Monitoring and evaluation is necessary for any program management endeavor however it has been a challenge for application to HIV/AIDS projects globally because of the multidisciplinary and multidimensional aspects of the epidemic. Results-based management has been the main driver behind monitoring and evaluation efforts with various methodologies and indicators used for different stages of the results chain. Complexity of the HIV/AIDS epidemic necessitates the use of triangulation approach and complexity science related methods in studying various HIV aspects from biology to social dynamics and policy-making. Participatory methods have also been utilized for enhancing trust, ownership and empowerment within affected communities. Some frameworks are introduced to help planning and implementing national monitoring and evaluation systems. The future of monitoring and evaluation could be more promising for ensuring accountability and scientific rigor.