Since the early 1980s, AIDS activists have developed their own alternative media projects in order to mobilize those infected and affected, challenge misconceptions regarding the disease, provide practical and useful information, and transform power structures which inhibit an effective response to the HIV/AIDS pandemic. In this article I examine several challenges for AIDS media activists arising from an expanded institutional response to the HIV/AIDS epidemic. First is the challenge posed by pressures to professionalize media projects for people with HIV/AIDS. The second challenge is the need to adapt the role of media projects as providers of information in relation to those institutional resources that are available to people with HIV/AIDS. Third is the challenge of overcoming the marginality of alternative media projects in order to effectively reach out to and inform people with HIV/AIDS and in order to continue to work toward transforming the meaning of HIV/AIDS. To conclude, I address the relevancy of AIDS specific struggles with institutionalization for media activism more broadly. This analysis provides insight into the dialectic between activists using media to challenge and transform the meaning of social problems and institutional forces of incorporation and containment exercised by the state, medicine, and the mass media.