A key element in dealing with HIV/AIDS in South Africa depends on the resolution of the antiretroviral therapy (ART) paradox: while a universal First-World-style ART programme is unaffordable, a rationed treatment programme that includes ART is not only affordable but also vital for basic human rights reasons, to enhance prevention efforts and to keep the fabric of society together. Our recent paper on ART demonstrated how such a rationed programme would be both affordable and highly cost-effective. Traditional rationing mechanisms are unable to provide sufficient guidance as to how to go about this novel form of rationing. An alternative rationing mechanism is therefore proposed which seeks to balance ART in terms of three primary dimensions: total resource allocation to treatment, design of the treatment intervention, and setting targets on numbers to treat. Two secondary dimensions, related to total HIV and social spending, deserve equal attention. The current global context that precipitates and exacerbates the parallel contouring of disease burden and poverty should be constantly challenged.