This study was to address the dilemmas of public policy on free and universal distribution of antiretroviral drugs in Brazil. The descriptive bibliographic research with a qualitative approach, prioritized the information from the Ministry of Health, ANVISA, Health Department, INPI and specialized journals. a brief discussion of barriers to distribution of antiretroviral drugs by the National Health System was introduced, highlighted some strategies that can be better exploited by public managers to ensure continuity of treatment of HIV / AIDS patients, as the drugs. The analysis undertaken it was established that the patent management of medicines needs to be aligned with public health policies and the negotiation with the pharmaceutical industry establishing exorbitant prices burdening the budget of public funds invalidating the sustainability of the national program of universal and free supply of medicines antiretroviral drugs to combat HIV.