John Donnelly
Globe Staff

p. A1.

Report predicts AIDS epidemic for five nations

WASHINGTON — HIV and AIDS are on the verge of exploding in five of the most populous nations in the world and could produce an estimated 50 million to 75 million cases by the end of the decade in those countries alone, according to a National Intelligence Council report released last night. The projections of the next wave of AIDS are the most extensive forecasts that have ever been made and show that the center of the crisis will no longer solely be based in sub-Saharan Africa.

The acceleration of cases in India, China, Russia, Nigeria, and Ethiopia could contribute to well over 100 million HIV cases worldwide by 2010, said David F. Gordon, director of the CIA's Office of Transnational Issues. There are currently about 40 million people infected, according to most specialists.

"The AIDS pandemic continues to grow significantly as a health threat around the world, despite a substantial growing awareness of it," Gordon said yesterday in a press briefing at CIA headquarters. "All the data suggests that we are in the early stages of the disease."

The National Intelligence Council, which serves as a think tank for the Director of Central Intelligence, George Tenet, has consistently given some of the most accurate forecasts on AIDS dating back to 1988. But only in the last four or five years have senior US officials seriously examined its projections.

"The report is a clarion call not only to these countries, but to the world at large that the pandemic extends far beyond sub-Saharan Africa," said Jack C. Chow, special representative of the secretary of state for global HIV/AIDS, who received a copy of the study. "The report should encourage action from those countries to take ownership of the challenge and mobilize resources."

In recent days, Chow has spoken to representatives of all five countries that received a declassified version of the study. He said they welcomed the information.

The new report said it would be difficult to avert an AIDS/HIV catastrophe in any of the five countries because of weak health infrastructures, lack of government leadership, and inadequate funding for treatment or prevention programs. These countries account for 40 percent of the world's population.

Gordon cautioned that the estimates "are not destinies. … but at the same time, these are not worst-case scenarios, either." The findings have attracted wide notice in the Bush administration but have received added urgency because all five nations are considered strategically important to the United States, either as regional or global players. A classified version of the report was given to Bush administration officials two months ago.

India was projected to have 20 million to 25 million cases by the end of the decade, by far outpacing any other nation. Other estimates were China, 10 million to 15 million; Nigeria, 10 million to 15 million; Ethiopia, 7 million to 10 million; and Russia, 5 million to 8 million.

Currently, those countries are reporting only a fraction of those numbers because the epidemic is in its early stages. For instance, India is believed to have 4 million to 5 million cases, and China 1 million to 2 million.

"All five next-wave countries will have difficulty controlling their HIV epidemics in the short to medium term," the report said. "The disease has built up significant momentum — especially in Nigeria and Ethiopia — and the governments have been slow to respond."

The five countries have responded differently to the epidemics. China has asked US officials for technical assistance, but has also detained outspoken AIDS activist Dr. Wan Yanhai, who was released by Beijing last week after a month in secret detention. Nigeria also has been uneven in addressing the crisis: It recently hosted an AIDS conference and purchased generic AIDS drugs, but its national and regional leaders have been silent in explaining to residents how to prevent further transmission of the disease.

"The purpose of declassifying the report is to raise awareness and share information," Gordon said. "It is, by no means, meant as an indictment of the governments."

The estimate of 50 million to 75 million HIV-positive cases in the five countries does not include another 30 million to 35 million cases that are expected throughout the rest of sub-Saharan Africa by the end of the decade. The report also did not forecast numbers of people infected in other parts of Asia or in Eastern Europe, where the disease has been growing at a rapid rate.

The total number of people infected in Africa is not forecast to rise dramatically in coming years, largely because the millions of new cases will be offset by those who already have AIDS and are expected to die. A UNAIDS report, released in July, predicted that the pandemic could kill 70 million people around the world over the next 20 years.

The National Intelligence Council's new forecast is partly based on the trajectory of the epidemic in several sub-Saharan African countries, where prevalence began to take off after infection rates topped 5 percent of the adult population. Nigeria and Ethiopia are both widely believed to have eclipsed that percentage.

In terms of percentages, HIV is in its infancy in China, India, and Russia. The number infected in China represents 0.14 percent to 0.27 percent of the adult population, while India has 0.9 percent to 1.4 percent and Russia has 1.3 percent to 2.5 percent. But a 1 percent jump in China and India, which combined have more than one-third of the world's population, would result in more than 20 million new cases.

The reasons for the surges of infections differ widely. The epidemic in Russia, for instance, is fueled by intravenous drug use, prison amnesty programs, and prostitution. China has witnessed the disease spread because of poor hygiene in plasma sales, a large migrant population, and intravenous drug use.

Of the five nations cited in the study, the greatest impact in coming years could be in Nigeria and Ethiopia — two countries considered strategically important by the administration. In particular, Nigeria is looked to provide stability in the region as well as a growing source of oil for US markets.

Regarding Nigeria and Ethiopia, the report concluded that the impact of the disease could mean the countries will become "seriously weakened states and is likely to reduce their ability to continue to play a regional leadership role."

The disease's impact on Russia is "likely to exacerbate the significant social, economic, health, and military problems already facing the country," the report stated, adding that HIV and AIDS also will accelerate Russia's population decline.

The effect on China and India is expected to be less acute because those infected will still be a small percentage of the population. But at a minimum, according to the report, AIDS will drive up health-care costs and reduce labor supply. Beyond 2010, the pandemic will "become an even more significant problem for China and India if government programs prove ineffective and prevalence rates jump significantly," the report said.

John Donnelly can be reached by e-mail at donnelly@globe.com.

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