AIDS activists reacted with dismay to President Bush's $2.9 trillion fiscal year 2008 budget that was sent to Congress last week and   acknowledged a difficult road ahead in getting Congress to provide significant increases in funding.

The major bright spot was internationally, where the President's Emergency Response for AIDS Relief program gets a large boost to remain on track for a promised commitment of $15 billion over five years.

The Department of Health and Human Services, the largest domestic federal agency, received a mere 0.3 percent increase in overall funding. The proposed budget for Ryan White CARE Act programs is $2.132 billion, an increase of only $20.1 million over the FY 2007 joint budget resolution passed by Congress, according to an analysis by AIDS Action. There would be a shuffling of a few million dollars from the AIDS Education and Training Centers to local clinics providing medical services to patients, and a modest increase in funds for the AIDS Drug Assistance Program.

"Barely two months after the president signed a bill to reauthorize the Ryan White CARE Act, his new budget request short-changes this vial program," said Joe Solmonese, president of the Human Rights Campaign. "It's time for the president to put his money where his mouth is."

"Same story, different year," said Anne Donnelly, with San Francisco-based Project Inform. "President Bush continues to call for balancing the budget on the backs of the sickest and poorest Americans, while promoting permanent tax cuts for the most wealthy. His priorities are wrong and Congress should reject this budget."

Five new cities with 19,000 people living with HIV/AIDS qualified for Title I funding under reauthorization approved late last year by Congress. "Despite the tremendous increase in the number of people to be served, President Bush has requested no new funds for Title I," said Christopher Brown, chairman of the Communities Advocating Emergency AIDS Relief, a coalition of organizations in cities hit first by the epidemic.

"Each time new cities have been added to Title I, there has been a corresponding increase in funds. This reauthorization should be no different. Without such an increase, desperately needed funds will be cut from existing Title I communities," Brown added.

"Once again, President Bush has turned his back on people with HIV/AIDS who rely on ADAP for lifesaving drugs," said Steve DeCorte, with the Save ADAP working group of the AIDS Treatment Activists Coalition. He called on Congress to add $232.9 million to fully fund that program.

Carl Schmid, with the AIDS Institute, found a positive note in the budget proposal. The Centers for Disease Control and Prevention's HIV prevention budget, which has been flat funded for the past five years, will receive and additional $93 million for testing for the virus. However, "It is questionable if $30 million of it will ever be spent due to grant restrictions," Schmid said.

Schmid was disappointed that there is no real increase for research at the National Institutes of Health, after budgetary shuffles and transfers are taken into account. As the American Society for Microbiology noted, over the last four years the NIH "has lost about 10 percent of its purchasing power when adjusted for biomedical inflation."

The president proposes, Congress disposes goes the saying in Washington. With Democrats newly in control of Congress that should mean that they will have their way with the budget. But there does not appear to be a consensus within the Democratic majority to significantly increase taxes and open the spigot of new revenue. Nor are they willing to cut back on military spending and risk being perceived as weak on defense when forces already are stretched very thin by the war in Iraq.

The problem for AIDS advocates is compounded by the fact that the Bush budget includes actual cuts in children's health care, Head Start, and Medicare and Medicaid. It is likely that restoring those cuts will take precedent over increasing funding for AIDS programs.