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This article examines the Treatment Action Campaign’s (TAC) evolution and attrition as a social movement organisation to discern its implications for practices of health citizenship at the grassroots level. A qualitative approach to case study research was used to collect and analyse data. Practices of health citizenship were framed around the integration of biomedical knowledge and people’s experiences of grassroots activism. By exploring how the TAC’s brand of activism filtered down to the community level, the findings reveal the importance of diverse forms of activist-led collective action in promoting health-seeking behaviour. These comprise activist-led branch meetings, community workshops, health promotion talks at clinics and community radio stations, as well as protest action at community clinics. Findings indicate that participation in TAC-led activism in Khayelitsha is not a passive form of responsible HIV citizenship. Rather, it is an active process through which TAC members integrate their lived experiences with biomedical knowledge to construct meanings and articulate grievances to enhance the quality of health service delivery in their community. Also, although the TAC’s practices of health citizenship have not changed significantly over time, its campaigns have evolved based on contextual factors. These practices have entrenched ways of being, doing and knowing that have become an important resource for activist-led health promotion. Key stakeholders in government and civil society can harness these practices to strengthen health systems.

Practices of health citizenship in South Africa: a case study of the Treatment Action Campaign (TAC) in Khayelitsha, Cape Town