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Background South Africa and Trinidad and Tobago are disproportionately impacted by high rates of HIV/AIDS among adolescents. Objective The article describes the HIV crises in these countries; outlines a community participatory research framework to adapt and deliver family-based prevention; and presents preliminary data from intervention pilots in each setting. Methods Adapted interventions were piloted with N = 140 families in South Africa and N=16 families in Trinidad and Tobago to refine recruitment and retention efforts and to assess the adapted interventions' impact on family and risk-related constructs. Results Both settings reported promising results including high recruitment and retention and favourable pre to post changes in parent/youth frequency and comfort in talking about sensitive subjects, HIV transmission knowledge and attitudes about persons with HIV/AIDS. Conclusion International HIV-prevention alliances are increasing. Such alliances are challenged by trust issues, power- differentials and ideological differences. Recommendations are provided on how some challenges can be overcome. [ABSTRACT FROM AUTHOR]