This study investigated the political, economic, cultural, historical and geographical context in which the AIDS epidemic emerged in Uganda in the early 1980s and became a big livelihood crisis and how this affected the rural households in Masaka district. The study shows how Masaka came to be an epicentre of the epidemic. By comparing the demographic features, agricultural production, and food security of households with a history of AIDS morbidity and mortality to households where this was not the case, impacts of the epidemic on the rural households were assessed. The conclusion is that these impacts were less than expected, which can be attributed to the greatly advanced coverage of antiretroviral treatment during the past decade. Furthermore, when applying an AIDS+ perspective, it is clear that factors such as crops diseases, declining soil fertility and climate change are equally challenging for these households now as was AIDS in the past.