Despite high levels of AIDS in Africa, there are few indications that the pandemic is directly leading to imminent state failure amongst those countries on the continent that manifest exceptionally high AIDS prevalence. Of the factors that threaten the ability of governments to govern, AIDS (or any other health threat, for that matter) is seen to be a derivative threat—at most. However, there has been significant conjecture about the purported link between the pandemic and state fragility. This polemic has been fuelled by the securitization of disease that has become so prevalent in the multilateral arena since 9/11 in particular. However, social science has for the most part left the key concepts in this arena uncomfortably unexplored, and there have been few attempts to speak intelligently about empirical or other indices of the epidemic's impact at the macro (state) level. This article is an attempt to come to grips with some of these issues, specifically in the context of the mature epidemics ravaging Africa.