At a Doctors Without Borders clinic in Khayelitsha, South Africa, patients are now resistant to the first-line regimen of HIV drugs, a generic combo based on the old drug D4T, which is barely used in the US or Europe because they have serious side effects and must be taken multiple times a day. But they cost less than $100 per patient per year, writes Forbes.

By contrast, Truvada, the world’s bestselling HIV pill, costs $12,000 annually in the US. Gilead sells Truvada to poor nations for $315 a year, a price at which it makes no profit but which DWB can’t afford. Generic-drug makers to which Gilead has licensed its patent will sell aid workers a similar pill for $120 a year, but that’s still unaffordable, the mag writes.

So DWB and Unitaid, a drug-purchasing agency in Geneva, are pushing an idea to allow African patients to get Truvada and a third drug for only $86 a year. The plan? Have drugmakers put patents for 19 HIV meds into a patent pool that could be licensed to select generic makers, which would pay inventors a small royalty and sell copycats only in certain developing countries. Presumably, prices would fall sharply, but inventors would still get some revenue from Africa.

But three years after Unitaid raised the idea, only Gilead, Johnson & Johnson and Merck are “actively engaged” in negotiating over a patent pool. Since February, Unitaid has lobbied nine other drugmakers and 17 generic makers. Unitaid met once with Abbott Labs, but it took eight months to schedule a second meeting. And Bristol-Myers Squibb says the pool could remove incentives for innovation. But Lisa Haile, a drug patent lawyer at DLA Piper, tells Forbes the pool won’t hurt earnings. “The good will outweigh the bad.”

As Forbes explains, getting different drugs into the pool is essential, because in order to control HIV and keep resistant strains from emerging, patients must take three meds at once. The stumbling block is how many countries to include. AIDS activists and generic makers want to include as many countries as possible, but a pool that covers China, Brazil or Thailand could be a deal breaker for branded makers.

The matter is likely to come to a head at a mid-December meeting of Unitaid’s board. “We’re negotiating with monopolies, and that’s not so easy,” Ellen ‘t Hoen, Unitaid’s senior advisor on intellectual property, tells Forbes.