Documenting the project from its inception through to its untimely demise due to the Covid pandemic, Miller and Ayala highlight the many ups and downs endured by activists and their allies as they tried to promote access to health care in politically and culturally hostile national contexts and with limited financial resources. They raise questions about the role of donors and partners from the Global North in supporting progress on the ground in Global South countries. They also consider effective strategies for evaluating human rights-focused HIV advocacy in these fraught environments. Ultimately, Miller and Ayala provide readers guidance on principles of practice for human rights advocacy and for planning, carrying out, and evaluating projects that aspire to create structural change to improve access to affirming HIV care for sexual and gender minority people.