This review describes the evolving AIDS epidemic in Ethiopia and examines its driving forces within the socioeconomic, cultural and political context. The early concentrated epidemic, which infected mostly high-risk males and commercial sex workers has evolved in recent years into a generalized epidemic affecting all segments of the population. Whereas the pervasive impact of societal poverty persists and recent political unrest poses a new threat to prevention and control efforts, the influence of past wars, gender inequality, and various harmful attitudes and practices in HIV transmission and spread is declining, apparently due to recent awareness, prevention and control initiatives and programs. Spread of HIV from urban to rural areas is facilitated by population movements, widespread prostitution in towns, and lack of education. More research on transmission patterns and better HIV and behavioral surveillance systems are needed, especially in rural areas and among different socioeconomic and ethnic groups, to more fully determine the dynamics of the epidemic in Ethiopia’s diverse population and to develop effective and
sustainable interventions.