PIP: Demand for treatment with antiretroviral (ARV) drugs increased in Africa in the wake of the July 1996 AIDS Conference in Vancouver, during which combination ARV treatment including protease inhibitors was shown to dramatically improve the quality and length of life for people with AIDS. However, 1 year after the Vancouver Conference, ARV drugs remain scarce in Africa. Most people treated with antivirals in Africa try to acquire their drugs by ordering them through friends outside Africa or by travelling to Europe or the US. ARV treatment is becoming more complicated and treatment strategies change rapidly. The imbalance between the high price of ARV treatment and the scarcity of resources, competing health care needs, and the continent's weak health care systems all impede the introduction of large-scale ARV treatment in Africa. Nonetheless, if neither governments, organizations, nor industry provide ARV, HIV-infected people, their families, and physicians may try to obtain them through informal channels. Poor quality ARV may then be procured, sold at extremely high prices, and inadequately administered. Indications for ARV treatment, indications of ARV as preventive therapy, and requirements to introduce ARV are discussed.