In industrialised countries, highly active antiretroviral therapy (HAART) has drastically reduced HIV mortality. Only few developing countries have introduced HAART on a large scale, leaving millions of HIV-infected individuals without life-saving therapy. Although HAART appears to be economically viable for middle income countries, it remains unaffordable for many of the poorest and worst affected nations. In response, significant discounts for antiretrovirals and debt relief have been granted. Apart from economic problems, other important issues need to be addressed before antiretroviral therapy can be optimally utilised, including the logistics of drug supply, HIV education for hospital staff and patients, and laboratory facilities that allow clinicians to assess the efficacy of HAART.