In African countries, like elsewhere, ethical issues arise in clinical practice and research. These often reflect wider issues of socio-economic and political disparities. The disparities between the researchers and the researched in terms of social, economic and cultural power and differences reinforce the potential for ethical questions to arise and perhaps for breaches to occur. The first part of this paper will examine the context and historical background underpinning ethics in clinical practice and research in sub-Saharan Africa. It will also examine the often used Beauchamp and Childress framework for biomedical ethics with its key principles of autonomy, non-maleficence, beneficence and justice and the application of this framework in clinical research and practice in Africa. To illustrate, the paper will examine two broad issues – ethics review committees and the recurrent question of informed consent – in an African context. The issue of clinical trials and ethical review of these trials will be examined as well as the dynamics of the distribution of risks and benefits that arise there from, especially in the context of HIV/AIDS. The paper will draw heavily from the author’s personal and professional experience as an African clinician, research student and public health practitioner in Nigeria and the United Kingdom in attempting to illuminate some of the pertinent issues in this area. A review of both published and unpublished literature in this area will be undertaken to further highlight areas of concern or weakness in current practice in this area.