Dirty work contexts refer to occupational settings characterized by marginal status, poor job design and stigmatization. While the literature has tended to focus on issues of manager and employee identity, organizational design challenges associated with coordinating dirty work have so far been neglected. Using exploratory, semi-structured interviews with healthcare professionals and front-line workers in the National AIDS Control Organization of India (NACO), this qualitative paper examines how interdependent activities are coordinated in spite of organization design failures induced by inherent characteristics of dirty work occupations. Our findings show how emergent responses at an individual level mitigate coordination failures to integrate interdependent tasks at an organizational level. Contributions to practice theories of coordination are discussed, as is the need to broaden our definition of dirty work to enable future research into the effects of stigma on organization design failure at multiple levels.