And funding was set to soar as well – starting at a high of $50 billion ($10 billion/year for five years) for global HIV/AIDS alone (Obama’s 2008 campaign promise FY2009-13) and then at $39 billion for global HIV/AIDS and $4 billion for global TB (PEPFAR reauthorization July 30, 2008). Instead of soaring budgets, we got stalled budgets FY2009-2012 (Kaiser figures for PEPFAR/HIV, PEPFAR/TB, and Global Fund/HIV-TB-Malaria: $6.7 billion FY 2009; $6.9 billion FY 2010; $6.8 billion FY 2011; and $6.7 billion FY 2012). This year’s FY 2013 budget proposal contains a whopping $546 million dollar cut to bilateral PEPFAR AIDS funding (partially offset by a $350 million increase to the Global Fund) resulting in an overall decrease in funding down to $6.4 billion.

If we do the math based on these rough estimates, total US global AIDS, TB, and Global Fund (global AIDS/TB/GF) funding commitments (not disbursements, which are substantially less) are only $33.6 billion – a whopping $9.4 billion less than Congress authorized just three and half years ago.

So the truth of the matter is that global HIV/TB/GF funding has not merely flatlined and then dropped by 7% from a high in 2010, but that funding overall is off nearly $22% each and every year from what was promised by Congress four years ago.

The White House and Ambassador Goosby try to sugar-coat this defunding by pointing to President Obama’s recent promise to treat 6 million PWAs by 2013 and to new efficiencies in treatment that have lowered annual per patient treatment costs from $1100 to $335 (for the US share of treatment costs, which is approximately 50% of total costs).

However, PEPFAR authorization was written so that newly achieved efficiencies in HIV treatment were supposed to be plowed back into treating new patients, an issue with increased urgency because of findings that early ARV treatment reduces the risk of transmission between partners by nearly 96%.

However, instead of having money poured back into treatment as a result of hard-won treatment efficiencies, as mandated by law, we’ve seen comparative defunding of treatment over the past two years and an emasculation of the AIDS budget overall. With even 50% of the $5.4 AIDS money that has been unappropriated by the Administration and Congress, the US could treat over 8 million patients – 12 million by 2013!

Promising 6 million patients in treatment by 2013 was actually easy for the President even though activists had to fight a year long battle to get it. 6-by-13 can be accomplished even as President Obama deflects $9.4 billion from global AIDS/TB/GF towards other uses.

The Global Fund is set to get its promised $4 billion because of some internal transfers within PEPFAR. Accordingly, the US contributions 2011-2013 now total $1.05 billion 2011; $1.3 billion 2012, and $1.65 2013. US bilateral funding, on the other hand, which is essential to treatment scale-up slides back big time and the waiting lines and cynicism in Africa and elsewhere only grows.

This election year is going to have zero focus on global AIDS and the funding fiasco unless activists raise stink. The US’s cynical hosting of the Int’l AIDS Conference will go unremarked unless activists point out the US’s defunding and under-achievement. The 8 million patients whose treatment goes unfunded will die, unless full global AIDS funding is restored.