Using data from the Demographics and Health Surveys for Tanzania in 2003–2004, 2007–2008 and 2011–2012 and borrowing from the methodology used in Parkhurst, the authors analyse the changing relationship between wealth and HIV prevalence in Tanzania. Findings are tabulated, graphed and discussed. The authors find the relationship is multifaceted and dynamic: women are disproportionately affected in all wealth quintiles and experience a stronger ‘wealth effect’; some groups experience an increase in prevalence even as population prevalence declines. Relative wealth and poverty are associated with increased prevalence, suggesting that structural drivers create a variety of risk situations – as well as protective factors – affecting different groups. The authors also consider data on testing refusals: wealthier men were consistently more likely to decline testing. Continuing to unpack this complex and shifting relationship is necessary in order to fully understand the structural drivers of HIV transmission and access of testing services, enabling the formulation of appropriate policy responses.