Contemporary thought on HIV prevention emphasises participatory practices: the empowerment paradigm advocates working with target groups and empowering them to minimise risk of infection, while the collective action paradigm advocates collaborative working that tailors prevention programmes to specific contexts and addresses structural constraints to HIV prevention. Limited attention has been paid to the influence of organisational factors in translating this rhetoric into practice. The current study addresses this gap, using a research framework based on a continuum with bureaucratic authoritarian organisational characteristics at one end and post-bureaucratic democratic characteristics at the other. Comparing HIV/AIDS programmes in three case study organisations (two schools and one non-governmental organisation) located at different points along this continuum yet using similar rhetoric, the study finds that none of the programmes delivered precisely matches the rhetoric. Nevertheless, the findings affirm the proposition that organisations with post-bureaucratic democratic characteristics are better suited to delivering effective self empowerment and collective action prevention programmes than those with bureaucratic authoritarian characteristics. Specific characteristics that contribute to these outcomes are identified, and the implications of the findings, both for the practical application of contemporary approaches and for the movement extolling schools as key settings for HIV prevention programmes, are presented