Despite global HIV/AIDS policies and the power of global multilateral and bilateral actors, HIV/AIDS responses and impacts have varied across countries in the Global South. Focusing on Mozambique, this case study aims at analysing the relationships between HIV/AIDS global policies and the Mozambique's successive governments' policies on health from the late 1980s to 2020. Using documents and semi-structured interviews, the findings of the study show that despite the power of multilateral and bilateral actors, there has been a permanent tension between global HIV/AIDS policies and Mozambique's former post-independence leftist tradition of decentralisation, socialisation and integration of health services into primary health care. This tension, it is argued, has been hugely influenced by the persistence of Mozambique's colonial and post-colonial initial conditions, largely the fact that most of the population still lives in poor rural areas with low levels of health coverage.