Contemporaneously, the rapid dissemination of highly effective combination HIV antiviral therapies was resulting in precipitous declines in short-term mortality from AIDS in the developed world (3), but there was uncertainty about the feasibility of using these drug regimens in Africa. Some experts argued that the cost of such expensive drugs was prohibitive in countries with a total per capita health expenditure of only a few dollars a year, and that even if introduced, would divert precious resources from more cost-effective prevention efforts (4–5). Further, African systems of care were said to be substandard, health care workers in short supply, and patients unsophisticated. All of these factors, it was argued, would make it impossible to ensure adherence to the complicated drug dispensing and monitoring that these regimens require, and thus use could even be detrimental owing to transmission of drug-resistant virus. By the turn of this century, it seemed that there would be 2 AIDS realities going forward: a chronic but increasingly manageable disease in the developed world, and an unstoppable, unspeakable tragedy in Africa and other resource-constrained countries.