FROM the beginning, AIDS has been a politically charged disease. It has pitted rich against poor, and puritans against the politically correct. For the most part, though, the different opinions of these diverse lobbies have been honestly held and vigorously defended. In that context, the release of this year's “AIDS epidemic update”, the annual report on the disease by UNAIDS and the World Health Organisation (WHO), may give the reader a slightly uneasy feeling. For, alongside the awful, inexorable figures—the number of people infected is now more than 40m, and more than 3m died last year alone—something has inexplicably vanished.

In 2003, the two agencies launched what was known as the 3x5 Initiative. This had the aim, by the end of 2005, of getting 3m people in poor and middle-income countries on to the antiviral drugs that sufferers in rich countries have come to regard as their birthright. It is hard, however, to find any mention of it in this year's report.

Presumably, that is because reality is going to fall woefully short of ambition. Though the final figures are not out, as the deadline has not yet passed, the last progress report talked of 1m rather than 3m.

Since then, things have gone rather quiet. And that is a pity, for there is enough genuine uncertainty surrounding AIDS, without manufacturing more. In retrospect, the target of 3m was far too ambitious. Even having 1m people on the drugs has achieved a lot. As the report puts it in a paragraph that studiously avoids the term “3x5”, “because of the recent treatment scale-up since the end of 2003, between 250,000 and 350,000 deaths were averted in 2005.” That is genuinely good news.

Reality check

The reason for worrying about all this is not that the target was missed, but that the feasibility of reaching it was based on a set of over optimistic modelling assumptions about such things as the effectiveness of drug distribution networks and the competence of local health services. Both the models and the reality on the ground have changed in the light of experience, of course. But a more open acknowledgment of past errors would give greater confidence that future targets might be hit. The G8 group of industrialised countries recently suggested that antiviral drugs should be available to all who need them by 2010, a target that has been enthusiastically embraced. It would be a pity if poor planning meant that objective were missed, too.

There was also some confusion around what looks, at first sight, like a piece of rare good news—that four countries previously regarded as AIDS basket-cases, namely Burkino Faso, Haiti, Kenya and Zimbabwe—had seen a fall in the prevalence of infection with HIV, the virus that causes the disease. Dig into the detail, though, and a good part of this decline seems to be the result of the infected dying, and thus no longer appearing in the statistics. How much is due to the rate of new infections falling is very hard to ascertain.

Certainly, as the report acknowledges, 80% of the decline in prevalence in a heavily studied part of Uganda was caused by such a die-off—and Uganda has, in the past, been trumpeted as the first, best example of a country that has got its epidemic under control. Sadly, not quite such a triumph as might at first appear.