Ten years after South Africa achieved democracy, HIV is arguably the most important problem facing the country and threatens to undermine many recent social achievements. Considerable efforts have been directed at harnessing the preventive potential of biotechnology in combating the epidemic, yet best estimates are that there will be no HIV vaccine for at least another 10 years (Esparza 2004) and no marketable vaginal microbicide for at least 5 years (Rosenberg 2004). Sexual behaviour change is the only current option for HIV prevention and it is likely to remain the central plank of prevention strategies in the decades to come. Whilst there is evidence that voluntary counselling and testing may have an important impact on sexual behaviour (The Voluntary HIV-1 Counselling and Testing Efficacy Study Group 2000), it is essential that other approaches to HIV prevention are evaluated. Developing an evidence base for HIV behavioural intervention in sub-Saharan Africa and other regions severely affected by the epidemic should be a very high priority.