Newsday - October 15, 2002
Laurie Garrett, Staff Writer

In new reports -- including one from the CIA's National Intelligence Council -- analysts paint a disturbing picture of the world that AIDS, if left unchecked, will create in less than a decade. And in a special national security meeting convened early this month in Washington by the independent Center for Strategic and International Studies, intelligence and health experts from six countries reached grim conclusions.

"This is a problem that is far vaster than we previously acknowledged," CSIS president John Hamre said. "And if anybody here thinks it's just a health care problem, we're in big trouble."

The concern that a second wave of HIV will devastate five nations -- Russia, China, India, Nigeria and Ethiopia -- was the focus of the National Intelligence Council report. In all five, said David Gordon, former National Intelligence officer for economics and global issues who prepared the report, HIV "has already built up significant momentum."

Analysts are predicting famines, civil wars, economic reversals and the collapse of social and political institutions in those five countries by 2010. Until now, concerns have centered on the nations of Africa, where 29 million people are living with HIV and adult-infection rates exceed 35 percent in some regions.

Yesterday, United Nations Secretary-General Kofi Annan, visiting China, warned that the nation has "no time to lose" in preventing a massive outbreak of AIDS and must take decisive action. "China stands on the brink of an explosive AIDS epidemic," Annan told students at Zhejiang University.

By 2010, the five nations in the report will have between 50 million and 75 million HIV cases, dwarfing Africa's numbers, Gordon said, and posing threat of a "Eurasian sweep, a significant expansion across that region."

U.S. Census Bureau demographer Karen Stanecki, who has forecast HIV growth since the 1980s, concurred with Gordon's estimates and predicted that HIV will have pushed life expectancies backward in each of the countries by 2010. In Nigeria, life expectancy is forecast to fall to age 47, compared with 61 before the arrival of AIDS; and in Ethiopia, to 40, from 53 pre-AIDS.

Stanecki expects a growing orphan population. Ethiopia and Nigeria are home to 64.5 million and 117 million people, respectively, or about half of Africa's total. Stanecki predicts that by 2010, 11 percent of Nigerian children will be orphans, 40 percent of them due to AIDS. In Ethiopia, she forecasts 14 percent, 43 percent due to AIDS.

The forecast for China is 5 percent orphans, 4.5 percent of them due to AIDS; and in India, 7 percent orphans, 1 percent of them due to AIDS.

At the recent meeting, representatives of the five nations generally appeared unwilling to accept the severe forecasts, but also decried their lack of financial resources to deal with such problems, demanding foreign assistance, particularly from the United States.

With the exception of Russia, all insisted the Gordon and Stanecki numbers were inflated.

For example, Dr. Hao Yang, director of the division of HIV in China's Ministry of Health, said only about 910,000 Chinese are infected -- 600,000 fewer than U.S. estimates. Publicly, he indicated that control of the disease won't be difficult, because, officially, the size of the country's high-risk populations, including homosexuals and illicit drug users, is very small. Privately, however, Hao conceded to Newsday that the official numbers are off base, and the numbers of those at risk is unknown. He acknowledged that some estimates put the prostitute population as high as 13 percent of all Chinese women.

"China just doesn't get it," said Kurt Tong, a special attache in the U.S. Embassy in Beijing. And analyst Nick Eberstadt of the American Enterprise Institute in Washington said computer models show the risks for spread of HIV will only worsen because of China's widening gender gap. Already there are 1.7 males for every one female under 15 years of age, a result of the nation's one-child policy in which parents tend to abort females.

The abundance of males is expected to create market demand for female prostitutes, and Hao acknowledged that prostitution is on an upswing.

The head of India's national AIDS program, Meenakshi Datta Ghosh, denounced the intelligence report as "alarmist," but admitted that at least four densely populated states already have infection rates above 1 percent of all pregnant women. India has set ambitious goals for its AIDS programs, but lacks a coherent infrastructure for executing prevention and treatment efforts. If India's programs can be solidified, Ghosh said, by 2006 the country will have 9 million people living with HIV. If those programs remain fragmented, she said, the number could reach 14 million, with 1.9 million annual deaths.

Gordon forecasts 20 million to 25 million HIV-positive Indians by 2010, or 4 percent of the nation's adults.

Russia's representatives did not dispute Gordon's forecasts of 5 million to 8 million in the country infected by 2010, or up to 11 percent of adults. "Russia today has the fastest-growing infection rate in the world, doubling annually," said Bertil Lindblad, deputy director of the UN AIDS Programme.

Russia's epidemic appears to be fueled by an explosion in injectable narcotics use among young people, which Lindblad said has tripled over the past three years.

Ethiopia and Nigeria are pivotal to the future of Africa, analysts say, because of their large populations and strategic influence. Nigeria, the world's sixth-largest oil producer with a sizable well-educated elite, is second only to South Africa in military, cultural, economic and intellectual influence over the continent.

Dr. Babatunde Osotimehin, who runs Nigeria's AIDS control programs, said that about 6 percent of the population is infected, and in some areas the rate among 15- to 30-year-olds is more than 15 percent.

But the Nigerian delegation insisted the real problem was the nation's debt. One delegation member labeled the $3-billion annual debt payment "a form of slavery," noting that the country spends only $100 million annually on health. A White House security representative, who spoke on condition she not be named, indicated the White House would entertain a proposal to forgive debts if African nations could, together, present a plan for spending the money on AIDS, malaria and other health crises.

Representatives of Ethiopia appeared frank about its inability to deal with its burgeoning epidemic without massive foreign aid. About one out of every nine African HIV cases is in Ethiopia, even though the country's epidemic is relatively new.

The impoverished country's efforts to thwart AIDS are headed by Minister of Youth Teshombe Toga, who said, "The security of our country will be threatened" by HIV. But decades of war and poverty have left the country so bereft of trained expertise that Toga cannot manage to spend the modest AIDS funds already in hand.

This lack of expertise is a problem in all five nations, experts said. Even India, which has a large, highly educated medical and scientific elite, lacks the skilled personnel to execute HIV control programs.

"You could put $1 billion worth of drugs on a boat, ship them to India, put them on a dock and they won't get anywhere," Rep. Jim McDermott (D-Wash.) said. McDermott has made 16 trips to India in recent years to inspect the country's AIDS efforts.

Last week the Global Fund to Fight AIDS, TB and Malaria convened in Geneva to review applications for aid. The fund is meant to distribute billions of dollars annually to poor countries for both prevention and treatment efforts. Annan said $7 billion to $10 billion would be needed annually.

Requests approved already outstrip the amount donors have committed. So far, $2.1 billion has been pledged over the next five years but only $650 million has been received, even as grants totaling $4.25 billion have been approved. The Global AIDS Alliance, which represents dozens of nongovernmental groups, estimates that by 2007 the gap between approved grants and donations will exceed $27 billion.

Last week the Global Fund board concluded that if donations don't double immediately, the fund will have to discontinue screening grants.

"The current situation requires a substantial front-loaded capital investment to scale up existing efforts," Richard Feachem, executive director of the Global Fund, said in a statement released to the media. "The programs are ready. Any delay now will be measured by millions of lives lost" as well as additional costs necessary to respond later to the expanded epidemic.

While most poor AIDS-afflicted countries are clamoring for anti-HIV drugs, and hope to build medical infrastructures to distribute treatments, some analysts argue that the medicines could actually heighten political instability. Alex de Waal, director of Justice Africa and a key adviser to African nations, has expressed concern that in many countries the elites, and armies, have access to anti-HIV drugs, while the populace at large does not.

"Rationing is already occurring," de Waal says, and "the potential for strife is obvious."

Overall, de Waal has only bad-to-cataclysmic political forecasts for Africa. He likens the impact of AIDS on the social fabric of Africa to the devastation HIV inflicts on the human body, saying, "An 'AIDS-related national crisis' will consist of a range of pre-existing social and political pathologies, rendered more common and more severe by the underlying vulnerability caused by human resource losses due to AIDS. ... Just as HIV destroys the body's immune system, the HIV/AIDS pandemic renders a society vulnerable to a range of familiar pathologies, rendered more deadly by the underlying 'infection.'"
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