The syndrome that later received the name AIDS was first announced by a communication published in the USA by the Centres for Disease Control (CDC): ‘In the period October 1980–May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia [PCP]’ (CDC, 1981). Looking principally at the epidemiological discussion of AIDS within the USA, I have noted the persistent homosexualisation of the condition and examined the spatial metaphors through which this prejudice was sustained (Kearns, 2016). In this chapter, I want instead to examine how AIDS has been conceptualised as an issue of global health. I will describe the geographical imaginary of the first attempts to conceptualise AIDS as an issue of global health. I will outline some of the consequences of this global imaginary for AIDS policies, both in the USA and in South Africa.