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In the 2000s, private companies have progressively become a key actor in the global governance of health and a part of the answer to the difficult question of the effectiveness of aid assistance. This article contributes to the debate on the role of the private companies in the local development, from the analysis of their initiatives in the fight against HIV/AIDS in Ivory Coast, supported by a qualitative investigation conducted among thirty private companies. This contribution highlights the ambivalences to consider private companies as public health actor equivalent to others, confronting their effectiveness to their legitimacy, their protection of human rights and equity in access to healthcare.