The impact of international donor arrival on local civil society organizations (CSOs) is well researched. Less well understood is how local CSOs react and adapt to donor withdrawal. This article explores this phenomenon in the context of the HIV/AIDS sector in Vietnam. Using data from government, donor and CSO sources in Vietnam, it examines how current and planned cuts in donor funding, including donor exit, impact local CSO agency and effectiveness. It finds that while donor withdrawal may reduce CSO capacity and independence, it can also prompt local innovations that—if successful—may improve CSOs’ responsiveness to local stakeholders.