Ninety-eight cases of acquired immune deficiency syndrome (AIDS) were reported in the Republic of South Africa by the end of 1987, and 166 by mid-December 1988. By 12 February 1990, 353 cases of AIDS had been reported: 326 in South Africans and 27 in people from either elsewhere in southern Africa or abroad. The South African patients comprised two main groups: white men with the pattern of infection typical of homosexual and bisexual men; and heterosexuals exhibiting the pattern common in much of central and southern Africa. There have been a small number of people with haemophilia affected with AIDS, but only one injecting drug user with AIDS to date. There is evidence of considerable spread of the epidemic into the South African black population; migrant labour, the high prevalence of sexually transmitted diseases and suspicion of government-directed family planning programmes have all contributed to this. Seropositivity rates in South African blacks are noted to be rising rapidly and the doubling time is considered to be about 8.5 months. The government and some employers have adopted discriminatory measures to control the disease, including the screening of migrant workers and the repatriation of those found to be seropositive. Public health leadership from the state authorities has been inappropriate. We argue for greater involvement of homosexual, worker, community and public health personnel in developing policies of control for human immunodeficiency virus (HIV) infection in South Africa, if the response is to be ethical, non-discriminatory, sensitive, prevention-orientated and effective.