With the number of South Africans living with HIV/AIDS soon exceeding six million, care and support for people infected and affected are becoming increasingly more important. The objective of this study was to develop and implement a support initiative addressing HIV positive people in a rural area in the Limpopo Province of South Africa, based upon an exploration of HIV positive persons’ perceptions, needs and resources. The longitudinal study was conducted within a frame of participatory action research (PAR) combining methods such as questionnaires, surveys, in-depth and focus group interviews, participatory observation, diaries and photo voice, SWOT analysis and reflexive field notes. In total, 250 HIV positive persons (186 women and 64 men) participated in the study. Of these, 67 persons joined the support initiative. All were recruited from the local clinics and hospital. Those who joined the support initiative were younger, mentally and physically healthier, more educated and had higher income than those who did not join the support initiative. The project moved through phases of planning, implementing, monitoring and evaluating specific support activities, in close collaboration with health workers, non-profit organisations and other stakeholders. The evaluation of the project showed an increase in knowledge and use of health services, decreased stigma and improved ability to disclose and to cope. Pre-and post test scores on the General Health Questionnaire 28 (GHQ-28) showed that the members of the support initiative reported improvements on all sub-scales as compared to the non-members.