The last fifteen years have witnessed a renaissance of philanthropic giving reminiscent of the early twentieth century. This new generation of philanthropists has consciously combined the ethics of charitable giving with business principles and practices in an effort to improve the health of the world's poorest people. In India, which has one of the largest HIV-positive populations in the world, much of this philanthropic effort has been focused on the funding of HIV/AIDS treatment programs. This particular model of philanthropic giving has become a driving force in reshaping the terrain of HIV/AIDS interventions in India, but has received little scholarly attention in studies of medical management. Through an ethnography of the decision-making practices of these new philanthropies, my research examines how practices of business become essential to the allocation of funds for HIV/AIDS-related interventions. Furthermore, this study investigates how categories of health and illness are translated into and reformulated within this business framework. This research will engage specifically with the anthropological literature on gift-giving and economic exchange, in order to understand how “philanthrocapitalism” offers a specific synthesis of these at-first seemingly antithetical transactional modes. Fieldwork at various foundations, intermediaries and hospitals in Tamil Nadu and Delhi will provide a broad picture of the contributions of various actors and agencies in the decision-making process as it occurs across multiple scales and geographic locales. By utilizing an ethnographic approach, this work moves beyond formal analyses of policy to provide a concrete analysis of the actual practices through which decisions are made, policies are crafted and funding is distributed.