Most who work in international development recognize the importance of implementing locally driven, grassroots initiatives for achieving positive outcomes. Yet, when it comes to HIV prevention strategies in Swaziland, there is a lack of understanding for the cultural and historical influences that determine group and individual behaviour. As a result, prevention efforts have failed to have a major impact on the world’s highest prevalence rate of HIV. Greater understanding and observance of historical influences, local norms and beliefs, and the ongoing processes of adaptation must be incorporated into all efforts if any HIV prevention strategies are to be effective.