There's barely enough money to pay for people whose treatment is underway and who will need it for a lifetime. There isn't enough to start treatment for about 5 million more who urgently need it.
Those new concerns about costs dominated the 18th International AIDS Conference, which drew 19,300 participants from 193 countries to Vienna last week.
"If I were to characterize the mood here, I would say it was a combination of rage and panic," said Joanne Carter, director of the anti-poverty group Results and a board member of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
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.