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Financial shortage in resource-limited and poor countries restricts treatment in HIV-infected patients especially in poor countries. Higher HIV prevalence in poorer countries makes drug rationing a real concern. Different countries solve the problem with different methods regarding WHO guidelines, but fairness and equity should be a major consideration in drug rationing. This paper is aimed at reviewing different strategic approaches to drug rationing in AIDS treatment and then discusses pharmacists' role. In conclusion, there is no fair and equitable strategy, and in each society, cultural, ethical and socioeconomic issues along with considering a critical role for pharmacists must be taken into account.