One of the major obstacles to meeting the Millennium Development Goals is the HIV-associated epidemic. Of the estimated 9.3 million new TB cases that occurred worldwide in 2007, 1.37 million (14.8%) were associated with HIV. Sub-Saharan Africa has borne the burden of this co-epidemic. South Africa alone accounts for a staggering one in four of the world’s cases of HIV-associated TB. This article gives an answer to the question why traditional TB control strategies have failed; what other interventions could do; what the possible TB preventive impact of antiretroviral therapy could be and how ART could be optimally used.