Over half of adults infected with HIV in Africa are female—but poverty and social structures still prevent many women from protecting themselves. The United Nations millennium development goals have set out specific targets for 2015, including commitments to reduce extreme poverty, increase women's empowerment, and reverse the spread of the HIV pandemic. In this respect, they clearly recognise what has been called the triple threat facing Africa: poverty, gender inequalities, and HIV and AIDS. Tackling these issues is clearly difficult, and many people have greeted these goals with a sense of scepticism and even futility. We describe why tackling poverty and gender inequalities is central to controlling the HIV pandemic in Africa and suggest how it might be achieved.