The process through which antiretroviral therapy became accessible in the South African public health sector was fraught with political conflict. A key aspect of securing access to treatment was the ability of the South African HIV/AIDS movement to influence the development of HIV/AIDS policy. In the narrative that follows, a series of HIV/AIDS policy consultations are analyzed. These meetings concerned the development of provincial guidelines for implementing national HIV/AIDS policy norms. The outcomes reached via this social process highlight the significance of localized political formations in transforming the influence of transnational donor capital and redirecting the South African HIV/AIDS policy process. Based on the interaction of actors, organizations, and influences that produced the policy outcomes under analysis, a critique of existing conceptualizations of transnationalism is put forward that points to the need to frame transnational influence within local social, spatial, and historical particularity.

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