Myanmar has one of the most serious HIV epidemics in Asia. Contrary to many perceptions, the response to the epidemic is expanding. Funding for the response has gradually increased over recent years. However, coverage remains unacceptably low, donors seem largely unwilling to inject the resources needed to meet health needs and the government itself significantly under-invests in health. The National Strategic Plan on AIDS 2006?2010 issued by the Ministry of Health provides the reference framework for the response. Despite what might be expected given the environment, the Plan was developed in a participatory fashion, is multi-sectoral and up to date and prioritises service provision for the most at-risk populations. It is supported by a government-led, inclusive technical coordination group. However, significant barriers to service provision exist. These include constraining administrative procedures, controlled access, limited research and a highly politicised context. Nevertheless, the results demonstrate that persistent negotiation can yield agreements resulting in increased services for those in need. Nearly 40 international and national NGOs are implementing successful activities in Myanmar, alongside government efforts and with UN support.