The Oslo Ministerial Declaration on the link between health and foreign policy has opened a window of opportunity for a concerted effort to mainstream health as an issue to be used not only to affirm the status quo of global health governance, but also to reform the health architecture and to consider the kind of global order that might be possible. Similarly, AIDS diplomacy can be a project of transformation and emancipation for South Africa, which is in need of a refocused and rejuvenated foreign policy. The country has overcome dread before, transforming the legacy of apartheid into an example for the rest of the world to admire. By exploring innovative diplomacy, South Africa can use AIDS as an issue to consolidate its young democracy, and it can work with transnational issue networks to strengthen middle power multilateralism more broadly. If South Africa can get this right, it has the real potential to turn dread into capital, rather than to default to positions of impotence and blaming outsiders.