The global community has no hope of ending the AIDS pandemic as long as the interests of drug companies are rated higher than the lives of people in low- and middle-income countries. The innovations of the pharmaceutical industry have transformed AIDS, at least in the western world, from a virtual death sentence into a chronic, treatable disease. Our aim is not to destroy the geese that lay the golden eggs. However, a balance must—and can— be struck between protecting profits and protecting people’s lives. Drug companies are in the business of protecting profits. It is incumbent upon the citizens of the global community to protect people’s lives. AIDS activists have succeeded in compelling drug companies to lower prices and allow generic versions of lifesaving drugs to be sold in Africa and in other parts of the developing world. This has significantly increased access and saved millions of lives. But there is another disaster looming ahead: Urgently-needed second-line AIDS treatment, a newer class of drugs that is a life line for patients developing resistance to current treatment, are priced far out of reach for people in low- and middle-income countries—where over 95% of people living with HIV/AIDS reside. In fact, low-income countries pay up to 12 times more for second-line treatments than they do for first-line drugs and middle-income countries pay up to 36 times more. Many people being treated for HIV/AIDS may develop resistance to their current regimen and will require these newer, second-line treatments to continue to stay alive. But, pharmaceutical companies hold tight patent control on over 74% of drugs called protease inhibitors—the key components of second-line AIDS treatment. Prices of second-line treatment will remain at extremely high levels as long as there is negligible generic competition, from nations like India, for the few specialized drugs for second-line treatment. The atmosphere of generic competition that created widespread access to AIDS drugs does not exist when it comes to the production of these newer medicines. The millions of people currently being treated successfully will be condemned to death without access to affordable second-line drugs. Since India’s generics manufacturing companies are the primary supplier of cheap AIDS drugs to most of the developing world, it would follow that India would be perfectly poised to deliver cheap, generic versions of this next wave of treatment, right? Not so. Strengthened Indian patent laws, combined with stricter patent enforcement by multinational pharmaceutical companies on its newest, most effective AIDS drugs, is keeping second-line treatment from being cheaply produced in India. This not only keeps these drugs out of reach for Indians in need, but also dries up the supply of effective lifesaving treatment for people in need all over the world. The solution? Brand-name drug companies must offer full and open voluntary licenses to countries with a domestic pharmaceutical industry, like India, in order to spur generic competition and lower the cost of second-line AIDS treatment to a level that includes the cost of production, distribution and a reasonable profit for the companies that produce the drugs. This will dramatically increase access to second-line treatment and mean the difference between life and death for millions of people living with HIV around the world. We also call on the Indian generic drug-manufacturing industry to choose patient lives over profits by lowering the cost of lifesaving AIDS drugs for Indians in need. Currently, Indian generics companies charge up to twice as much for its lifesaving AIDS drugs in India, as they do in Africa. With an estimated 5.7 million people infected, India now has the most people living with HIV in the world, but seems the least effective at getting drugs to its own people who need them. In fact, a recent report revealed that only 1 in 14 Indians in need of AIDS treatment are receiving it: a dismal record—and a cruel irony, considering the starring role that Indian generics manufacturers have played in increasing access in Africa. When it comes to doing battle against the global AIDS epidemic, every weapon must be made available. The cost of treatment will continue to be an obstacle, as long as patents—and profits—come before patients. What good does it do to make lifesaving products, if drug companies cannot provide them to the people whose lives need saving? We believe a balance between profits and patients is possible, but will only happen if aggressively pursued by all stakeholders. The global community must decide: Are we willing to let people in lower and middle-income countries die to protect patents and excessive drug company profit? With millions of lives at stake, we hope the answer is a thunderous and resounding No. *Chinkholal Thangsing, M.D.* is Asia Pacific Bureau Chief for AIDS Healthcare Foundation, operator of free AIDS treatment clinics in the US, Africa, Latin America/Caribbean, and Asia, including three in India (in Mysore, Koppal & New Delhi). *K.K. Abraham* is the General Secretary of the Indian Network of Positive People (INP+).