The advent of Highly Active Anti-Retroviral Therapy (HAART) changed the course of AIDS but its availability remains limited in many poor countries. Thus far, only about 100 or so patients receive Antiretrovirals (ARVs) in Pakistan either by out of pocket payments or NGO support (at Rs 2000 to 60000 monthly). This is changing as ARVs imported by the National AIDS Control Program (NACP) with a Global Fund grant have now arrived and the government has agreed upon the policy to allow importation of ARVs. Local manufacturing of ARVs will further relieve these pressures in 2006. However, this good news comes some unique problems.