From 1999 to 2008, delays in the adoption of a comprehensive treatment and prevention programme shortened the lives of people living with HIV/AIDS in South Africa. While the slow implementation of antiretroviral therapy has been attributed to a lack of institutional capacity, dissident views on HIV/AIDS and the effects of fiscal austerity, it was also an expression of power. This article analyses how the South African HIV/AIDS movement overcame this exercise of power by the AIDS dissident faction of the African National Congress (ANC) by building an alliance with the South African labour movement and moderate elements within the ruling party. The ANC’s dissident faction responded to this by developing para-state partnerships with non-state organisations to support the AIDS dissident agenda. This study highlights the need to expand the para-state concept to take into account a wider range of social formations and the historically particular conditions under which they emerge.