The bio-clinical efficacy of ART in Africa has now been proven. In 2001, the resolution adopted by the UNGASS meeting confirms that "effective prevention, care and treatment strategies will require [...] a non-discriminatory access to [...] anti-retroviral therapies". Most of the programmes that give access to ART initiated in the sub-Saharan region in 1998 are based on the principle that the patients participate financially to the purchases of ART. Some countries (Côte d'Ivoire, Senegal, and Mali) subsidize ART medications to favour a better access. The financial contribution of patients is supposed to: 1/ translate patient support into government action; 2/ favour a closer therapeutic adherence; 3/ assure the access programmes sustainability. However, despite the subsidies provided by some states, the cost of medical treatment greatly exceeds the resources available to most of the sufferers. The analysis of ART access programmes, specifically in Senegal and Côte d'Ivoire, shows that: 1/ Patient support to government action does not need to be more demonstrated while general access to treatment is officially recognised and recommended by the United Nations. 2/ Patient involvement and better adherence have been noted with patients that receive free ART. 3/ Patient contribution represents less than 10% of the medication's purchasing cost, thus, the cost recovery is marginal and does not allow for sustainable ART access programmes. The cost charged to patients for ARV still represents a major obstacle for proper medical management. Care programmes in African countries should implement free access to ART as a priority.