If that money is not appropriated, the program, which provides treatment for 822,000 AIDS patients in 15 focus countries, will have to stop enrolling new individuals by February. Its counseling and testing programs, which have thus far reached 19 million people, will also feel the budget squeeze.

The lack of treatment means that people will die, Dybul said in a speech to the Global Health Council.

"You can't just start up again in 2008 and bring them back," he said. "They're gone."

In fiscal year 2007, 50,000 people in need of treatment will be turned away by the program, and medical evidence predicts that about half of them will die within 18 months if the lack of treatment continues, Dybul said. If the shortfall is not addressed, it could lead to the deaths of 110,000 to 175,000 HIV-infected individuals.

If counseling and treatment programs for pregnant women grind to a halt, it could also lead to 23,000 new child HIV infections. More than one in three of those children will soon die without treatment, he said.

In addition to the human toll, the program will lose the trust of partnering governments if it is unable to deliver on its promises, Dybul added. "The chilling effect long-term on scale-up is almost beyond comprehension."

President Bush has included the full expected increase from $3.2 billion in 2006 to $4 billion in his 2007 budget. But Democrats, now in control of Congress, have pledged to balance the budget -- a decision that will lead to tough spending choices.

A short-term option is the passage of a continuing resolution that would restore some or all of the expected funding until the budget issue is resolved.

"We understand that budget negotiations are difficult," Dybul told United Press International. "We're not pointing fingers at anyone."

However, he said, "this is the president's request, and we'd like to recognize the president's request."

The PEPFAR program has been the subject of some criticism because it contains earmarks for certain kinds of programs. One of the most controversial of those is the requirement that one-third of its AIDS-prevention spending go to abstinence programs. The program's policy of supporting faith-based efforts has also raised the ire of some opponents.

But the main hang-up in Congress is budgetary, not ideological, Allen Moore, a senior fellow at the Global Health Council, told UPI.

"It has nothing to do with HIV or AIDS," he said. "They have domestic priorities. It's a balancing act where they have to choose between AIDS and veterans or AIDS and the uninsured. The outcome is not clear."

A continuing resolution will likely be passed to restore some of the funding, he said, but not all of it. And the fact that the program is caught up in budgetary battles "doesn't bode well for next year."

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U.S. Global AIDS
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