The purpose of this study is to identify and explain recent US human rights policy in the Multilateral Development Banks (MDBs). Foreign aid, whether distributed directly (bilateral aid) or indirectly through multilateral institutions such as the MDBs, is one of several tools through which the USA furthers its human rights policy. Several studies show the conflicted human rights policies the USA pursues with bilateral aid, but very few examine the role of human rights in US multilateral aid policy. It is this deficit that the present study addresses by examining what factors determine how the USA votes on proposals before the Executive Board in the various MDBs. Using a multinomial logistic regression model I test whether US votes in the MDBs are conditioned on recipient countries’ respect for human rights along with other strategic interest variables. The study finds that respect for political rights has an important role in determining US votes in the MDBs although much of the impact is accounted for by votes specifically against China. Conversely, respect for rights of personal integrity do not have an impact on US voting. Level of economic development and whether the country receives military aid from the USA are also important determinants of US votes, as well as the level of trade between the USA and the recipient country.