But as the United States and other rich nations hit by the global financial crisis face their own daunting challenges, there is heightened competition for foreign assistance. President Obama has proposed a 2 percent increase in spending on H.I.V. and AIDS for 2010 and a 6 percent rise for maternal and child health, according to the Global Health Council, but the disparity in American spending on AIDS and the big child killers remains stark.

In Africa’s two most populous nations, Nigeria and Ethiopia, the number of people who died of AIDS in 2007  237,000  was less than half the 540,000 children under 5 who died of pneumonia and diarrhea. But this year, the $750 million the United States is spending on H.I.V. and AIDS in the two countries not only dwarfs the $35 million it is spending there on maternal and child health, but is also more than the $646 million it is spending on maternal and child health in all the world’s countries combined.

“AIDS is still underfunded, no question,” said Jeremy Shiffman, a political scientist at Syracuse University who has documented global health spending patterns. “But maternal, newborn and child mortality is a tremendous tragedy and gets peanuts.”

Dr. Ezekiel J. Emanuel  a bioethicist, White House official and brother of Rahm Emanuel, Mr. Obama’s chief of staff  has contended that international aid for health is limited and would save more lives if increases focused on maternal health and the “mundane but deadly diseases” that kill young children. Such choices are necessary, he and a co-author wrote in the Journal of the American Medical Association in April, “if the United States is going to shoulder the burden of choosing which lives to save in the developing world.”

Jeffrey D. Sachs, the Columbia University economist, countered that wealthy donors still spent far too little on global health and rejected what he called the wrong-headed idea that “we need to make a terrible and tragic choice between AIDS or pneumonia.” The United States has invested heavily in the fight against AIDS, and other wealthy nations should pick up more of the cost of other global health priorities, he says.