Changes in agriculture and rural livelihoods in Africa are often attributed to the HIV epidemic. While acknowledging that the epidemic has devastated many families and communities because of excess morbidity and mortality, this review explores other causes of change in agriculture practices and production in southern Uganda. Over the past 20 years labour shortages, because of labour migration and changing aspirations (as well as HIV), crop and livestock pests and diseases, declining soil fertility, changes in commodity markets and a growing off-farm sector have contributed to the changes seen in rural southern Uganda. Policy interventions outside agriculture and health have also had an impact on households. The HIV epidemic has not happened in isolation. The perceived impacts of the epidemic cannot be addressed in isolation from these other drivers of change.