Although the statistics are contested by international NGOs and official sources, the magnitude of the HIV/AIDS epidemic has recently gained greater recognition within Iran. This comes simultaneously with a shift in public health frameworks, which have become increasingly globalized and couched in the language of human rights. The United Nations General Assembly passed the nonbinding Declaration of Commitment on HIV/AIDS in 2001 as part of the Millennium Development Goals. As a signatory to the Declaration, Iran has committed to recognizing the human rights of those affected by HIV/AIDS, including nondiscrimination and access to health care. However, this linkage of the epidemic and a universal human rights discourse stands in contradiction to Iran’s opposition to the human rights agenda, which the state in many instances constructs as a tool of cultural imperialism and foreign interventionism (as in the 1993 Human Rights Conference in Vienna, when Iran and other countries asserted the limitations of universal human rights). This paper therefore uses the lens of HIV/AIDS policies to explore the Islamic Republic’s political ideology in a context of international human rights discourse and evaluates what kinds of spaces of possibility for treatment and prevention programs are created by this ideology. It draws on two sources: official statements regarding the scope, causes, and treatment of the epidemic; and both official Iranian and other, non-state news sources dealing with relations of the state to NGOs and other civil society actors treating HIV/AIDS. This paper finds that the Islamic Republic has constructed a unique brand of Islamist political resistance to the dominant discourse of human rights and that HIV/AIDS programs in particular have become a site of manifesting this anti-imperial identity. NGOs are especially vulnerable because of their trans-national nature; especially since government-run centers treating HIV/AIDS as well as associated risk behaviors are minimal compared to the work of NGOs and others, the relationship of the state to these actors has important consequences for Iran’s most vulnerable HIV/AIDS sufferers.