Abstract Fishing communities are often among the highest‐risk groups in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from complex, interacting causes that may include the mobility of many fisherfolk, the time fishermen spend away from home, their access to daily cash income in an overall context of poverty and vulnerability, their demographic profile, the ready availability of commercial sex in fishing ports and the subcultures of risk taking and hypermasculinity among some fishermen. The subordinate economic and social position of women in many fishing communities in low‐income countries makes them even more vulnerable. HIV/AIDS in fishing communities was first dealt with as a public health issue, and most projects were conducted by health sector agencies and NGOs, focusing on education and health care provision. More recently, as the social and economic impacts of the epidemic have become evident, wider social service provision and economic support have been added. In the last 3 years, many major fishery development programmes in Africa, South/South‐East Asia and the Asia‐Pacific region have incorporated HIV/AIDS awareness in their planning. The HIV/AIDS pandemic threatens the sustainability of fisheries by eclipsing the futures of many fisherfolk. The burden of illness puts additional stresses on households, preventing them from accumulating assets derived from fishing income. Premature death robs fishing communities of the knowledge gained by experience and reduces incentives for longer‐term and inter‐generational stewardship of resources. Recent projects championing local knowledge and resource‐user participation in management need to take these realities into account. If the fishing communities of developing countries that account for 95% of the world's fisherfolk and supply more than half the world's fish are adversely impacted by HIV/AIDS, then the global supply of fish, particularly to lower‐income consumers, may be jeopardized.