Pharmaceutical markets in low resource settings are imperfect. Suppliers provide information on 'suggested' medicine prices, but actual purchase prices vary substantially across purchasers and these prices paid are typically unavailable. Public procurement databases now, however, provide timely market intelligence on prices for antiretroviral (ARV) medicines purchased with donor funds, allowing for careful examination of market trends. We used data posted by the World Health Organization to create a longitudinal database of 15 111 ARV procurements from 2002-2008. We noted dramatic price reductions for ARVs over this 6-year time period. Most generic ARVs were cheaper than branded counterparts, with the exception of protease inhibitors (PIs) in which some generic versions were more expensive than branded counterparts. Less price variation was noted for ARVs in low-income countries than middle-income countries where price variations of threefold or greater were noted in five of 28 (18 per cent) generic and 15 of 25 (60 per cent) brand dosage forms. In order to meet global goals of universal access to HIV/AIDS treatment, further price reductions are needed for abacavir, tenofovir and PIs. New approaches are needed to create incentives for generic manufacturers of these ARVs to enter the market and create price competition with these medicines. doi: 10.1057/jgm.2010.6 Keywords: antiretroviral; price; policy; access ; transparency; procurement