The transition to democracy in South Africa promised a new equitable social order that would be responsive to the needs of “the people.” These hopes were very quickly eclipsed by a transition to neoliberalism and by the HIV/AIDS crisis. An examination of the HIV crisis provides insights into how responses to the disease are situated within the landscape of neoliberal discourses and policies, revealing the fissures and inconsistencies of neoliberalism. As communities mobilize varied local, national, and international networks of support to reshape the fields of power, they draw on old and new modes of organizing. These struggles have yet to result in widespread transformations of structures of governance, but they reveal the ways people work within and against them. We can begin to map and link the diverse local practices and transnational solidarities that are deployed to contest and disrupt neoliberal and other forms of governmentality, in order to assert individual and communal rights. Activists and academics seeking to shift policy and public health practice, in particular, would do well to examine more closely the ways in which HIV/AIDS discourse and activism in South Africa challenges the neoliberal biomedical framing of the disease and offers alternate approaches.