It is especially the social aspects of the disease that make HIV/AIDS in sub-Saharan Africa different - and worse - than HIV/AIDS in the United States or Europe. By making Africans more vulnerable to economic and sexual exploitation, poverty first increases the likelihood that they will be infected. By making them unattractive customers for pharmaceuticals, poverty also puts therapies out of the reach of most Africans who need them. This review examines research on the integration of sub-Saharan Africa into the international worlds of the pharmaceutical trade, public health, and medical research. It finds that the pull of these institutions diminishes but does not disappear as we move from the realms of trade treaties to the clinics where testing and treatment occur and, finally, to the daily lives of people living with HIV.