The HIV prevalence rate among men who have sex with men in Africa is high, yet a limited number of prevention interventions target this vulnerable group. The study aims to explore factors affecting the design and implementation of HIV-prevention interventions for men who have sex with men in Cameroon using Alternatives-Cameroun as a case study. It further examines the context in which these interventions are created and implemented. Operating in a repressive environment, facing criminalisation and stigmatisation, one organisation, Alternatives-Cameroun, has adopted an 'umbrella approach', using human rights as a platform from which to negotiate for greater recognition of men who have sex with men. Success has been achieved through a 'proximity approach to prevention', setting up a local Access Centre and using a base of volunteers to create interventions that venture into the community. The organisation faces many obstacles such as repressive legislation, stigmatisation and volunteer fatigue. Findings reveal that understanding local realities and reinforcing multi-sectoral mobilisation around men who have sex with men issues are important first steps towards launching HIV-prevention interventions for men who have sex with men in sub-Saharan Africa.