The use of NGOs to promote development and reduce human suffering has become a major feature of the aid industry. Donors lavish NGOs with funds while governments relinquish major responsibilities. Their numbers and sizes are multiplying exponentially. How have their role and identity changed over time? This case study of NGOs in Zambia finds that increased aid to NGOs has eroded their autonomy, compromised their legitimacy, swayed their focus, skewed their accountability, diluted their voluntary spirit and alienated them from key stakeholders. The study finds that aid for AIDS has monetized the response to AIDS and made NGOs more homogeneous. It posits that the once-genuine claims of government inefficiency, corruption and incompetence now serve to mask a deeper scandal: the rise of a predatory form of AIDS Capitalism that uses HIV to champion personal and organizational interests behind the veil of charity and altruism. NGO-bashing? Probably! But the study blends passion with evidence to show that donors, governments, NGOs, CBOs and individuals need to re-examine their roles, choices, actions and relationships to enhance aid effectiveness.