The proliferation of nongovernmental organizations (NGOs) in the last three decades has constituted one of the signal changes in the landscape of development policy in Africa. Countries such as Kenya, which saw just a handful of foreign or religious groups in the 1980s, now host several thousand NGOs, including a growing number of local organizations. Often dependent on foreign aid, not always boasting the highest ethical standards, and prone to instability, these NGOs have drawn criticism for the way they affect policymaking in African countries, specifically how they sometimes erode the capacity and legitimacy of the state. This detailed ethnographic study of the grassroots activities of four Kenyan NGOs involved in HIV prevention argues persuasively that even the smallest and least well-funded organizations can have a significant and positive policy impact. Hershey finds that these small NGOs have proved surprisingly resilient and able to adapt to the vagaries of donor funding by shifting objectives and tactics.