The rage is directed at the Obama administration

The rage is directed at the Obama administration, which many activists say is reneging on a commitment to continue big annual increases in global AIDS spending. The panic arises from the knowledge that in some African countries, patients who want antiretroviral treatment are being turned away and will soon start dying.

Some activists pine for former president George W. Bush, who launched a much-praised multibillion-dollar fund to fight AIDS around the world. But now, in the eyes of many, the U.S. government has replaced the pharmaceutical industry as the main impediment to progress.

"The paradox is that the United States government and other funding partners have decided to either flat-line or reduce their spending just when funding should be ramped up so we could actually win the battle," said Paul Zeitz, director of the Global AIDS Alliance.

U.S. overseas AIDS funding is part of the Global Health Initiative (GHI), the Obama administration's $63 billion, six-year program. The portion devoted to HIV and tuberculosis, an infection to which AIDS patients are particularly prone, is $44 billion. The rest goes to malaria, maternal and child-health programs, and the hard-to-define goal of "health systems strengthening." Although larger than Bush's revolutionary President's Emergency Plan for AIDS Relief (PEPFAR), Obama's GHI is spread across more agencies. It is less a bullet aimed at the heart of AIDS than a net cast to capture a flock of health problems.

"What it takes to save lives of those with HIV and those most at risk to contract it is a comprehensive approach that recognizes the roles of other diseases," Gayle Smith, Obama's special assistant for development and democracy, wrote on the White House blog last week.