Since 2002, when WHO announced the 3X5 target, there has been a remarkable scale-up of ART driven by resources from the Global Fund and PEPFAR in particular and supported by an unprecedented partnership of HIV⁺ people and numerous government and non-government actors. As of the end of 2007, there were an estimated 3,000,000 on ART of whom 2,000,000 were in Sub-Saharan Africa. However these figures still represent only 30% of those in need of ART, and the estimated 200,000 children on ART are only 10% of those who should be on treatment. Current constraints to further rapid scale-up of ART include lack of knowledge of one’s HIV status or lack of awareness of when to start ART. Additional limits to further scale-up of ART could include a limitation in the global funding levels needed to maintain current beneficiaries and support additional millions to start treatment. Other real barriers are the exhaustion of the health system in developing countries, as well as the challenge of how to take treatment to hard to reach population groups. Among those who do manage to start treatment, several studies indicate a high level of early deaths and loss to follow-up, particularly in the first 12 months of initiation of treatment. In addition, longer term drug adherence continues to be a challenge with the reported emergence of drug resistance, drug toxicities, and other disabling chronic disorders. Several countries continue to be challenged with logistics and infrastructure, particularly the laboratory services necessary to diagnose and monitor complicated cases. Other emerging social challenges to the scale-up of ART include the challenge of providing sexual and reproductive health services for HIV⁺ persons who wish to resume or continue safe sexual activity, the economic challenges of being alive, feeling well but having to find a job; or how to juggle a job while receiving chronic care. In addition, there is also the re-emergence of stigma issues—particularly when denial of one’s HIV status is needed to fully reintegrate into society.