The purpose of this study was to analyze how international HIV/AIDS treatment providers in Australia, Kenya, and Lebanon navigate systematic social and political barriers to ethically meet the needs of their clients living with HIV through grounded theory methodology. Data collection methods include the use of interviews, filed notes, observations, historical media publications, and scholarly literature on barriers to ethical decision-making for treatment providers. Data collection took place with key informants, agency care workers, and community respondents from July 15, 2015 to August 4, 2015 in Melbourne, Australia, Beirut, Lebanon, and Nairobi, Kenya. After data collection, three clear opportunities for meaningful analysis emerged to inform international HIV social work practice, including: 1) a case study from Lebanon evaluating the utility of the four quadrants model to ethical decision-making; 2) an evaluation of the core challenges to consensual HIV disclosure and ethical-decision making for treatment providers and their clients; and 3) an examination of the new challenges from diminishing funding to ethical decision-making by HIV treatment providers. These three research papers are presented in a potentially publishable format and bookended between introduction and conclusion chapters. Implications for international social work practice and policy recommendations are discussed at length.