New AIDS study -- India among worst scenarios
� A Giridhar RAO wrote:
Date: Tue, 1 Oct 2002 11:46:55 +0530
Intelligence Study Raises Estimate of AIDS Spread
Worst Scenarios for India, China, Russia, Nigeria and Ethiopia Project Over
50 Million Cases by 2010
a Washington Post Staff Writer
Tuesday, October 1, 2002; Page A07
A government intelligence panel estimates that by the end of this decade the
growth of AIDS infections in five populous countries, including India and
China, may dwarf the current epidemic in sub-Saharan Africa and outstrip
current worst-case scenarios for the global burden of the disease.
The National Intelligence Council predicts that by 2010 there will be
between 50 million and 75 million cases of human immunodeficiency virus
(HIV) infection in India, China, Ethiopia, Nigeria and Russia. That is
double or triple the estimate of 25 million cases an international team of
experts projected for those countries as part of a study published last
There are now 42 million people living with HIV infection, according to
UNAIDS, the joint program run by the United Nations and World Bank. The
agency estimates there will be about 60 million cases worldwide by 2010.
Extrapolations from the intelligence report suggest that projection is much
too low, with the global HIV burden more likely to fall between 80 million
and 110 million cases by then.
The five nations together contain about 40 percent of the world's
population. In each, the AIDS epidemic has barely started or not yet peaked.
The experience in these nations -- and the response of the five
governments -- hold the key to the next phase of the pandemic, most experts
The unusually bleak estimates were reached by experts inside and outside the
government who agreed that current projections are too low. No new data were
gathered. Epidemiologists at UNAIDS and the World Health Organization
questioned the validity of the council's projections, while acknowledging
that most demographers in the past underestimated the scope of the epidemic.
"They are applying a worst-case scenario systematically through all of these
countries," said Neff Walker, an epidemiologist at UNAIDS, which is
headquartered in Geneva. " I wouldn't rule out these projections. They could
be right, but they're not probable."
Nevertheless, the focus of the report "is right on target" said Richard G.
A. Feachem, director of the Global Fund to Fight AIDS, Tuberculosis and
Malaria, which will have a major role in deciding where donor countries'
money will be spent to treat and prevent AIDS over the next decade.
"Paying attention to these large next-wave epidemics is extremely important,
and has been a neglected subject in the international debate," Feachem said.
"India is certainly going to experience a massive epidemic, and so will
China. India is on an African trajectory, only 15 years behind. In both
countries, the national responses are grossly inadequate to begin to
confront the wave of devastation and death that is breaking over them."
The National Intelligence Council is a panel of experts that performs
strategic analysis for the president, the CIA, the Defense and State
departments, the National Security Council and other government agencies.
The new document, titled "The Next Wave of HIV/AIDS: Nigeria, Ethiopia,
Russia, India and China," follows up a report the council released two years
ago assessing publicly for first time the issue of the global AIDS pandemic
as a threat to U.S. security.
The 28-page report doesn't discuss how the projections might affect U.S.
foreign policy. But it briefly notes possible effects on the five countries
Because the disease is relatively new to India and China, and because there
is a lag of many years between infection and death in most individuals,
those two nations "can manage the impact of the disease through the end of
the decade," the authors of the report wrote. The epidemic "by itself will
not pose a fundamental threat through 2010 to the rise of China and India as
major regional players."
The assessment is bleaker for Russia, which had 700,000 cases at the end of
last year, the vast majority in drug users, according to UNAIDS estimates.
By 2010, the council projected there will be 5 million to 8 million cases --
a situation that will worsen Russia's shrinking population and work force,
and could cut annual economic growth by one-half a percentage point.
"Russia faces so many other serious problems that HIV/AIDS is unlikely to
receive high-level attention for an extended period until the economic and
security costs of neglect become more tangible," the authors wrote.
Nigeria and Ethiopia "will be the hardest hit . . . decimating key
government and business elites, undermining growth and discouraging foreign
investment," the report said. The council estimated there will be 10 million
to 15 million cases of HIV in Nigeria, with 18 percent to 26 percent of
adults infected. The Ethiopian projections are for 7 million to 10 million
cases, and a prevalence of 19 to 27 percent.
Epidemiologists from UNAIDS, WHO, the U.S. Census Bureau and two other
groups in July published in the medical journal Lancet estimates for the
epidemic's growth through 2010. Individual country projections were not
However, one of the authors, John Stover of the consulting firm Futures
Group International, said yesterday that the 2010 estimate for India, China,
Nigeria, Ethiopia and Russia was 25 million cases.
The National Intelligence Council's estimate of 10 million to 15 million
cases in China -- up from about 1 million now -- is not very different from
that of the group that wrote the Lancet article, Stover said. But the other
The head of the AIDS program for WHO, Bernhard Schwartlander, said he doubts
the India projections in the new report, which are for 20 million to 25
million cases, up from about 4 million now. That would mean that 4 percent
to 5 percent of adults would have the virus.
"India has almost twice the population of what there is in sub-Saharan
Africa. I can see such a scenario happening in certain cities and perhaps
even in states. But it would be difficult to see it happening on a
nationwide basis, at least with the data we have," said Schwartlander, an
epidemiologist who has been responsible for much of the WHO and UNAIDS
Similarly, he doubts the projection that 8 percent to 10 percent of Russian
adults will have HIV infection eight years from now. That would require
"massive spread in the heterosexual population" from the now heavily
infected drug users.
David F. Gordon, formerly the head of economics and global issues on the
National Intelligence Council and now with the CIA, said 10 to 20 experts on
each country were consulted and came up with the estimates, using data
gathered by other agencies as a starting point.
"We do not have a model that we are comfortable with to generate these kinds
of numbers," he said. "The main methodology was to seek the consensus of
experts. These should not be seen as destiny."
� 2002 The Washington Post Company
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