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To the Editor: In their Special Communication, Dr Attaran and Mr Gillespie-White¹ claim that the major bottleneck for access to antiretroviral drugs in Sub-Saharan Africa (SSA) is the lack of financing mechanisms, rather than patents. The combinations zidovudine/lamivudine/nevirapine or stavudine/lamivudine/nevirapine are often considered among the most appropriate for developing countries because of a relatively simple dosing schedule and an acceptable toxicity profile. However, Attaran and Gillespie-White found that patents on zidovudine block these combinations in 33 of 53 countries they surveyed, and that patents also blocked nevirapine in 25 of these countries. Patents on antiretroviral medications conferred monopolies and ensured extremely high pricing on the world market until 2000. This surely has caused a significant delay in thinking in terms of access to therapy in SSA. Until recently, in the light of a yearly drug cost of $10 000 per patient, few would consider the use of antiretroviral medications in SSA. . . . [Full Text of this Article]