The supply of Antiretrovirals (ARVs) to HIV/AIDS patients in most of the provinces in South Africa is hindered by various factors such as ineffective and inefficient drug procurement, and drug distribution systems. In the QwaQwa district in the Free State Province, a major barrier to the consistent supply of Highly Active Antiretroviral Treatment was identified to be the lack of an effective and efficient ARV drug distribution system. This resulted in major drug supply shortages in the QwaQwa district. A continuous, uninterrupted supply of ARVs to HIV/AIDS patients is critical to avoid drug resistance and therapy failure. Failure of a patient to respond to treatment results in a deterioration of a patient's health, and ultimately leads to death. The purpose of the study was to determine whether the ARV drug distribution practices at the Manapo Hospital in the QwaQwa district were effective and efficient in the management of ARVs. The distribution practices reviewed were the ordering, transportation, the management of inventory and warehousing, and the distribution of treatment to HIV/AIDS patients. Quantitative exploratory, descriptive and contextual methods were used to determine the relationship between the ARV drug distribution practices and the effective management of the ARVs. The study comprised of a sample size of twenty-one participants. The sample size entailed the Manapo Hospital pharmacists and pharmacist assistants who have been or are currently involved in the distribution of ARVs in the QwaQwa district since the initiation of the ARV rollout programme in 2004. The study revealed that the practices performed in the management of ARVs in the QwaQwa district were neither effective nor efficient in the distribution of ARVs. The recommendations of the study were identified to further ensure the effective and efficient management of the ARV drug distribution system, which will ensure a consistent supply of treatment to HIV/AIDS patients. Guidelines were developed for better circulation, thus meeting the objectives of the research.