As the South African HIV/AIDS epidemic enters its fourth decade, universal access to treatment has begun to extend the lives of people living with HIV/AIDS. While the South Africa's ruling party - the African National Congress - has seized on improved health to bolster their political profile, the key agitators in producing this outcome were South African HIV/AIDS activists. Narrative accounts of the extended initiative have focused on the organisations that led the campaign for treatment access, such as the Treatment Access Campaign. Reflecting present trends in social movement theory, the emphasis in these accounts has been on transnational and/or horizontal' ties in alliance building. This approach obscures continuities with early South African HIV/AIDS activism during the late apartheid era. The concept of verticality is proposed as a means of highlighting the role of interpersonal relationships in the development of institutions and transmission of knowledge practices that link the waves of South African HIV/AIDS activism.