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Africa: Next Wave of HIV/AIDS
Africa: Next Wave of HIV/AIDS
Date distributed (ymd): 021008
Document reposted by Africa Action
Africa Policy Electronic Distribution List: an information
service provided by AFRICA ACTION (incorporating the Africa
Policy Information Center, The Africa Fund, and the American
Committee on Africa). Find more information for action for
Africa at http://www.africaaction.org
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +security/peace+ +economy/development+ +health+
SUMMARY CONTENTS:
This posting contains excerpts from a new report by the U.S.
National Intelligence Council, identifying five countries including
40% of the world's population as the focus of the next wave of the
HIV/AIDS pandemic. These countries include two African countries,
Nigeria and Ethiopia, as well as Russia, India, and China. The full
study is available at the NIC's web site at:
http://www.odci.gov/nic
Note that the projections in the study are even higher than most
others currently presented, and are acknowledged to have wide
ranges of uncertainty. Note also that the study repeats the
conventional assumption that over 90% of HIV in Africa results from
heterosexual transmission. In contrast, a recent article in the
Royal Society of Medicines' International Journal of STDs (Sexually
Transmitted Diseases) and AIDS, excerpted in another posting today,
contends that the proportion of transmission of the virus through
unsafe medical care (injections,transfusions, and other procedures)
is being grossly underestimated, and may even exceed the proportion
transmitted by sexual intercourse.
The new NIC report was featured at a two-day meeting at the Center
for Strategic and International Studies, including a luncheon
keynote address by Stephen Lewis, special envoy of the U
Secretary-General on HIV/AIDS. See
http://www.csis.org/press/ma_2002_1003.htm
Lewis' speech is available at:
http://sustainable.allafrica.com/stories/200210040603.html
+++++++++++++++++end profile++++++++++++++++++++++++++++++
The Next Wave of HIV/AIDS:
Nigeria, Ethiopia, Russia, India, and China
ICA 2002-04D September 2002
National Intelligence Council
Prepared under the auspices of David F. Gordon, formerly National
Intelligence Officer for Economics and Global Issues.
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. 5
- 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.
...
We project that China probably will have 10 to 15 million
HIV/AIDS cases by 2010. India is likely to have 20 to 25 million
higher than projected for any other country. We estimate Nigeria
probably will have 10 to15 million cases, Russia 5 to 8 million,
and Ethiopia 7 to 10 million.
Country Profiles
Nigeria.
The HIV/AIDS epidemic in Nigeria is significantly ahead of that in
India, China, and Russia - already advancing well beyond highrisk
groups and into the general population. The official adult
prevalence rate is almost 6 percent, but unofficial estimates range
as high as 10 percent which represents 4 to 6 million people
infected.
Heterosexual transmission of the HIV virus is the primary mode of
spread in Nigeria, and infections appear to be as numerous in rural
areas as in the cities. The reported rate of infection apparently
varies significantly by region, with the lowest reported rate found
generally in the predominantly Muslim northern parts of the country
(see 9 figure 3). Infections are most numerous among men ages 20
through 24, but some experts caution that infection rates are
rising quickly in young women.
Given the already advanced state of the disease and the government
s limited capacity to respond, we expect HIV/AIDS to infect as many
as 10 to 15 million people by 2010. This number would constitute
roughly 18 to 26 percent of adults close to the current rates in
some of the hardest hit countries in southern Africa.
Ethiopia.
Ethiopia's adult prevalence rate estimated at between 10 and 18
percent is the highest among the five countries, indicating that
like Nigeria the disease has moved significantly into the general
population. Government figures cite 2.7 million Ethiopians
currently as HIV positive, although experts believe the actual
number may be between 3 and 5 million. Adult prevalence is much
higher in cities (13 to 20 percent) than in rural areas (5 percent)
(see figure 4). The generally poor health of Ethiopians as a result
of drought, 10 malnutrition, limited healthcare, and other
infectious diseases has caused HIV to progress rapidly to AIDS.
Heterosexual transmission is the primary mode of spread, and people
with multiple partners especially those with sexually transmitted
diseases (STDs) and prostitutes have significantly higher
infection rates, ranging from 30 to 40 percent in STD- positive
individuals to 50 to 70 percent in prostitutes.
Unlike conditions in other next- wave countries, war has
significantly contributed to the spread of the disease in Ethiopia.
Many soldiers contracted HIV/AIDS during the civil war in the 1980s
by having contact with multiple sex partners. When the war ended in
1991, thousands of infected soldiers and prostitutes returned home,
spreading HIV/AIDS in their villages and towns
- Another surge of infections may be underway. Ethiopia has
demobilized 150,000 soldiers over the last two years as the
conflict with Eritrea has wound down. More troops will be sent home
as the border dispute is settled
- As soldiers demobilize, prostitutes who have even higher rates
of infection disperse around the country as well.
Looking ahead, we expect 7 to 10 million Ethiopians probably will
be infected by 2010 because of the high current rate of adult
prevalence, widespread poverty, low educational levels, and the
government's limited capacity to respond more actively.
...
HIV: The Science of the Disease
HIV-1 is a fatal infection acquired by contact with the blood or
body fluids of an infected person. A transfusion with infected
blood almost always results in spread of the virus, and children
born to infected mothers have an up to 40 percent chance of
contracting the virus prior to birth, during birth, or through
breastfeeding. The transmission rate of the disease through sexual
contact ranges from 1 to 3 percent. Reusing infected needles
results in infections less than one percent of the time.
Sexually transmitted diseases or reproductive tract infections
greatly increase the risk of contracting HIV, and uncircumcised men
transmit HIV and other STDs to their partners more frequently than
circumcised men.
As the disease progresses, a type of infection-fighting white
blood cell the CD4 positive-t cell decreases, leading to an
irreversible loss of immune function. This period is marked by many
illnesses, or unusual opportunistic infections that healthy
immune systems protect against.
HIV-positive persons are susceptible to opportunistic and
infectious diseases, especially TB. Once they have contracted TB,
the disease progresses to the highly infectious, active stage much
more quickly and frequently than in HIV-negative persons and is
often what kills them. ...
Prospects for Control
We assess that all five next-wave countries will have difficulty
controlling their HIV epidemics in the short to medium-term. The
disease has built up significant momentum especially in Nigeria
and Ethiopia and the governments have been slow to respond. None
of the five next-wave countries in this report is on a trajectory
to replicate the success of such countries as Uganda, Thailand, and
Brazil in stemming the spread of the disease. Several leaders of
the nextwave countries are focusing more attention on the AIDS
threat, but all face a host of competing demands. In addition,
these countries have weak healthcare infrastructures and severe
budget constraints, which will create difficulty in financing
education and treatment programs for their large populations.
...
Nigeria's leadership has been the most active of the five countries
in trying to raise AIDS awareness, for example, by hosting a
regional AIDS conference in 2000 and publicly warning about the
risk of extinction on the continent. Nonetheless, the Obasanjo
administration is beset by such other pressing problems as an
approaching election and rising ethnic and religious tensions.
Moreover, Nigeria s government institutions have deteriorated so
badly over the last decade that Obasanjo has few functioning public
sector assets left to mobilize even if he chose to engage fully on
the issue
- Nigeria has taken some steps, however, to build domestic
monitoring and diagnostic capabilities especially in Lagos and a
major study on the economic effects of HIV/AIDS is underway. *
The Nigerian military, concerned about the loss of key personnel
from AIDS, now mandates training about the disease for soldiers
- The Ethiopian Government does not appear focused on AIDS, despite
occasional statements on the issue. The government has focused in
recent years on the conflict with Eritrea. Healthcare workers
privately have criticized efforts in recent years as half hearted,
and UN officials have publicly warned Ethiopian leaders to take
more measures to stem the epidemic.
...
Weak Healthcare Infrastructure
Although significant differences in capabilities exist among nextwave
countries, all five have overburdened and under funded
healthcare systems and limited abilities to provide integrated,
nationwide programs to test people, track infections, and deliver
treatment and education programs. Even within each of the five
next- wave countries there are disparities in the ability of cities
and regions to deal with the epidemic that are likely to grow in
the coming years
- Nigeria's public healthcare system, which has been deteriorating
for years, is hard pressed to provide even the most basic public
services. Many facilities lack electricity, water, and soap; even
betterequipped hospitals are beset by strikes by medical staff
- Ethiopia has never had a viable national healthcare system
because of overwhelming poverty and years of war. The government is
soliciting international assistance to build its capabilities, but
progress on this front is likely to take years.
Implications
The rise of HIV/AIDS will have significant economic, social,
political, and military implications in Nigeria, Ethiopia, Russia,
India, and China, although the percentage of the adult population
in each country that is infected is likely to remain below the
hardest hit countries in southern and central Africa. The impact
of the disease by the end of the decade will vary among the five
countries, given differences in disease trajectories government
responses, available resources, and demographic profiles.
Nigeria and Ethiopia: Hardest Hit
The social and economic impact of AIDS in Nigeria and Ethiopia
probably will be similar to the hardest hit countries in Africa.
The disease is likely to negatively impact almost all sectors of
society by 2010. AIDS will take a heavy economic toll by robbing
the countries of many key government and business elites and by
discouraging foreign investment, although the oil sector is
unlikely to be hurt significantly. 22
- The professional classes in Nigeria and Ethiopia like other
African countries are more vulnerable in comparison to other nextwave
countries because adult prevalence rates already are much
higher and relatively fewer elites are concentrated in a smaller
number of key positions
- The drag of AIDS on economic growth will further reduce the
ability of the government to handle the rising social and
healthcare costs.
The further deterioration of already weak government institutions
by the escalating HIV/AIDS crisis could leave Nigeria and Ethiopia
seriously weakened states and is likely to reduce their ability to
continue to play a regional leadership role
- HIV/AIDS probably will complicate staffing in the military
officer corps of the two countries as it has in other African
states. Ethiopia is more likely to suffer military manpower
shortages through the lower ranks, however, because it has a much
larger army and smaller population than Nigeria, which plans to
reduce the size of its force
- Rising social tensions over AIDS and related economic problems
could exacerbate regional and ethnic tensions within Nigeria and
Ethiopia while leaving both governments less able to manage the
problem.
This material is being reposted for wider distribution by
Africa Action (incorporating the Africa Policy Information
Center, The Africa Fund, and the American Committee on Africa).
Africa Action's information services provide accessible
information and analysis in order to promote U.S. and
international policies toward Africa that advance economic,
political and social justice and the full spectrum of human rights.
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