The debate keynote points to the fact that disempowered population groups, such as mothers and children, are being excluded from access to treatment. Although treatment is likely to become more widely available, it will fall far short of need for many years to come. In the meantime, should medical practitioners alone select candidates for treatment or is there a case for prioritising 'strategically important' groups? The debate raises issues about ethics, about corruption and about the way wealth is being used to jump the queue.