Over 5 million people continue to be newly infected with HIV every year, despite advances in understanding the factors that drive the epidemics. It is apparent that control of the HIV epidemics has often proved difficult due to the complex web of behavioural, biological, social and structural vulnerabilities to infection. In this paper we discuss the epidemiology and control of HIV in sub-Saharan Africa, and draw parallels with the emerging epidemic in South and South-East Asia. Prevalence of infection in sub-Saharan Africa has continued to increase overall, but a few countries have successfully reduced national infection rates by employing an integrated, multisectoral control strategy. Prevention of similar devastating epidemics in other regions will rely upon an openness in recognizing risk and upon a concerted multisectoral approach to reduction of risk of risk at the individual level and level and vulnerability at the societal and structural levels.