Until recently, few people living with HIV/AIDS in developing countries could access ARV treatment. This is beginning to change as drug prices have come down, allowing governments to take the first steps towards larger-scale treatment programmes. At WHO's request MSF has documented its experiences in procuring ARV medicines in 10 countries, in the hope that this will benefit others. This report also shares observations about how government and market dynamics impact drug availability in poor countries. Apart from the price of medicines, there are many real and perceived barriers to expanding ARV treatment to large numbers of people in the developing world. Among those most often referred to are lack of political will, lack of trained staff and other elements of health care infrastructure, and the complexity of treatment protocols and laboratory monitoring. However, these barriers are not absolute. The question is no longer, "do we scale up treatment?" but "how?". Procurement strategies are a key element of scaling up, which is why this report focuses on how to procure ARVs effectively.