This study benefits from access to extensive data collected by the researcher who is undertaking the first ethnographic study of ARV roll out in a state that by many criteria meets the definition of “fragility”. The main objectives of this particular study in the context of Mozambique are to qualify and analyze ARV treatment expansion in relation to state fragility as well as to identify other forms of fragility in relation to ARV treatment expansion. The health sector occupies a very particular position in relation to the politics of the Mozambican state. It represents the success of the incumbent political party in the struggle for independence. ARV roll out presents a challenge to this ideological position and therefore a particular test of state capability and autonomy in its relation with bilateral and multilateral donor partners.