*EPF214 10/01/2002
Text: HIV/AIDS Surge Foreseen for Nigeria, Ethiopia, Russia, India, China
(National Intelligence Council prepares report for CIA) (1070)

The expected rise in HIV/AIDS cases worldwide during the current decade will be driven by spread of the disease in five populous countries: Nigeria, Ethiopia, Russia, India, and China, according to a U.S. government advisory group report.

The number of cases in those countries, says the report from the National Intelligence Council, which advises the U.S. Central Intelligence Agency, will grow from an estimated 14 to 23 million at present to 50 to 75 million by 2010.

The HIV/AIDS epidemic has built up momentum, and it will be difficult for any of these countries to slow it without dramatic shifts in priorities, says the report, released to the public September 30.

The rise of HIV/AIDS in these five "next-wave" countries is likely to have significant economic, social, political, and military implications, hitting Nigeria and Ethiopia the hardest, but also exacerbating the population decline and severe health problems already being experienced in Russia, the report says. HIV/AIDS is expected to push up social and healthcare costs in India and China, "but the broader economic and political impact is likely to be readily absorbed by the huge populations of these countries."

Following is the text of the report's summary. The text of the full report can be found at http://www.cia.gov/nic/pubs/index.htm

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The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China

Summary

The number of people with HIV/AIDS will grow significantly by the end of the decade. The increase will be driven by the spread of the disease in five populous countries -- Nigeria, Ethiopia, Russia, India, and China -- where the number of infected people will grow from around 14 to 23 million currently to an estimated 50 to 75 million by 2010. This estimate eclipses the projected 30 to 35 million cases by the end of the decade in central and southern Africa, the current focal point of the pandemic.

We project China will have 10 to 15 million HIV/AIDS cases, and India is likely to have 20 to 25 million by 2010-the highest estimate for any country. By 2010, we project Nigeria will have 10 to 15 million cases, Ethiopia 7 to 10 million, and Russia 5 to 8 million.

HIV/AIDS is spreading at different rates in the five countries, with the epidemic the most advanced in Nigeria and Ethiopia. In all countries, however, risky sexual behaviors are driving infection rates upward at a precipitous rate.

Adult prevalence rates-the total number of people infected as a percentage of the adult population-are substantially lower in Russia, India, and China, where the disease remains concentrated in high-risk groups, such as intravenous drug users in Russia and people selling blood plasma in China, where some villages have reported 60 percent infection rates.

Nevertheless, the disease is spreading to wider circles through heterosexual transmission in India, the movement of infected migrant workers in China, and frequent prison amnesty releases of large numbers of infected prison inmates and rising prostitution in Russia.

It will be difficult for any of the five countries to check their epidemics by 2010 without dramatic shifts in priorities. The disease has built up significant momentum, health services are inadequate, and the cost of education and treatment programs will be overwhelming. Government leaders will have trouble maintaining a priority on HIV/AIDS-which has been key to stemming the disease in Uganda, Thailand, and Brazil-because of other pressing issues and the lack of AIDS advocacy groups.

The governments of Nigeria, India, and China are beginning to focus more attention on the HIV/AIDS threat.

Even if the five next-wave countries devote more resources to HIV/AIDS programs, implementation is likely to miss significant portions of the population, given weak or limited government institutions and uneven coordination between local and national levels.

Nigeria and Ethiopia have very limited public services to mobilize. Russia is beset by other major public health problems. China has decentralized most responsibility for health and education issues to local governments that often are corrupt.

India has taken some steps to improve its healthcare infrastructure to combat HIV/AIDS, but the government has few resources to treat existing infections and must cope with other major health problems such as tuberculosis (TB), which has become linked to the spread of HIV/AIDS.

The rise of HIV/AIDS in the next-wave countries is likely to have significant economic, social, political, and military implications. The impact will vary substantially among the five countries, however, because of differences among them in the development of the disease, likely government responses, available resources, and demographic profiles.

Nigeria and Ethiopia will be the hardest hit, with the social and economic impact similar to that in the hardest hit countries in southern and central Africa-decimating key government and business elites, undermining growth, and discouraging foreign investment. Both countries are key to regional stability, and the rise in HIV/AIDS will strain their governments.

In Russia, the rise in HIV/AIDS will exacerbate the population decline and severe health problems already plaguing the country, creating even greater difficulty for Russia to rebound economically. These trends may spark tensions over spending priorities and sharpen military manpower shortages.

HIV/AIDS will drive up social and healthcare costs in India and China, but the broader economic and political impact is likely to be readily absorbed by the huge populations of these countries. We do not believe the disease will pose a fundamental threat through 2010 to their status as major regional players, but it will add to the complex problems faced by their leaders. The more HIV/AIDS spreads among young, educated, urban populations, the greater the economic cost of the disease will be for these countries, given the impact on, and the need for, skilled labor.

The growing AIDS problem in the next-wave countries probably will spark calls for more financial and technical support from donor countries. It may lead to growing tensions over how to disburse international funds, such as the Global Fund for AIDS, TB and Malaria.

The cost of antiretroviral drugs-which can prolong the lives of infected people-has plunged in recent years but still may be prohibitively high for populous, low-income countries. More importantly, the drug costs are only a portion of HIV/AIDS treatment costs. Drug-resistant strains are likely to spread because of the inconsistent use of antiretroviral therapies and the manufacture overseas of unregulated, substandard drugs.

If an effective vaccine is developed in the coming years, Western governments and pharmaceutical companies will come under intense pressure to make it widely available.

The next-wave countries are likely to seek greater US technical assistance in tracking and combating the disease.

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(Distributed by the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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