Abstract
This study investigates the relationship between HIV/AIDS prevention programmes and the lived realities of people most 'at risk' in the poor community of Ajegunle in Nigeria's Lagos State. While providers, international NGOs and their client NGOs, emphasize Western medical models for HIV/AIDS intervention and prevention, 'at-risk' groups expressed strong feelings of powerlessness over socio-cultural and political conditions affecting them. We suggest that multi-sectoral responses with full community participation are necessary in order to engage in more effective preventive action. This requires a major power shift, whereby local people are fully involved in decision-making about policies and their implementation.