Cultures all over the world have evolved illness representations that can accommodate not only new diseases. but also new epistemologies for explaining disease. This paper examines illness representations in Sub-Saharan Africa, and how these have responded to the emergence of AIDS. Indigenous views of illness (particularly STDs) exhibit coherent structure, in which causation, prevention and treatment relate to one another in functional ways. As an STD. an epidemic, and a disease which leads to premature death. AIDS lends itself readily to accommodation into established indigenous representations of illness. Even biomedical views of causation can be readily incorporated into traditional views of how illnesses are caused. However, biomedical and traditional views concerning prevention appear to be in direct conflict with one another, with potentially hazardous consequences. Research exploring the extent to which indigenous beliefs may be influencing people's decisions about safe sex could offer useful insights for AIDS prevention programs. (C) 2004 Elsevier Ltd. All rights reserved.