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Brazil was once a model country in terms of government support for sex worker rights organizations and its solidarity based approach to HIV prevention. In the early 2010s, however, political setbacks in these areas raised important questions regarding the limits of state sanctioned activism. Using the extended case method approach, I conducted an ethnography of sex worker activism and the complex bureaucratic field in which this advocacy took place. I explored the following questions: What motivates the state to defend sex workers in some contexts and not in others? Why and how do sex worker organizations attract or deflect the state’s attention? What are the most effective and sustainable forms of activism? What can be learned about state and civil society relationships more broadly through the lens of Brazil’s sex worker movement? I conducted field work over a thirty-six month period from November 2011 through October 2014 in three Brazilian cities: Corumbá, Belém and Rio de Janeiro. Research included archival research, participant observation, twenty-one life histories with activists at three sex worker rights organizations and forty-four in-depth interviews with members of government, social service agencies, NGOs, and security officials (i.e. police) who regularly interacted with sex workers. My results suggest that the difficulties sex worker activists faced are related to a broader pattern of how the Brazilian state has historically structured its relationship to prostitution. I argue that state action and inaction in prostitution contexts is purposefully ambiguous and flexible. This allows state actors, through their diverse and non-unified mechanisms, the autonomy to shape the inclusion/exclusion of sex workers into government policies and programs that align with current sexuality politics and neoliberal agendas. I conclude that sex worker activists produced new meanings of prostitution and activism through what I term “puta politics.” By using the body and cultural forms as sites of resistance, they celebrated and made visible what is commonly perceived of as transgressive and/or immoral. In doing so, sex worker activists challenged gender and sexuality norms and disrupted hierarchies and divisions between institutional structures and the street. Such activism permitted several of the organizations at the center of my research to survive, though not unscathed, the deleterious effects of institutionalization and bureaucratization.