Center of AIDS Pandemic No Longer Only in Sub-Saharan Africa; More Than 100M HIV Cases Possible Worldwide by 2010, Intelligence Report Says

HIV/AIDS is "on the verge of exploding" in India, China, Russia, Nigeria and Ethiopia -- five of the world's most populous nations -- and the number of HIV cases worldwide could reach 100 million by 2010, according to a report released yesterday by the National Intelligence Council, a panel of experts that prepares reports on issues of strategic importance for the CIA, State Department, Defense Department, National Security Council and other government agencies, the Boston Globe reports. According to the report, the five countries, which are all considered "strategically important" to the United States, could account for an estimated 50 million to 75 million HIV cases alone (Donnelly, Boston Globe, 10/1). That estimate is "double or triple" a projection made for those nations last summer, the Washington Post reports, noting that UNAIDS estimates that there will be 60 million HIV cases worldwide by the end of the decade. The new projections have been disputed by some epidemiologists, such as Bernhard Schwartlander, head of WHO's AIDS program, who said that the predicted jumps in rates in Russia and India were too high based on current data. Neff Walker of UNAIDS also questioned the figures, which he said were made by applying a "worst-case scenario systematically through all of these countries," but added that he "wouldn't rule out" the projections entirely. However, Richard Feachem, director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the focus of the report is "right on target," adding, "Paying attention to these large next-wave epidemics is extremely important, and has been a neglected subject in the international debate" (Washington Post, 10/1).

Epidemic's Impact
According to the report, HIV/AIDS could "harm the economic, social, political and military structure" in each of the countries, leading to conflict over spending priorities, health care costs and "military manpower shortages" (Altman, New York Times, 10/1). The report predicts that Nigeria and Ethiopia, which are "key to regional stability" in Africa, will be the "hardest hit" of the five countries and notes that the two countries could soon have epidemics on the same scale as several Southern African nations (Sternberg, USA Today, 10/1). Dr. David Gordon, the report's lead author, said that HIV/AIDS could also have a dramatic impact in Russia, where the disease is likely to "help shape how that country emerges in the post-Soviet era" (New York Times, 10/1). According to the report, HIV/AIDS, which has spread in Russia largely through injection drug use, is "likely to exacerbate" the country's already "significant" social, economic, health and military problems, as well as increase the pace of the country's population decline (Boston Globe, 10/1). HIV/AIDS is also likely to "generate political tensions" in Nigeria, where the military is affected by the disease, Gordon said. The Nigerian government has been the "most active" of the five in raising public awareness of HIV/AIDS, and the military, which plays a major peacekeeping role in Africa for the United Nations, mandates HIV/AIDS education for its members (New York Times, 10/1). The impact of HIV/AIDS is expected to be less dramatic in China and India because HIV-positive individuals will still represent only a small percentage of the countries' large populations (Boston Globe, 10/1). The report also notes that antiretroviral drug resistant HIV strains are likely to become more common due to inconsistent medication use and the foreign manufacture of "unregulated, substandard" drugs (New York Times, 10/1).

Next Steps
According to the report, it will be hard to avoid an HIV/AIDS "catastrophe" in any of the five countries noted because of their "weak" health infrastructures, a lack of government leadership and "inadequate" funding for HIV/AIDS prevention and treatment initiatives, the Globe reports (Boston Globe, 10/1). However, the report's projections "aren't destiny," Gordon said (Zakaria, Reuters, 9/30). The report calls on all five governments to make "dramatic shifts in priorities" to contain their epidemics. China, India and Nigeria have already taken some steps but more needs to be done because the disease has "built up significant momentum" and could "overwhel[m]" the nations' health services, the report says. Gordon said that the governments of all five nations were provided with copies of the report two months ago, but said that NIC has not received any replies thus far (New York Times, 10/1).