The first report of the red imported fire ant (RIFA), Solenopsis invicta Buren, in Taiwan was in the city of Taoyuan in 2003. The government has made great efforts to bring RIFA-infested areas under control. RIFA has gradually spread outward since its discovery, but it is still confined in northern Taiwan, in part due to the control efforts. RIFA is well established in densely populated environments (i.e., urban areas), causing damage to public utilities and significantly affects the inhabitants of Taiwan. Out of 10,127 human encounters with RIFA reported by the Plant Pest Information Management System in the Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture, Executive Yuan, 3819 (37.71%) persons were stung, with 834 (21.8%) persons exhibiting wheal-and-flare reaction (swelling and redness of the skin). Among the victims, 288 (7.5%) sought medical care, and about 21 (0.6%) developed severe cellulitis and urticaria. Unexpectedly, 2.8% (106) of the victims exhibited anaphylactic shock, which was higher than previously reported cases (1%). The high anaphylactic shock percentage was probably because most victims were elderly farmers or because Asian people have higher sensitivity to the RIFA sting. RIFA is well adapted to the environmental conditions in Taiwan, which makes it extremely difficult (if not impossible) to eradicate. The management of RIFA in the future should focus on lowering the speed of spread to mitigate possible dangers to the inhabitants. Six major challenges of RIFA management in Taiwan are also discussed.