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Sub-Saharan Africa still bears an inordinate share of the global HIV burden. The epidemics in sub-Saharan Africa vary considerably, with southern Africa still the most severely affected. An estimated 11.3 million [10.6 million-11.9 million] people were living with HIV in southern Africa in 2009, nearly one third (31%) more than the 8.6 million [8.2 million- 9.1 million] people living with HIV in the region a decade earlier. Globally, 34% of people living with HIV in 2009 resided in the 10 countries in southern Africa; 31% of new HIV infections in the same year occurred in these 10 countries, as did 34% of all AIDS-related deaths. About 40% of all adult women with HIV live in southern Africa.

HIV incidence is falling in 22 countries in sub-Saharan Africa. The HIV incidence appears to have peaked in the mid-1990s, and there is evidence of declines in incidence in several countries in sub-Saharan Africa. Between 2001 and 2009, the incidence of HIV infection declined by more than 25% in an estimated 22 countries. In Zimbabwe, the main behavioral change appears to have been a reduction in the proportion of men with casual partners, while condom use with nonregular partners has remained high since the late 1990s. With an estimated 5.6 million [5.4 million-5.8 million] people living with HIV in 2009, South Africa's epidemic remains the largest in the world. New indications show a slowing of HIV incidence amid some signs of a shift towards safer sex among young people. The annual HIV incidence among 18-year-olds in South Africa declined sharply from 1.8% in 2005 to 0.8% in 2008, and among women 15-24 years old it dropped from 5.5% in 2003-2005 to 2.2% in 2005-2008. Other epidemics in southern Africa have also leveled off at very high levels. At an estimated 25.9% [24.9%-27.0%] in 2009, Swaziland has the highest adult HIV prevalence in the world.

The epidemics in East Africa have declined since 2000 but are stabilizing in many countries. The HIV incidence slowed in the United Republic of Tanzania to about 3.4 per 1000 person-years between 2004 and 2008. The national HIV prevalence in Kenya fell from about 14% in the mid-1990s to 5% in 2006. The HIV prevalence in Uganda has stabilized at between 6.5% and 7.0% since 2001. The HIV prevalence in Rwanda has been about 3.0% since 2005.

The HIV prevalence in West and Central Africa remains comparatively low, with the adult HIV prevalence estimated at 2% or under in 12 countries in 2009 (Benin, Burkina Faso, Democratic Republic of the Congo, Gambia, Ghana, Guinea, Liberia, Mali, Mauritania, Niger, Senegal, and Sierra Leone). The prevalence of HIV is highest in Cameroon at 5.3% [4.9%-5.8%], Central African Republic 4.7% [4.2%-5.2%], Côte d'Ivoire 3.4% [3.1%-3.9%], Gabon 5.2% [4.2%-6.2%], and Nigeria 3.6% [3.3%-4.0%]. Slight declines in prevalence have been detected in household surveys in Mali and Niger and among antenatal clinic attendees in Benin, Burkina Faso, Côte d'Ivoire, and Togo.