This article explores sexuality and its role in cultural reproduction amongst Akha, a minority group living in the mountainous reaches of southwest China, northern Thailand, Laos, Vietnam and Burma. For many minority peoples in the region sexuality has been a marker of cultural difference within trajectories of nationalist assimilation. In northwest Laos, Akha sexuality is currently a focus of intense interest as infrastructure development, increased interactions with lowland populations, and targeted state and donor-funded health programs are dramatically altering Akha lifestyles. Whether by conscious design to intervene in sexual lives, or through the numerous ways that affective domains merge with material aspirations, social structures shaping Lao Akha sexuality are being "re-formed" through engagement in processes of modernisation. As a result, sexuality remains central to ongoing ethnic marginalisation and evolving vulnerability to health threats.