In sub-Saharan Africa, infectious diseases still cause the majority (69%) of deaths; chronic non-communicable diseases such as cardiovascular disease, diabetes, chronic respiratory disease and cancers, contribute around 25%. But this picture is changing as sub-Saharan Africa undergoes an epidemiological transition with a rapidly increasing chronic non-communicable disease burden. The authors explore the relationships between tuberculosis and diabetes, HIV, its treatment and metabolic risk, look at some of the key issues surrounding these associations in sub-Saharan Africa, and describe the impact of globalization upon them.