FACING a growing deficit and political demands to cut spending, the Obama administration is planning to scale back US support for global HIV/AIDS programmes and is pushing to unload some of the burden onto other countries.
The shift comes at exactly the wrong time in the 30-year fight against the virus, activists say.
There are a record 34,2-million people worldwide living with HIV/AIDS and the virus killed more than 4000 people a day last year, according to the World Health Organisation (WHO). In SA alone 18% of those aged 15 to 49 are infected, the data show.
Over the past two years, scientists have found a daily pill, Gilead Sciences ' Truvada, can reduce the risk of healthy people getting HIV/AIDS by as much as 94%, and early treatment can stop those infected from spreading the virus.
What is lacking is the money needed to convert that knowledge into an endgame attack on the epidemic, said Chris Collins, a vice-president at amfAR, the Foundation for AIDS Research. His point, echoed by the WHO among others, promises to be a central debate at the International AIDS Conference, which started in the US on Saturday.
"We are at risk of not following through on one of the great global health opportunities of our generation," Mr Collins said by telephone. "Either we make more investment now, and really begin to see the end of this, or we don't do that and see this epidemic go on for generations."
The HIV/AIDS meeting, to be attended by more than 20000 activists and researchers, comes at an awkward time for President Barack Obama.
Former president George W Bush, a Republican, more than tripled US funding for global treatment during the last five years of his administration through the President's Emergency Plan for AIDS Relief, or Pepfar. With that increase, US funding covered about 59% of all donations for global HIV/AIDS relief, says Jennifer Kates, director of HIV/AIDS policy at the nonprofit Kaiser Family Foundation.
In 2010, the year after Mr Obama took office, the Pepfar budget was $6,9bn, including money to combat tuberculosis, the leading killer of HIV/AIDS patients. Next year, the funding will fall to $6,4bn, if Mr Obama's proposed budget is enacted. The administration believes other countries need to step up and help to carry the financial load in the future, says Eric Goosby, Mr Obama's global HIV/AIDS co-ordinator.
"The US can't be ministries of health for all of these countries," Mr Goosby said. "Our best chance at not having the US be the predominant resource motor for HIV/AIDS treatment and HIV/TB treatment on the planet is to bring others to the table to put their resources to it."
Mr Goosby said he did not expect to face financial constraints for global HIV/AIDS when he joined the Obama administration in June 2009, and he had had to spend time lobbying members of Congress who control appropriations to sustain support for the programme.
The funding cuts are being questioned, even by some in the president's Democratic Party, at a time of extraordinary scientific progress.
"We cannot walk away thinking we've done our part and it's on them now if we are serious about our goal of an HIV/AIDS-free generation," congressman James McDermott, a Democrat from Washington, has said.