It is now widely understood that the HIV/AIDS epidemic has a debilitating impact on rural farming households and their livelihoods in sub-Saharan Africa. In Southern Africa where the HIV prevalence rates continue to be the highest in the world, the HIV/AIDS epidemic has been singled out to be aggravating food insecurity and negatively impacting rural livelihoods. It is in this context that ECA-SA commissioned a project to: (i) review the impacts of HIV/AIDS on smallholder agricultural production, food security and rural livelihoods; (ii) identify mitigation interventions that are being implemented in the sub-region; (iii) identify the major challenges affecting HIV/AIDS mitigation work; and (iv) suggest an action plan to reinforce HIV/AIDS mitigation on smallholder agriculture, household food security and rural livelihoods.