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This review examines the persistence of chronic hunger in Sub-Saharan Africa in the twenty-first century and reviews dominant famine theories, concepts of vulnerability, and household livelihood security and responses to recent food crises in the region. The authors argue that famine occurrences are linked to historical and contemporary socioeconomic processes that have increased over time the vulnerability of African households to hunger and reduced their resilience to environmental and economic shocks, political conflict, and the rapid spread of HIV/AIDS. Approaches to famine need to move away from the “emergency relief” framework to better address the underlying conditions that make food shortages endemic. Future food security for Africa requires an integrated long-term response to household vulnerability on the part of African governments, civil society, and international partners by incorporating new technologies, local expertise, and active involvement of African communities living with the realities of recurrent famine.