December 1 is the 16th World AIDS Day. The major theme of the past year has been on strengthening the campaign for cheap antiretroviral drugs. This thrust, some critics maintain, has been to the detriment of HIV prevention efforts. Perhaps the most ambitious HIV/AIDS development in the past year has been WHO's focus on the “3 by 5” target—a commitment to provide antiretroviral drugs to 3 million people in developing countries by the end of 2005. For many the “3 by 5” initiative, if successfully implemented, will bring a longer life. But how useful is this and other antiretroviral-based initiatives to those people with AIDS in the developing world who will die today, tomorrow, or in the very near future? For these people, the stark reality is that it is too late for antiretroviral treatment; what they need, yet rarely receive, is palliative care. According to this year's UNAIDS/WHO update published on Nov 25, sub-Saharan Africa remains by far the region worst affected by HIV/AIDS. By the end of this year, AIDS will have killed an estimated 2·3 million people in the region. The key role of palliative care in tackling the AIDS pandemic has been acknowledged in the detail of US President George W Bush's proposal for $15 billion over five years as part of an Emergency Plan for AIDS Relief. Speaking at a meeting hosted by the UK All-Party Parliamentary Group on AIDS in London earlier this month, Director of the White House Office of National AIDS Policy Joseph O'Neill emphasised that “the people of the United States have acted, and acted boldly, to support palliative care for global HIV/AIDS to the tune of $2·25 billion”. O'Neill's personal commitment is evident from his involvement with the palliative-care community—for example his co-authorship of a recent survey, the first of its kind, of current practice in HIV/AIDS end-of-life care in sub-Saharan Africa (BMC Public Health 2003; 3: 33). This survey revealed, perhaps unsurprisingly, significant limitations in, and the pressing need for expansion of, palliative care in this part of the world. One weakness identified in many countries was a lack of government understanding of palliative care and absent national policies. The central role of an enlightened and informed government approach is illustrated in a report on the development and expansion of a model home-based palliative-care programme in Uganda in this week's Lancet (see p 1812–13). Palliative care is now part of the Ugandan government's national health plan and morphine for the control of severe pain has been provided free since 2002. Moreover, a law soon to be passed will allow nurse specialists to prescribe oral morphine. Good home-based palliative care encompasses not just the patient but also the whole family. On Nov 26, UNICEF's report, Africa's Orphaned Generations, projected that by 2010, 20 million children under the age of 15 will have witnessed the sickness and death of a parent from AIDS. In many cases, the eldest child will have been the sole caregiver for the parent at the end of life. Counselling these children, and equipping them with the skills and drugs necessary to bring some relief to the parent, can help these children cope. Crucially, skilled management of pain and other symptoms also allows the dying parent to help the child. Such help might be as far-reaching as being capable of preparing a will, or as simple as being able to give a hug. Advocates for the need to tackle the other pressing issues, such as antiretroviral availability, prevention, or vaccine development, may be concerned at a new AIDS cause being championed. The key point, however, is that none of these approaches individually is sufficient, and all must be addressed if HIV/AIDS is to be contained. Home-based palliative care allows access to the family members who are not infected with HIV or terminally ill with AIDS. The provision of tangibly effective care, especially pain relief, helps to break down barriers of mistrust between these communities and “outsiders”. Cheap, effective, and culturally appropriate palliative-care programmes are therefore a powerful tool for reaching vulnerable populations and so ideally should be locked into prevention and treatment programmes. Palliative care with effective pain relief, and the funding it is starting to attract, presents not a threat but an advantage to more mainstream anti-AIDS activities. We urge all those involved in tackling the HIV/AIDS pandemic to seize this opportunity.