The global economic crisis threatens recent gains in health and poverty reduction in developing countries. What is the effect of the crisis on HIV programs, especially in high HIV prevalence countries? What are the possible consequences? What can be done to avoid negative impacts? Much is at risk: increased mortality and morbidity, unplanned interruptions or curtailed access to treatment, with increased risk of HIV transmission, higher future financial costs, increased burden on health systems and reversal of economic and social development gains.