South African higher education celebrated a decade of democracy in 2004. As the country's institutions and its citizens celebrate this freedom, it is time to reflect on the enormous challenges which confront South African society and the role which higher education is expected to play. Just over four years ago, institutional leaders in government and in the higher education community committed themselves to supporting and implementing a programme aimed at putting in place a comprehensive response to HIV and AIDS across the higher education system. In effect, this meant putting in place policies, programmes, services and management arrangements that would prevent, manage and mitigate the impacts of HIV and AIDS on individuals and on the institutions as a whole.This review is, in part, based on evidence from a recent audit of responses to HIV and AIDS in higher education, but it also describes activities and interventions that have taken place over the past four years as a result of the national SAUVCA/DoE/CTP initiative. It shows significant progress over three years in the provision of prevention services, treatment, care and support and the establishment of institutional capacity to manage HIV and AIDS programmatically - across each institution. It also examines what progress has been made, albeit more slowly, in the integration of HIV and AIDS into the curriculum, research on HIV and AIDS and workplace issues.The review places these issues in the context of the epidemic in South Africa, the massive and complex process of structural changes taking place in South African higher education and strategic issues facing the Higher Education HIV/AIDS (HEAIDS) programme. A collection of good practice case studies drawn from higher education, highlights innovations in peer education, teacher education and prevention strategies using interactive media.