Activism for the right to health is strong in India, and Indian civil society has traditionally been dynamic and occasionally successful in pushing for better HIV care. However, the same health and HIV activists who are experienced in battle and accustomed to victory are surprisingly quiet when it comes to access to routine HIV viral load monitoring for patients receiving ART. Although the Department of AIDS Control recognises the need of routine viral load testing, there are serious barriers to scale-up: high costs, weak sample transport services, lack of trained staff and limited laboratory infrastructure. Over 800, 000 tests are needed annually instead of the estimated 7000 being done. This comment lists numerous recommendations to scale up HIV viral load testing in India.