Throughout the 2000s, donor organizations successfully argued for the inclusion of men who have sex with men (msm) in the global response to HIV/AIDS. These efforts have had unintended consequences for msm and lesbian, gay, bisexual, and transgender (lgbt) populations in sub-Saharan Africa. Focusing on Malawi and Senegal, we find that donors’ emphasis on msm provided new urgency and sources of support for nascent lgbt- and msm-identified groups to organize around sexual identities and disseminate prevention strategies to their communities. These interventions increased the visibility of msm and lgbt populations in both countries; however, this new visibility also positioned msm and lgbt organizations between Western donors and political elites, contributing to political backlash against lgbt Malawians and Senegalese by the late 2000s. Further, while some msm- and lgbt-identified organizations in Malawi and Senegal ultimately expanded their activism to include lgbt rights, other HIV organizations working with msm to gain access to new donor funding did not advocate for the rights of lgbt populations. We discuss the implications of these processes for development initiatives and argue for a more expansive definition of health in HIV and development work to address a broader set of community concerns.