US President Barack Obama’s 2013 budget plans include a significant cut to the President’s Emergency Plan for AIDS Relief (PEPFAR), the administration’s signature global AIDS programme.

The 2013 budget request would cut 13%, or $542.9 million, from PEPFAR, leaving total spending for that programme at $6.4 billion. The request, however, does call for an 57% increase in funding, to $1.65 billion, for the Global Fund to Fight AIDS, Tuberculosis and Malaria, a multilateral aid program, in order to fulfill Obama’s pledge to provide that programme with $4 billion during his term.

The planned cut for PEPFAR stunned global health advocates, who were buoyed late last year when administration officials championed the fight against AIDS. In a speech at the US National Institutes of Health on 8 November, Secretary of State Hillary Clinton said that the administration was committed to scaling up treatment and prevention interventions that have been shown to slow the spread of AIDS. On 1 December, World AIDS Day, Obama said that the United States would aim to treat 6 million HIV-positive people around the world, 2 million more than were expected to be treated under PEPFAR’s previous targets.

Overall, the President’s budget request would cut a total of just over $300 million from global health programmes.

“For those of us treating patients in some of the most affected areas, President Obama’s proposed budget cuts to many global health programs – including programs to fight HIV, TB, and neglected diseases – is deeply disappointing and a far cry from what he has promised,” said Sophie Delaunay, Executive Director, Doctors Without Borders, in a statement. “It defies logic that the U.S. global AIDS program, PEPFAR, could treat 40% more people in 2012 with 10% less funding.”

And Judith Aberg, chair of the HIV Medicine Association, called the PEPFAR cut “draconian,” and would comes at an inopportune time: just a year after a landmark clinical trial showed that early HIV treatment helped slow the spread of the virus.

“The $4 billion commitment to the Global Fund must be maintained but not at the expense of the highly successful PEPFAR programs,” Aberg said in a statment. “Now is not the time to retreat on our investment in either of these lifesaving programs.”

Ambassador Eric Goosby, US Global AIDS Coordinator, defended the budget request in a statement posted on the State Department’s web site. 

“In their remarks in late 2011, President Obama and Secretary Clinton put forward the inspiring vision of an AIDS-free generation,” Goosby said. “With this budget, the United States will keep our commitments, and we will meet our ambitious targets.”