*EPF211 10/08/2002
U.S. Officials Plot Strategy to Confront Second Wave of HIV/AIDS
(New study predicts drastic expansion of epidemic by 2010) (1300)

By Charlene Porter
Washington File Staff Writer

Washington -- U.S. officials from several key agencies have identified new activity they are pursuing to address predictions that the global HIV/AIDS epidemic will escalate dramatically through the remainder of this decade.

A report released in late September by the National Intelligence Council (NIC) forecasts that HIV/AIDS cases are about to climb steeply in five populous nations -- China, India, Ethiopia, Nigeria and Russia. "The Next Wave of HIV/AIDS" focuses on these five countries because of their strategic importance to the United States, and because of their large populations. Together, they comprise 40 percent of the entire world population.

The NIC, an advisory panel to the Central Intelligence Agency, also selected these countries because the epidemic is at an early-to-mid stage in each of them, and because their governments "have not yet given the issue the sustained high priority that has been key to stemming the tide of the disease in other countries."

The report predicts that the number of HIV/AIDS cases in the five countries could increase from the current high-end estimate of 23 million to as many as 75 million by the end of the decade. While sub-Saharan Africa is the world region with the greatest number of cases today, cases in the five "next wave" countries will be more than double the number in Africa by 2010, according to the report����s estimates based on a consensus attained through consultations with a variety of experts in the field.

Though the report and the data it presents are new, the findings are no surprise to those who have been on the front lines of the battle against the epidemic. A group of those U.S. officials assembled at a forum conducted in Washington October 4 by The Center for Strategic and International Studies (CSIS). Public health and government officials from each of the five "next wave" countries also attended the two-day session.

At the U.S. Agency for International Development (USAID), the goal is to insure that the predictions of a burgeoning HIV/AIDS population don't come true. "Our role is to prioritize that budget that Congress has given us to make sure that it isn't so, if we possibly can make a difference," said Dr. Anne Peterson, the assistant administrator in the Bureau of Global Health at USAID.

U.S. officials also emphasize that Washington is the world's largest donor to HIV/AIDS prevention efforts globally. It has made the largest contributions to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, and is also the world����s largest donor of bilateral aid to disease programs in other nations. The Bush administration is seeking an international HIV/AIDS budget in 2003 of more than $1,000 million, a more than 50 percent increase over the allocation in 2001.

Peterson said the USAID commitment to addressing the global epidemic is also borne out by the numbers. The agency's health budget has increased by 500 percent in the last four years. The leading U.S. development agency already has well-established HIV/AIDS programs in four of the five "next wave" countries, and in each of them funding for those programs has almost doubled in the last three years.

"The programs are already being geared up so we have a better chance of intervening," Peterson said. USAID has designated 23 countries as high priority for support in containing and treating the epidemic, and is operating a variety of programs emphasizing prevention, care, support and treatment of AIDS patients.

The Centers for Disease Control and Prevention (CDC) is another significant player in the U.S. government's global campaign against the HIV/AIDS epidemic. Like USAID, CDC has had programs underway in four of the five "next wave" countries, and is currently launching new efforts in the fifth, China. Harold Jaffe, director of CDC's National Center for HIV, STD and TB Prevention, told the CSIS forum that his agency has begun to work with Chinese public health officials on disease surveillance. Further, Jaffe said CDC will have staff on the ground in China by the end of the year to expand assistance.

In collaborative relationships with international public heath agencies, national health programs, non-governmental organizations and other groups, Jaffe said CDC is assisting other nations in a variety of initiatives: disease surveillance, voluntary counseling and testing, developing laboratory systems, prevention of mother-to-child transmission, and assisting people living with HIV/AIDS, including the care and treatment of opportunistic infections.

"Each country faces major challenges in confronting the epidemic. What's true across the board is that unchecked, AIDS threatens to overwhelm countries���� health care systems, disrupt work forces, destabilize production and economies," Jaffe said. "Intervention now is critical."

Programs like these will not be enough to stem the tide of disease, the officials agreed, unless national political leaders in affected countries are prepared to recognize the scope of the problem and work aggressively to counter the trends. The NIC report underscores the importance of this leadership in countries such as Uganda and Thailand, where significant success has been made in containing the spread of the epidemic.

Under Secretary of State for Global Affairs Paula Dobriansky, also on the CSIS panel, said that the diplomatic effort to counter the scourge works to elevate the importance of preventive action and to press national leaders to confront the difficult decisions about the allocation of resources to contain and treat the disease. As an example, she noted that Russia has made a significant and commendable contribution to the Global Fund, but the contribution exceeds the amount that Moscow has devoted to countering the disease within its own borders.

"There are some tough decisions which countries have to take a look at," Dobriansky said.

Similarly, the global community will face hard choices on how to allocate finite resources. "A huge challenge for all of us will be balancing the need to prevent a major spread of the disease in the five countries that we're focused on without hurting our efforts to deal with the disease in countries where it already has exploded," Dobriansky said.

The creation of the Global Fund is widely viewed as a major step forward in raising more international financing to combat the epidemic. It was officially organized early in 2002 and has completed one round of grant distribution. Money is awarded to grant applicants based on the submission of specific program proposals that are considered on their merits by the fund's board.

William Steiger, a senior advisor to Secretary of Health and Human Services Tommy G. Thompson, has participated in the organization of the fund and the grant awards. He cautioned attendees at the CSIS forum that "the fund is not going to be the answer" to all the problems.

The "next wave" countries "have the potential to exhaust the fund's resources very quickly," Steiger said. "They also have their own resources and need to muster the political will on their own and devote more of their health budgets domestically to taking on the problem."

USAID's Peterson said she encountered the difficulty of mustering this political will at the World Summit on Sustainable Development in Johannesburg, South Africa in September. She said it was a "hard sell" to convince many participants about the linkage between investments in public health and economic development. She encountered this difficulty even as the talks were held in a nation where the workforce has been so severely weakened by AIDS that economic reversals are occurring in some sectors.

Peterson implored the representatives of the "next wave" nations at the CSIS forum, "We need you working with us to get that message out."

A spokesman for CSIS said the October 3-4 forum marked the first occasion when health care officials from all five of the "next wave" countries had been able to meet in a setting for discussion of their mutual problems. CSIS will attempt to continue contacts with these officials to better direct U.S. and nongovernmental assistance in efforts to contain the epidemic.

(The Washington File is a product of the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

Return to Public File Main Page

Return to Public Table of Contents