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In 2018, Achmat was accused of intimidating women against speaking about sexual harassment while he was the chair of the board of Equal Education, specifically regarding allegations against Doron Isaacs. Achmat has denied the claims, while also publicly defending Isaacs, stating that he does not believe Isaacs is a sexual predator.

In 2013, Achmat and 18 other SJC activists were arrested for an illegal gathering outside the Cape Town Civic Centre, where they were protesting about sanitation services in the township of Khayelitsha.

In 2008, Achmat co-founded the Social Justice Coalition (SJC), an organisation with the aim of promoting the rights enshrined in South Africa's Constitution, particularly among poor and unemployed people living in the country. In 2009 he co-founded the Centre for Law and Social Justice, subsequently renamed Ndifuna Ukwazi (Dare to Know), with Gavin Silber.

On 5 January 2008, Achmat married his partner and fellow activist Dalli Weyers at a ceremony in the Cape Town suburb of Lakeside. The ceremony was attended by then Mayor Helen Zille and presided over by Supreme Court of Appeal judge Edwin Cameron. The couple divorced amicably in June 2011.

Achmat was one of 44 TAC activists arrested in 2006 for occupying provincial government offices in Cape Town as a protest in order to call for Health Minister Manto Tshabalala-Msimang and Correctional Services Minister Ngconde Balfour to be charged with culpable homicide for the death of an HIV-positive inmate at Westville Prison in Durban. The protesters were charged with trespassing and ordered to appear before court. The inmate was one of 15 prisoners who were plaintiffs in a case against the Departments of Health and Correctional Services, suing to be provided access to antiretroviral drugs. The court ordered the government to provide the drugs immediately.

Before co-founding the Treatment Action Campaign (TAC) in 1998, Achmat was a director of the AIDS Law Project based out of the University of the Witwatersrand, which is now headed by Achmat's longtime collaborator Mark Heywood. The AIDS Law Project and TAC work closely together in all the legal matters that arise in the course of advocating for the right to health, including prosecuting cases and defending TAC volunteers.

Achmat publicly announced his HIV-positive status in 1998 and refused to take antiretroviral drugs until all who needed them had access to them. He held firm in his pledge until August 2003 when a national congress of TAC activists voted to urge him to begin antiretroviral treatment. He finally announced that he would start treatment shortly before the government announced that it would make antiretrovirals available in the public sector.

Achmat co-founded the National Coalition for Gay and Lesbian Equality in 1994, and as its director he ensured protections for gays and lesbians in the new South African Constitution, and facilitated the prosecution of cases that led to the decriminalisation of sodomy and granting of equal status to same-sex partners in the immigration process. Achmat wrote a much-cited article about sexuality in South African prisons, based on his personal experiences.

He did not matriculate but nevertheless graduated with a BA Hons degree in English Literature from the University of the Western Cape in 1992 and studied filmmaking at the Cape Town Film School.

Achmat describes his political ideology as democratic socialist since the unbanning of the ANC in 1990. Despite being a member of the ANC, he vigorously opposed the HIV/AIDS denialism promoted by former President Thabo Mbeki and other senior ANC members and in 2004 he withdrew his ANC membership under Mbeki's leadership. In 2006, Achmat called on fellow party members to formulate appropriate HIV policies and oust Health Minister Manto Tshabalala-Msimang. He has also been outspoken in his criticism of President Jacob Zuma and ANC corruption.

Achmat was diagnosed HIV-positive in 1990. In 2005 he suffered a heart attack, which his doctor said was unlikely to be caused by his HIV-positive status or treatment. He recovered sufficiently to return to his activism work.

Achmat set fire to his school in Salt River in support of the 1976 student protests and was imprisoned several times during his youth for political activities. He joined the African National Congress (ANC) in 1980 while serving time in prison. Between 1985 and 1990 he was a member of the Marxist Workers Tendency of the ANC, a Trotskyist breakaway group of the ANC and precursor to the Democratic Socialist Movement.

Abdurrazack "Zackie" Achmat (born 21 March 1962) is a South African activist and film director. He is a co-founder the Treatment Action Campaign and known worldwide for his activism on behalf of people living with HIV and AIDS in South Africa. He currently serves as Board member and Co-director of Ndifuna Ukwazi (Dare to Know), an organisation which aims to build and support social justice organisations and leaders, and is the Chairperson of Equal Education.