HIV-associated Kaposi sarcoma (HIV-KS) is common in African countries where HIV infection is pandemic and anti-retroviral medication is not readily available. Human herpesvirus-8 (HHV-8), which is the essential, but not the sole aetiological factor in KS, is endemic in sub-Saharan Africa and is substantially more prevalent in HIV-seropositive than in HIV-seronegative subjects. In children in sub-Saharan Africa, KS, whether it be HIV-KS or African endemic KS is much more prevalent than any other epidemiological forms of KS. In addition, in sub-Saharan children oral KS is common, and the life-expectancy of HIV-seropositive children with KS is short. Since generalized systemic KS is frequently associated with oral HIV-KS, it is advisable to introduce systemic cytotoxic chemotherapy early in the course of oral HIV-KS. Although the introduction of highly active antiretroviral therapy (HAART) brought about a decline in the incidence of HIV-KS worldwide, HIV-KS remains a significant problem in sub-Saharan Africa where the prevalence of HHV-8 infection is high and access to HAART is limited.