Delayed access to HIV care and treatment in sub-Saharan Africa meant that the early years of HIV scale-up were characterized by a largely North-to-South transfer of knowledge and resources. Clinicians from wealthy countries were among the first to gain experience with antiretroviral treatment and care of people living with HIV and shared key lessons with their colleagues in sub-Saharan Africa. Ten years later, lessons from Africa learned from the remarkable achievements of HIV programs now have the potential to inform the response to the US domestic epidemic.