Why would many Zambians be reluctant to access lifesaving antiretroviral treatment? Does the process of accessing an HIV test in Zambia promote an identity that can change individuals' livelihood strategies? What happens to individuals when people access treatment? Voluntary testing and treatment centres and the HIV-prevention programmes that support them have come to embody explicit messages about 'health,' 'progress,' 'civilisation' and 'modernity,' and through this they compel individuals to take on a particular identity. In Zambia the pursuit of HIV testing and biomedical treatment forces individuals to locate themselves somewhat differently in relation to community support structures, placing their faith in the future on an uneasy foundation of a 'modern' identity. This is embodied in the deep-rooted suspicion that many Zambians have toward the international HIV/AIDS-response sector from which HIV and AIDS treatment programmes are derived. Drawing upon the notion of 'therapeutic citizenship' I examine why the 'AIDS industry' continues to symbolise such tension. I explore how individuals believe their identity will shift through participation in HIV testing and treatment options and how that might impact long-term and short-term livelihood strategies.