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There are a number of reasons:

  • lack of education regarding AIDS/ HIV, ;
  • lack of preventative/ prevention programs;
  • lack of primary health care and tertiary medical care;
  • poor diet and nutrition;
  • social issues such as polygamy
  • transient labour (i.e. people that move from area to area in search of work, miners, truckers etc.) - you could also probably include forced population movements like civil war and refugees which increase the speed and progression of the disease;
  • social and financial consideration, poorer countries are more prone to prostitution;
  • as with most diseases the point of origin often has the highest concentration of infections due to the exponential nature of infections;

I'm sure there are plenty more reasons than this

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Q: Why is the percentage of people with AIDS so much greater in Africa than it is anywhere else in the world?
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