AIDS first manifested itself in the early 1980s as an apparent “gay disease.” Cases soon appeared outside the industrialized west and among other communities. Given HIV's modes of transmission, sex workers, drug injectors, and those who engaged in unprotected nonmonogamous sex were at higher risk, and the political economy of the virus was such that communities on domestic as well as international margins had the highest prevalence. Governments were slow to respond seriously. In their place, segments of the gay and lesbian community united by the late 1980s to educate, protect, and care for themselves, even in countries in which cases of homosexual transmission comprise a relatively small proportion of infections. At times, governments' abdication of responsibility left those nongovernmental organizations (NGOs) less closely-scrutinized than others—most notable where associational life is generally subject to illiberal controls—leaving them relatively free to advance explicit or implicit community-building among their marginalized constituencies. Though governments and media gained interest as heterosexual transmission rates rose, both still neglected the highest-risk groups. Importantly, the perspectives, perceived constituencies, and approaches of HIV/AIDS-related NGOs may diverge sharply from those of public health authorities, with unambiguous consequences in terms of the relative empowerment, receptivity to messages, and, ultimately, behaviors of target communities.Meredith L. Weiss is a Research Fellow at East-West Center Washington (WeissM@EastWestCenter.org). Preliminary research for this project was supported by a DePaul University faculty research grant.