Chinese NGOs face strong coercive pressures and limitations yet have still emerged as notable actors in several issue areas. This article studies why and explains how a group of NGOs working on AIDS-related issues have been able to progress into relatively large and vibrant operations. It documents how NGO leaders have learned to navigate opportunities and risks, circumvent formal restrictions and broker pragmatic and largely informal arrangements that have enabled their organizations to grow and advance within China's authoritarian settings. The article contributes to the literature on Chinese NGO development and new institutionalism theory, and introduces a framework for studying NGOs based on their organizational forms and activities.