Finding “efficiencies” in global HIV programs is the buzzword of the hour. This term has peppered speeches of everyone from Global AIDS Ambassador Eric Goosby to President Clinton and Bill Gates. Even UNAIDS is utilizing new frameworks for costing HIV interventions focusing on strategic investments instead of needs-based costing. “Efficiency” here is generally taken to mean “do more with less” — save lives with fewer resources and win the war against HIV without funding increases. Although there are efficiencies to be gained, additional up-front investments are necessary to turn the tide against HIV and save future costs. It is also important to highlight what efficiency talk avoids: the other 3 “E's”: equity, effectiveness, and empowerment. This Commentary will critically examine efficiency rhetoric and discuss achievable efficiencies in treatment and healthcare delivery that also meet equity, effectiveness, and empowerment goals.