The budget for global AIDS treatment and prevention increased about 2 percent to almost $7 billion, while the global health budget for the U.S. Agency for International Development, which provides humanitarian assistance, jumped 25 percent to $3 billion. The increase is primarily for health programs in poor countries that will build on U.S.-funded efforts to combat AIDS, said Jenny Peterson, spokeswoman for the Office of the U.S. Global AIDS Coordinator.

In some of the world’s poorest regions, AIDS clinics offer the only medical treatment option, and doctors have argued the services should be broadened. In May, Obama proposed spending $63 billion over six years to extend U.S. programs to battle global poverty and disease, with $51 billion to combat HIV/AIDS and malaria. The program built on an initiative by President George W. Bush to fight AIDS, malaria and tuberculosis.

“AIDS services have tended to be the backbone of other health services,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition, or AVAC, in New York, in a telephone interview today. “The question is: how do you build that in a way that continues the progress in respect to HIV/AIDS, without shifting the focus away?”

AIDS Focus

The $19 billion spent during the Bush administration on its AIDS program from 2004 to 2008 was the single biggest U.S. health assistance program ever, according to the budget. The initiative, known as PEPFAR, invested most of its money to help people already infected with HIV, the virus that causes AIDS. The relief program devoted a smaller share to prevention programs, which often focused on sexual abstinence.

“Keeping AIDS as a sort of ‘special disease,’ with separate clinics, elaborate counseling and testing, training and procedures outside of the rest of the health system has been a major contributor to the stigma of AIDS,” said William Aldis, assistant professor of global health at Thammasat University in Bangkok and a former representative of the World Health Organization in Thailand.

“Dealing with these problems requires making the system, including hospitals, work better,” Aldis said. “There’s no profit margin here for the donor countries, unlike vaccines and new brand-name drugs.”

Little Attention

Programs to address maternal and neonatal mortality have historically attracted little funding, Aldis said. He supports the U.S. wanting to work closer with individual countries “as long as the U.S. pays attention to what countries want to do, and works with them respectfully and early in the planning process to get genuine national commitment country-by-country to the U.S. investment.”

About 33.4 million people live with HIV around the world, and about 90 percent of them live in low- and middle-income countries, according to the WHO, a United Nations’ agency based in Geneva. Today’s budget doubles aid for tropical diseases and expands funding for maternal and child health by 28 percent, according to Global Health Council, an advocacy group in Washington.

Congress will decide how the money from today’s budget plan is allocated, and their negotiations in coming weeks and months will determine the success of the budget initiatives, AVAC’s Warren said. Warren said he’s concerned that money might be taken away from AIDS research and treatment to build more general health infrastructure.

“There are fundamental resource constraints. A broader global health strategy is important, but not at the expense of AIDS,” Warren said. “There is never a good time to make cuts in HIV/AIDS, but I would argue this would be the worst time.”

To contact the reporter on this story: Tom Randall in New York at trandall6@bloomberg.net.

Last Updated: February 1, 2010 17:21 EST

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