How to you keep those who seek HIV treatment when they are already very sick, or when their immune system is badly damaged, alive long enough for Anti-Retroviral Therapy (ART) to kick in? Around a quarter of patients in sub-Saharan Africa present late. Of these, 10% die within the first three months on treatment with ART. Late presenters are where most HIV related deaths occur. The REALITY trial found that this mortality rate could be reduced by 27% with the use of a package of cheap and easily available anti-microbial medicines during the first three months of treatment. The study also highlights reasons why so many people seek treatment late. It suggests that community perceptions of HIV are still dominated by fear and key messages about the effectiveness of HIV treatment are poorly understood.