NGOs have more influence at the United Nations than with any other international governmental organization. Yet only a limited number of NGOs have historically been able to access the avenues open to civil society within UN fora, exposing a (widely commented upon) democracy deficit. Efforts to remedy this deficit have been met with a substandard answer: consultation with NGOs as the voice of civil society. I argue that a particular type of NGO federation, federations of affected persons and affected persons organizations (APOs), is effective and efficient at empowering local-level actors and raising local, regional, and national concerns at the United Nations. I examine in this chapter two cases of APO federations: The International Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer + Association (ILGA) and the Global Network of Sex Work Projects (NSWP). APO federations embody an increasingly institutionalized model of self-representation, one that departs from the typical gatekeeper model.