The ARV treatment program run by Medecins Sans Frontieres in Khayelitsha outside Cape Town, South Africa is one of the longest running ARV treatment programs in sub-Saharan Africa. Medecins Sans Frontieres is seeing patients failing first-line treatment in increasing numbers and others not responding to available and affordable second-line treatment regimens. It is a wakeup call to all those in the global health field who no longer consider AIDS an emergency.