This article critically examines the fight against hiv/aids in sub-saharan africa. As the epidemic revealed its devastating power when neoliberalism emerged as a dominant force in economic and development thinking, it investigates how policies like saps have affected the severity of the epidemic in a country like zambia. Moreover, the article examines how the dominance of medical and private actors has influenced the fight against hiv/aids. By, for example, tracing the influence of the pharmaceutical industry and conservative christian forces in pepfar, it is argued that the epidemic has been largely conceptualized in biomedical and behavioural terms – placing too much emphasis on african sexuality and culture – while ignoring structural factors like poverty and inequality. As a result, inhumane conditions for millions persist and solutions that would be unacceptable for the affluent are still implemented. Inspired by the work of farmer (2005) and pogge (2008), a more inclusive development agenda is outlined that involves structural democratic reforms of global institutions.