This review provides an update on HIV/AIDS based on a literature search (1989-1999) in respect of its epidemiology and oral manifestations in sub-Saharan Africa. The African epidemic is unique in its heterosexual spread, high prevalence in men, women and children, rapid rise in young women and risk of vertical transmission. Viral subtypes A and D predominate in Africa, subtype C in South Africa and subtype E in Central Africa. The pandemic is fueled by endemic poverty, malnutrition, gender inequality and sexual and cultural practices. Oral lesions may frequently be the initial presenting signs of HIV infection, early clinical features, predictors of progression of disease and may be useful in staging and classification. Health care workers require training to understand, diagnose, manage and research these manifestations.