescence. Arriving on the first day shortly before my fourteenth birthday, I felt nearly suffocated with apprehension and excitement. I craved all the elegant learning Pretoria Boys’ High School seemed to offer, and all the opportunities beyond that. I could hardly believe that all this had become available to me.

The school changed my life. What I learned there – perhaps even more importantly, those I met there – gave me access to rich opportunities. These included the fulsome Anglo American Corporation open scholarship that enabled me to study law and English and Latin and Greek at Stellenbosch (a lovely university town near Cape Town whose oak-lined streets are filled with Cape-Dutch architecture), and later one of the world’s very best openings – three years at Oxford as a Rhodes Scholar. Back from Oxford, I joined the Johannesburg Bar as an advocate. But in the growing crisis of apartheid a commercial practice did not attract or satisfy me. It seemed imperative that if law should survive as a way of regulating social conflict in South Africa – if it deserved to survive at all – more lawyers should get involved in fighting injustice in the courts and by offering legal advice and support to organisations and individuals resisting apartheid. Through November 1985, as I packed up my fledgling commercial practice to move to full-time work as a public interest lawyer at the University of the Witwatersrand’s Centre for Applied Legal Studies, I closely followed reports about a murder trial that, twenty-five years after the original Sharpeville tragedy, was once again bringing that name into resonant public prominence throughout the world.

The gruesome murder on 3 September 1984 of Jacob Kuzwayo Dlamini, an apartheid-structure councillor, by an enraged crowd of town-ship residents, produced a grim atmosphere when eight Sharpeville residents were put on trial for their lives in 1985. Defence advocates told of a hostile judge and a determined prosecutor. Even so, when six death sentences were pronounced in December 1985 (two of the accused were acquitted), they came as a shock. For my own part, I knew that, beyond any question of individual moral accountability, the underlying iniquities of apartheid were to blame for the growing cycle of violence that was sweeping the country. As a white South African, I saw that the executions would only add to the injustice and resistant rage that apartheid had spawned. And as a human rights lawyer, the way in which the courts I operated in daily dealt with the case left me appalled and angry.

The trial judge sentenced all six to the gallows, even though the prosecution could not prove that the actions of each had actually contributed to Dlamini’s death. The case of one of the condemned six shocked me particularly. Fearing for his life, the embattled councillor had fired a shot that wounded one of a hundred-strong crowd surrounding his house. In response, a young woman named Theresa Ramashamola was found to have shouted: ‘He’s shooting at us, let us kill him.’ Others certainly heard her. But in the hubbub, who could say that her cries had actually heightened tensions, incited the perpetrators, hastened the murder? The court heard no such evidence. Later, when someone pleaded that the injured councillor should not be burned, Theresa slapped her. For these words she was not only convicted of murder but the judge refused to find ‘extenuating circumstances’, which would have permitted a jail sentence. He sentenced her to hang. I was aghast.

The case of another accused appalled me as much. None of the witnesses placed him on the scene of the crime. Unlike the other accused, he was arrested more than two months after the murder. One of those directly linked to the murder took the police to his home to retrieve the dead man’s firearm that the killers had wrested from him in his dying moments. When confronted by the police, the accused man readily produced the weapon from a hiding place in his ceiling. He had taken it, he claimed, from youths who were nearby on the day of the murder. He denied being present at the murder.

The judge disbelieved his evidence – he had lied about events at his house; he couldn’t explain why the other accused knew that the firearm was with him; and in court he falsely disputed that the weapon produced in court was identical to the one he had retrieved from his ceiling for the police.

Was this enough to hang a man? Was this enough to conclude beyond reasonable doubt that he was the very man who had wrested the deceased’s firearm from him in his death struggle? Did his lies together with possession of the crucial weapon prove that he was one of the killers? Surely not. The firearm was retrieved from him nine weeks after the murder. English judges had developed a logical way to link someone caught red-handed with an incriminating object to a recently committed crime. South African judges adopted it – the ‘doctrine of recent possession’. But it had never been applied after so long a delay. No civilised system, I thought, could do so. After nine weeks the possessor of the incriminating firearm could not possibly be described as ‘red-handed’. And however many lies he told, there was a substantial – and, I thought, obvious – chance that he had come into possession of the dead man’s weapon in a way that did not implicate him in the murder.

Well, why then did he lie? South African courts treat a lying accused with scant sympathy. But a number of authoritative judgments warned that a criminal defendant might lie for reasons other than that he was guilty. In the case of this accused, it seemed more than reasonable – indeed, I thought, obvious – to assume that he might have lied about when and how he got the firearm because he didn’t want to implicate the co-accused who had brought the police to him. To exculpate himself, he would have had to say, ‘I took the weapon from him and agreed to hide it in my ceiling because he told me he got it from the dead man at the time of his murder.’ Was it unreasonable to suppose that the motive for his trivial lies was a reluctance to ‘snitch’ on his friend – particularly given the fraught racial and political tensions surrounding Dlamini’s murder and the police investigation?

To me the verdict seemed an outrageous curvature of the laws of logic and fairness – a miscarriage of justice symptomatic of the extremities apartheid was inflicting on the legal system.

But the trial judge decided otherwise. And five judges of appeal in the appeal court in Bloemfontein confirmed his verdict. Incensed, I became vocal in an international campaign to save ‘the Sharpeville Six’. I wrote an article for a scholarly journal. I addressed meetings. I spoke to foreign correspondents posted to Johannesburg. Three weeks before the six were due to stand on the gallows, after the government had refused to commute their sentences, I attacked the verdicts in an opinion piece in the mass-circulation Johannesburg Sunday Times. I pointed a finger at the appeal court for ‘widening the doctrines of criminal liability in response to evidence of township revolt’. My criticisms were quoted in London newspapers, where a distinguished former law lord, Lord Scarman, and a senior British barrister who observed the trial, Louis Blom-Cooper QC, also attacked the outcome. When one of the prosecution witnesses recanted his evidence, the unflagging lawyer for the six, Prakash Diar, asked me to join the team fighting for their lives by applying to reopen the case.

But those defending the courts’ verdict counterattacked. Chief Justice Rabie was greatly offended. He sent a message through Judge-President Moll to the Johannesburg Bar Council, asking the body to institute disciplinary steps against me. To its credit, the Council voted overwhelmingly (though not unanimously) against any sanction.

The year before, the minister of justice in State President PW Botha’s cabinet, Kobie Coetsee, had attacked me for accusing three prominent judges of pro-apartheid collusion. His official statement slated me, ‘the young Mr Cameron,’ as a ‘lesser known officer of the court’. He dismissed my criticism of the judiciary as ‘distasteful and improper’. He added for good measure that I appeared to derive ‘some sort of misguided pleasure from denigrating great Chief Justices’. Now at a national Bar conference Chief Justice Rabie himself condemned my criticism of the verdict, saying it was little short of ‘shocking and disgraceful’. In a later case the appeal judge who authored the Sharpeville Six judgment took the unprecedented step of responding to the criticism, saying that he had ignored ‘the misguided comments of hysterical politicians masquerading as lawyers’. It was a bad jibe. But what it showed was that criticism of the verdict had certainly found its mark.

I refused to apologise. There seemed to be nothing to apologise for. My criticism to me seemed well justified – even mild. It stood out only because during the 1980s few lawyers in practice or at universities within South Africa dared to criticise apartheid judges. At Wits University, two gifted colleagues, Etienne Mureinik (who later died tragically by his own hand) and Carole Lewis, wrote to the press defending my right to criticise. And they organised a colloquium to discuss my intervention. But from other legal and academic institutions there was mainly a deathly reverential hush. Books critical of the South African legal system, by lawyers associated with the exiled African National Congress, were prohibited from circulation. In this near vacuum, outspoken challenges resounded loudly.

Instead of backing down from my public criticism, I threw myself into the court bid to reopen the case of the Six. The recanting prosecution witness had earned them a merciful reprieve. The afternoon before they were due to hang the trial judge, in a lifesaving fit of doubt – aware no doubt of the international outrage – granted them a temporary reprieve to plead for a new trial. Shortly afterwards I visited them on death row. In the corner of the cramped warder’s office where we met there was a scale. Next to it stood a vertically adjustable wooden device with centimetre markings. They told me that the day before their scheduled execution the hangman had carefully weighed and measured them. He had to calculate exactly what length of rope was necessary to kill each of them efficiently.

In the 1980s, South Africa had one of the highest number of recorded hangings in the world. In 1987, no fewer than 164 people were hanged. One almost every second day. Executions were carried out in a severely guarded, bleak new cell block in Pretoria’s maximum security prison. I visited death row only three or four times. Each time I left chilled within. To reach it one had to cross a final quadrangle with painstakingly nurtured lawns and flowerbeds. Inside, the windows were vertical slits, the interior drably painted, the atmosphere one of controlled desperation. In the courtyard outside, the warders kept ducks. Perhaps their necks were never wrung.

While the Six remained in their cells on death row, Sydney Kentridge, the famed South African advocate then gaining prominence at the London Bar, flew back to present the argument. We lost. But Chief Justice Rabie and his appeal court colleagues gave us a respectful hearing. And as so often under apartheid, a legal challenge, even when it did not attract a favourable judgment, helped to secure a favourable outcome. The court bid bought the six vital time. The Sharpeville Six, too, would have a second chance. Even though the legal challenge had failed, the apartheid government could no longer afford to hang them. The international outcry had saved their lives. It had also saved the country from the explosion that was certain to have followed their executions. It had also saved, I thought, the South African judiciary from the irremediable ignominy that the deaths of the Six would surely have earned it.

In late October 1997, travelling the busy highway through the industrial heart of South Africa to start the Vereeniging circuit, I, too, yearned for a second chance at life. I was now part of the judiciary, one of the first High Court judges President Mandela had appointed in 1994 under the new democratic constitution. I wanted to fulfil my duties. And I wanted to concede as little as I possibly could to the disease that now threatened to stifle my life. The cases on the court roll that October/November in Vereeniging presented all the problems and pains of our nascent country’s transition from an unjust past to the better future to which we all – lawyers, politicians, judges, people – had committed ourselves. I wanted to be part of it.

The first case my assessors and I heard involved a vigilante killing. A family claimed that the victim had murdered their uncle. They had brought the victim to their home to confront him. When he tried to escape they beat, stoned and stabbed him to death. Then they poured petrol over his body. The district surgeon told us that the flames had reduced it to charcoal. One murder had led to an even more gruesome second. My assessors and I convicted two nephews of the first victim for murdering the second. Other family members, including a sister, we acquitted, because of weak prosecution evidence. In our judgment we emphasised that justice was, or should be, the exclusive prerogative of the courts.

But mistrust of apartheid law and order had set off a grim cycle of vigilantism in many townships. Even a newly accountable police force could not perform miracles. Still too few people trusted police or courts to deal effectively with offenders. And still too few police themselves engendered that trust – as one of our next cases harrowingly showed. A packed courtroom rose as we entered to hear the prosecutor call the trial of police sergeant Jappie Masilo Twala. He faced two separate charges of murder plus two of attempted murder. When his brothers became involved in a Sunday night bar-room spat about a stolen watch, Sergeant Twala went to intervene. As tempers flared and a stone-throwing crowd gathered, he pulled out his service pistol and fired three shots. One of the shots proved fatal for a stone-thrower. When Sergeant Twala and his brothers fled the scene they left a corpse behind – that of a nineteen-year-old pupil at a local school.

Days passed. Yet the police did nothing. Sergeant Twala was not arrested. Was he immune? The dead youth’s school friends seemed to fear that he was. On the eighth day of police inaction, they gathered at a special school assembly. There they resolved that they would confront Twala themselves. They abandoned their classes. They took to the streets and forced commuter buses to a halt. They boarded them en masse, and compelled the drivers to divert to Twala’s home. Twala was out. So the crowd destroyed his home.

The house was modest but recently built, neatly middle class and well appointed. When the youths were done, it was no longer a home. In court we saw the photographs. The damage the youths had caused was literally devastating – they lit fires, broke doors, shattered windows, ripped fittings from the wall, overturned cupboards and fridges. What they didn’t destroy they carried away with them. It was a terrible, unlicensed rebuke for a deed Twala had not been charged with, had not been tried for, nor convicted of. It was also vengeance born of police inaction.

Sergeant Twala was out investigating a crime. He received an urgent radio message summoning him home. He hastened back to find his household wrecked. School children were still running from the scene. Inspecting the damage, a senior colleague tried to console him. He assured Twala that three of the guilty youths were under arrest. Indeed, they were right outside, safely locked up in the back of his police van.

On hearing this Twala left the house. He went to the police van and unlocked its back doors. Precisely what followed was sharply disputed at the trial. What was certain was that a fusillade of shots was fired into the van. After it, Twala’s service pistol magazine was empty. And one youth lay dead. Another was critically injured. A third was wounded. The shots had ripped through the chest of the dead youth, killing him instantly. The second they rendered a spinal paraplegic, with permanent partial paralysis of his ankles and feet. The third suffered wounds to his chest, thigh and arm. Fortunately he was not permanently injured. But in court he told my assessors and me about the psychological suffering he had endured.

Before us, Twala faced two murder charges – the stone-thrower he had shot in the spat with his brothers; and the schoolboy killed in the back of the police van. Twala denied any culpability. In the barroom brawl he had acted in necessary self-defence. At the police van, he claimed, the youths inside had set upon him when he opened the doors. In the ensuing struggle his firearm went off – quite unintentionally.

On the first killing my assessors and I found the prosecution witnesses honest. But their evidence was not sufficiently firm for a murder conviction. Everyone had been drinking, and accounts as to what had happened when differed. Besides, everyone agreed that a hostile crowd had gathered and that tempers were running high. Self-defence could not be rejected as untrue beyond reasonable doubt. Twala had to be acquitted.

But on the police van shootings we had no hesitation in rejecting his account. The two surviving youths gave pitifully convincing, unembroidered evidence of how Twala had opened the doors of the police van, produced his pistol and then wildly emptied the magazine. The district surgeon gave detailed evidence on the sites of the wound entry and exit points. He confirmed that the young men’s account squared with the medical evidence. We found Twala guilty of the murder of the dead youth, and of the attempted murder of the two survivors. He was lucky not to have had the survivors’ lives on his hands as well.

Even so, we found that he had not acted cold-bloodedly. He was in a desperate rage, overcome by the awful devastation he had gone home to witness. Mercy required that I take this into account in sentencing him – and that I purge from my mind suspicion about the earlier killing. I did so. Despite the death of the youngster, and the horrific injuries to the other two, I imposed a strongly mitigated sentence of nine years’ imprisonment.

Twala was not content. His defence – like that of most policemen charged with on-duty killings – was conducted by the state legal office, which briefed experienced counsel. His case ended three years later in the Constitutional Court. A judgment in his name set a precedent about appeal procedures. But the murder findings and his nine-year sentence remained intact. With remission and parole, he is by now probably long out of jail. Sergeant Twala, too, has had a second chance.

After my session with the X-ray doctor, my clerk and assessors and I travelled to Vereeniging and back every day. Each morning I donned the bib, sash, waistband and flowing scarlet robes that English judges had imported to South Africa when the British took the Cape from the Dutch in colonial conquest in 1803. The resplendent robes gave me a full-body disguise. This was just as well. Despite the radiologist’s confidence that the antibiotics would repel the AIDS pneumonia within ten to fourteen days, it proved to be surprisingly stubborn.

Ten days into the circuit, I returned for my fourteen-day check. Studying the new X-rays with me, Dr Jacobs gave me the bad news. It had not cleared. I needed more antibiotics – in a stronger daily dose. Dr Johnson had underestimated the dose my still substantial body weight demanded.

Naturally, if I had got into bed and rested, the drugs would have had a better chance of slaying the microbial dragon raging within me. But bed rest had never seemed an option. In near despair, I returned to Dave Johnson for a further script. He gave me another week on a double dose of bactrim.

The next morning I travelled back to Vereeniging.

But the treatment was ghastly. The powerful antibiotics, in their as yet unavailing onslaught on the PCP, caused a red rash to flush out over my upper torso and face. My appetite, sparse as it was, seemed to vanish. My stomach tightened. Eating was becoming even more difficult. I lost more weight. After being diagnosed with HIV in 1990, my friend Zackie Achmat had experienced a lung infection. On the Sunday after I was diagnosed he came to visit me at home. My breathing was even more laboured than before. I did not feel at all well. It showed. Zackie knew all too well. We sat facing each other, rigid, each unable to speak the words of reassurance and comfort the other needed.

Worst of all was that the antibiotics had further suppressed my body’s weakened antifungal defences. The result was the return of oral and oesophageal thrush. Dave Johnson had prescribed Diflucan – a fantastically expensive, but blessedly effective, antifungal drug. Its expense was later to trigger one of the most dramatic activist challenges to the pharmaceutical industry (which I describe in Chapter 6). For me, the cost of the tablets – about R120, or nearly US$20 a tablet: the approximate equivalent of the daily earnings of an employee in the business sector – was fortunately covered by the judges’ medical insurance scheme. I thought that the precious and expensive Diflucan had done the trick. But no. One of my worst moments – I often think the worst – was one morning at the mirror, two weeks after diagnosis, when I noticed that my tongue once more was flecked with resurgent thrush. My heart sank. It felt like a defining moment, inviting despair. Fungal spores grow on dead bodies . . . The treatment hadn’t beaten the PCP. The thrush was back. I was feeling ghastly. Was my body shutting down for death? Would the treatment fail me?

But I could not allow such thoughts to be more than momentary. I could not let them take hold. I was not yet a dead body. And I didn’t want to become one. I wanted a second chance. Determinedly, perhaps desperately, I continued working. There was in fact much to do. A committee I had been leading since 1996 was advising the country’s law commission, an influential national statutory law reform body, on AIDS. Already, several reports we had delivered had impressed the commission with their thoroughness and their powerful, well-balanced arguments. The commission had endorsed our findings and sent them on to Parliament, where they had found their way into beneficent legislation.

Now we were close to producing recommendations to ban pre-employment testing for HIV – a widespread practice that irrationally and unfairly barred job applicants with HIV from finding or taking up employment. I knew something about the effects of pre-employment HIV testing. In 1993 I started a university-based AIDS law project that offered legal services against AIDS discrimination. One of the reasons was the stream of calls for help I’d been receiving at Wits University’s human rights centre. As the South African epidemic took hold, people came for help against high-handed, sometimes cruel behaviour by employers who were determined – completely impractically – to have nothing to do with AIDS: an ‘AIDS-free’ workforce, as some put it. Some callers were policemen, others were in the army, many were in business and in industrial concerns.

By and large the law commission committee – composed of business people, health specialists, lawyers and activists – agreed that both justice and good sense demanded that the practice be outlawed. Zackie joined soon after we started. He added fire as well as strategic wile to our discussions. We had to work out a compromise to place unanimously before the commission, and with it prepare watertight draft legislation for the commission to pass on to Parliament. It was not easy. One day I adjourned court early in Vereeniging to meet committee members in Pretoria. Soon after, we fitted in an extra Saturday meeting to finalise our proposals. None of this, I thought, could wait. And immersing myself in it somehow anaesthetised me against the panic that my bodily frailty was inducing in me.

Yet there was a tension, and a paradox. I was dealing with AIDS as a judge, chairing a committee, making public statements and important public recommendations. But I was also dealing with AIDS within myself. As the disease’s symptoms raged through my body, the split between the two roles unsettled me more than ever before. I began to think that at some time, sooner rather than later, I would have to unite the public and the personal. I couldn’t continue being a highly visible and respected AIDS policy advocate in public life while dealing secretly with the debilitating effects of the sickness in my own life. It wasn’t a question of ethics. Despite holding public office as a judge, I was, I thought, entitled to keep my state of health to myself. But in simple practical terms it just seemed to divert too much energy. Secrecy is all too often a worrying and time-consuming and energy-sapping business. And it was just unnecessarily exhausting. These thoughts bore fruit just a short while later.

Meanwhile, the extra effort the committee put in at the end of 1997 proved thoroughly worthwhile. Early in 1998, the full commission approved our recommendations on prohibiting pre-employment testing for HIV. The recommendation that pre-employment testing for HIV be prohibited went to Parliament – and just months later a new statute enshrining workplace fairness banned all HIV testing of workers and job applicants unless special court authority was obtained from the labour court.

But the flecks I saw on my tongue and the unrelenting PCP at last persuaded me that I had to allow myself some time off for recovery. The next week offered a respite, as the case my assessors and I were currently trying was drawing to a close. Some of the later trials I could postpone to catch up on during the ensuing January’s court vacation. With my heart in my mouth I called Judge-President Eloff to arrange time off. What questions would he ask? What would he say? Would he support me? As it turned out, he asked nothing. I told him that I had a chest infection and was not feeling well. He asked for no details. Instead, he assured me immediately that it was paramount that I should recover. There would be no problem if I rearranged the circuit to finish the delayed cases later.

Relieved, I put down the phone. For now at least, work could take second place. The last few weeks had taught me some important lessons. For the first time I could contemplate using a space in which I could feel better. For the first time I learned to risk relying on other people for help during my illness. And in every case their responses touched me and moved me and reassured me.

Under attack from the doubled dosage, the PCP was beginning to recede. As it did, Dave Johnson and I discussed when I would take my first dose of antiretroviral therapy. By now there was no question but that I had to start combination therapy. Even if we managed to deal with the PCP and thrush this time with ordinary medications, further HIV-induced weakness and illnesses, progressively increasing, were all that awaited me, like so many before, like so many others in Africa.

The experience of an incapable, inefficient chest and a fungus-clogged gullet had scared me right out of further ambivalence or uncertainty. If there was a chance that the treatment would fail me, there was twice as much chance that it would succeed. What distinguished me from other Africans dying of AIDS was that I had the means – though barely – to clutch at the near miraculous new remedy of antiretroviral treatment.

Dr Johnson and I agreed that I would take my first dose of antiretroviral therapy on the day I had arranged with the judge-president for my break from circuit court to begin. I told my family and some close friends – those whom I felt that I could trust with my HIV status. In a jovial, nearly festive, atmosphere, I took my first pills on Thursday evening 13 November. With a small group of friends sitting around a table on my porch in the warmth of the early summer’s evening, to determined cheers I solemnly took six capsules of one of the new, breakthrough class of anti-HIV drugs – a powerful ‘protease inhibitor’ called ritonavir (marketed as ‘Norvir’).

The cost of the new treatment was enormous. The three drugs I was taking (as well as the protease inhibitor, I started taking an AZT-like drug called D4T, and another called 3TC) cost more than R4 000 (or roughly US$600) for one month’s supply. This was fully one-third of my after-tax monthly income. Unless the prices of the drugs came down sharply, and soon, I would not be able to continue to afford to pay this amount every month. Too many others too close to me shared my monthly salary.

The medical insurance scheme for judges – the same one that covered members of the new democratic parliament – limited AIDS benefits of any kind to a derisory R800 per year. That amount would cover barely one-fifth of a single month’s supply of my new lifesaving drugs.

This surely was monstrously unfair. My fellow judges and Members of Parliament who had high blood pressure (and comparable ailments) enjoyed a chronic medication scheme of R10 000 per year – more than twelve times the maximum cap for AIDS. Why should AIDS be treated differently? Realising, as my CD4 count gradually fell, that I would at some stage need to rely on AIDS medications (or, at worst, on terminal treatment for AIDS), I had gone a year or two earlier to see a judicial colleague in Cape Town who had been specially appointed by the heads of court to represent the interests of judges on the scheme’s governing board.

I had told my colleague that I had HIV – and that I feared that at some point I might fall ill with AIDS. Initially he seemed shocked and sympathetic. He promised me that he would have the unfair limit removed to equal that of comparable chronic conditions. If blood pressure or heart disease or diabetes were covered, indeed why not AIDS?

But perhaps the shock he felt at hearing that I had HIV overcame his sense of purpose. For nearly two years I sent him repeated reminders and pleas. He asked for information and statistics, which I produced. He said that he needed a memorandum to put before the board. I gave it to him. All this resulted in repeated promises, but no action. The AIDS treatment limit of R800 per year stayed. No doubt he had other things on his mind. Perhaps he temporised because he found AIDS a difficult issue.

But the extremities of illness lent me boldness. Besides, I felt more and more that I had less and less to hide. While I was absent from the judges’ common room in Vereeniging, Judge-President Eloff must have mentioned to colleagues that I wasn’t well. (And why should he not?) Colleagues began calling me at home. How was I? Could they do anything to help? They were missing me at court. I should get well soon.

My family’s love and that of many friends had always felt secure. But it began to dawn on me that there was much, much more support and acceptance available to me than I had realised. And that I could draw on it. My anxious fears about my colleagues’ possible reactions to AIDS began to yield to the loving reality of collegial acceptance and support. Of course they didn’t know (or didn’t know for sure) that it was AIDS. But some of them surely guessed. And in any event the fact was that it didn’t and shouldn’t make a difference.

After six weeks of feeling seriously sick, I was no longer in any mood to footle around with discrimination in the judges’ medical insurance scheme. By Africa’s standards, my salary was indeed comparatively large. But needy dependants in my household and outside it shared it with me. And I could simply not afford to continue spending one-third of my total disposable income on the new drugs.

Towards the end of November, after my ten days off, we resumed in Vereeniging. During a short adjournment, while police witnesses were being summoned to court, I opened my laptop. Spurred on by new energy and new determination, I wrote my judicial colleague a swingeing account of my sustained entreaties to him. Yet, I charged, he had delivered on none of his promises. If he was not willing to take immediate action to end the irrational discrimination against AIDS, he should, I suggested, resign from the medical scheme’s board.

For good measure I wrote also to Judge-President Friedman of the Cape, a wise and humane man who had had originally been responsible for securing my colleague’s appointment to the insurance scheme’s board. The reaction of both was immediate – and positive. Expressing warm concern, Judge-President Friedman invited me to meet him in his chambers in Cape Town during the December vacation. I arrived fully prepared for confrontation with my dilatory colleague. Instead, he too was all readiness to help. Both he and Judge-President Friedman undertook that the matter would be dealt with properly and immediately. The unfair anti-AIDS discrimination would be set right.

And in the new year it was. The judges’ and parliamentary medical insurance scheme stopped discriminating against AIDS as a chronic medical condition. First it granted AIDS the same coverage that all chronic medical conditions received. Later it increased its coverage for all AIDS conditions and treatments even more. Currently it offers judges and parliamentarians more than ample support for antiretroviral treatment – at least, for those judges and members of the legislature who are willing and able to claim its benefits.

In the meantime, the court year was drawing to a close. My colleague in the case of the young insurance fraudster called me to say that he had thought further about the case. He was now more convinced than ever that the magistrate’s sentence was correct. I took the opposite view. Further reflection had made me conclude that the magistrate’s sentence was wrong, and that our intervention was required. It be-came clear that we would not reach agreement on the outcome on whether the young man should be given a second chance. Because of our deadlock, Judge-President Eloff had to convene a new panel to hear the appeal again. He presided himself. Two other judges sat with him – three in all, so that if they too disagreed, the majority would prevail. Although the new panel also hesitated, the three judges all decided that justice required that the young man be given a chance to make good. He would not go to jail. He would keep his job. And he would repay the insurance company benefit payout that he had falsely claimed. He, too, would have a second chance. A sentence hanging over him – admittedly, not a death sentence – would be remitted.

My week-long break had come to an end. Again I started the daily drive to Vereeniging. But by then I realised that something incontrovertibly extraordinary was happening with my body. I was taking all my antiretroviral tablets twice a day, observantly and carefully. It certainly was not a breeze. The protease inhibitors in particular were difficult and unpleasant. The tablets were bulky and hard to swallow. At room temperature the precious drug soon degraded and lost its efficacy. The plastic capsules became blistered and started bleeding their contents. So they had to be kept chilled at all times – for the eighteen months I took them – making travelling very complicated.

What was more, the protease inhibitors left an utterly vile taste. Two hours after taking them, morning and evening, my stomach would erupt in gastric protest. For months after starting on them, I battled nausea. I also developed what the doctors call ‘peripheral neuropathy’ – nerve endings that responded badly to the new chemicals in the body. In my case, the nerve response manifested as perioral neuropathy. My teeth and sinuses became intensely and painfully sensitive. I remember coming into the kitchen one morning and biting into what seemed a deliciously tempting watermelon slice someone had left out of the fridge overnight. The room-temperature contact caused me to wince and then weep with pain. It was far too cold for my agonisingly ultra-sensitive teeth.

But all this was trivial beside the growing realisation that something quite unmistakably dramatic was taking place within my body. My tiredness was lessening. It was disappearing. In its place, I could feel a daily access of miraculous new energy. Life forces were coursing through my body. Illness was yielding to a nearly novel feeling – renewed and joyful wellbeing. Every evening, every morning, every long court day in Vereeniging, as I heard evidence in court, evidence of a different kind presented itself to me through my body. It was there – in the way my blood coursed through my veins, the way I heard myself breathe, the way my muscles felt. I not only regained my appetite – despite the nausea the protease inhibitors induced when I took them, I became ravenously and continuously hungry. For the first time in months, my stomach was digesting food properly. And my gaunt body avidly claimed every morsel of it to make up for the twelve kilograms (twenty-five pounds) in weight I had lost.

There was only one word for it. It was glorious. The drugs were working. I could feel that I was getting healthy again. I knew that I would be well again. That, in turn, spurred my inner confidence. Physiological wellbeing had a pronounced psychic effect. If the drugs were working – and it was utterly clear that they were – it meant that for the first time since my infection more than twelve years before, the virus was no longer multiplying within me. It was no longer progressively taking over my body, taking over my life. It was being beaten back to some deeply secluded (although still latently dangerous) viral reservoirs. But outside those recesses the rest of my body was free of it. And my immune system was, for the first time in all these years, free of its burdens.

The feeling was exhilarating. For the first time in more than a decade I was no longer – no longer felt – contaminated. From the world I had little to hide, and less to fear.

In December, just days after the meeting in Judge-President Fried-man’s chambers, my computer analyst sister Jeanie, her scientist husband Wim, and their two children joined me for a few days in Cape Town. After my original HIV diagnosis in 1986, I made a secret promise to myself – while they were young I would offer each year to take my niece Marlise and nephew Graham for a short pre-Christmas holiday in Cape Town. The beneficial delight in the beaches, long drives, silly vacation movies and chatter was, I always suspected, more wholly mine than theirs. The glorious Cape sun always blessed us with indolence. It was perfect rest. But each year we did one incontestably strenuous thing. We climbed Table Mountain.

Perhaps one of the best-known sights in the world, the sandstone massif dominates Table Bay. For hundreds of years, since Sir Francis Drake’s voyage around the world, the view of it and the view from it have arrested travellers, justly evoking lyrical descriptions. The whole mountain is now a nature reserve, jealously guarded by Capetonians and the conservationists and researchers from all over the world who treasure and study and walk amidst its priceless floral and faunal heritage.

The mountain rises 1 000 metres above sea level, its sheer rock faces hundreds of metres high. From a distance, the famous ‘table’ front looks like a monolith of rock. It is not. The frontal rock is deeply split by a gorge that angles across and into its face. Platteklip Gorge is a particular hikers’ favourite, and one of the best-known routes to the top. In the 1940s Churchill’s ally, South African Prime Minister Jan Smuts, favoured it for his regular walks.

We decided to tackle Table Mountain. On International Human Rights Day, 1997, early on a startlingly sunny morning, we started the ascent. My brother-in-law, Wim, was not as keen as the rest of us. But with an accustomed family mix of infectious enthusiasm and browbeating coercion we persuaded him to join us. Little did we know how well-justified his reluctance was. Two days later he was diagnosed with acute appendicitis and had to be rushed into hospital for emergency surgery.

But at the time no hint of illness of any nature seemed to mar the day. The path up Platteklip Gorge begins at a fresh reservoir of mountain water. As we set out past it I wondered whether I would make it to the top. Just seven weeks before I had not been able to climb forty steps from the common room to my chambers. Now, cleared of the PCP and with the virus incapacitated by four weeks of effective antiretroviral therapy, I proposed to tackle more than eight hundred steps up the face of Table Mountain.

Jeanie and Wim stopped often to check on me. Was I making it? Yes, I was. Not without effort. Not with any speed. But I was making it. Twice the path crosses the stream that feeds the reservoir below. Then it heads steeply into the gorge that splits the sandstone cliffs. I drank deeply, thirstily, from the stream each time. The proteas, ericas, disas and pelargoniums that line the path, magnificently casual in their beauty under the mild December sunshine, seemed to beckon me up and on.

As we reached the top we paused, relieved and exhilarated, before strolling to the cable station restaurant 500 metres away across the flat rock plateau. As so shortly before, the climb had made me breathless, panting and sweating. But this time it was with exuberant joy. I knew that I was well, could be well, would be well. I had been given a second chance. As I gasped in the mountain air, I also knew what a mountain of privilege had brought me there. There was much work to do.