Returning to Durban, South Africa for the International AIDS Conference sixteen years later, the issue of high drug prices remains front and center. First generation antiretroviral medicines remain accessible and affordable in most low- and middle-income countries and some people in some regions have access to low-priced second-generation medicines because of voluntary licenses and discounted prices. But millions of people with HIV and their governments, especially in middle-income countries in Asia, Latin America, Eastern Europe and Central Asia, and in the Mideast and North Africa, face antiretroviral drug prices that are exclusionary because of drug monopolies. And yet, people with HIV have better access than most – our brothers and sisters living with cancer, hepatitis, mental illness, and other treatable health conditions face unrelenting intellectual property barriers. Meanwhile, the Indian generic industry – often referred to as “the pharmacy of the developing world” – is under threat.