Hepatitis C virus (HCV) is a major cause of chronic liver disease in the world. The WHO estimates that 3% (170 million) of the world's population are chronically infected with HCV. Sub-Saharan Africa is of great interest because it is reported to have the highest HCV prevalence rate (5.3%), and a concurrent HIV epidemic. In our review of the published literature we found consistent evidence of high HCV prevalence in many countries of Africa. We estimate the overall prevalence of HCV in Sub-Saharan Africa is 3.0%. The central African region has the highest estimated prevalence of 6%, west Africa has an estimated prevalence of 2.4%, and southern and east Africa with the lowest estimated prevalence of 1.6%. Given low sexual transmission of HCV and infrequency of intravenous drug use in Sub-Saharan Africa, iatrogenic causes of HCV transmission need to be further evaluated.