Although the proximate cause of Africa’s AIDS crisis is HIV, the underlying societal causes are much broader and more familiar. Across the continent, poverty structures not only the contours of the pandemic but also the outcomes for individuals. Until poverty is reduced we will make little progress toward either reducing transmission of the virus or enhancing capacity to cope with its socio-economic consequences. It follows that sustained human development is an essential precondition for any effective response to the pandemic in Africa. Herein lies Africa’s predicament: How can we achieve the sustainable development essential for an effective response to the epidemic when the epidemic destroys the very capacities essential for the response—namely, by killing the most economically productive members of the continent?