Malawi continues to face rising numbers of people infected by HIV with approximately one million adults and children currently infected. With Global Fund resources, Malawi aims to provide anti-retroviral therapy (ART) to at least 50,000 people over a 5-year period (depending on the cost of drugs and infrastructure capacity). The World Health Organization (WHO) estimates that 10-15% of all HIV positive people will progress to AIDS at any given point in time. Based on this about 100,000 to 150,000 Malawians would need ART at any one time, hence there is an enormous shortfall. The challenge will be to decide who should have access to ART given the limited resources.