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What did South African AIDS activists contribute, politically, to early international advocacy for free HIV medicines for the world's poor? Mandisa Mbali demonstrates that South Africa's Treatment Action Campaign (TAC) gave moral legitimacy to the international movement which enabled it to effectively push for new models of global health diplomacy and governance. The TAC rapidly acquired moral credibility, she argues, because of its leaders' anti-apartheid political backgrounds, its successful human rights-based litigation and its effective popularization of AIDS-related science. The country's arresting democratic transition in 1994 enabled South African activists to form transnational alliances. Its new Constitution provided novel opportunities for legal activism, such as the TAC's advocacy against multinational pharmaceutical companies and the South African government. Mbali's history of the TAC sheds light on its evolution into an influential force for global health justice.