Human rights discourse in health advocacy is largely correlated with experiences of vulnerability, marginalisation and discrimination, with the global story of HIV activism the most visible example. In a domestic context where culture, consensus and belonging are highly valued, both human rights and lesbian, gay, bisexual, transgender and intersex (LGBTI) people face critiques of being foreign, un-African, new, individualistic and threatening to tradition. Why, when and how do civil society actors draw on human rights to advocate for LGBTI health in relation to HIV in Botswana? I examine this paradox through a case study of the key civil society actor in this sector. I argue that while formal structures and belief shape why the group engages with human rights, when and how human rights are invoked is shaped by perceptions of threat, cultural context, and belonging.