World's AIDS crisis worsening, report says

Disease spreading fast in sub-Saharan Africa

By John Donnelly, Globe Staff, 6/16/2002

WASHINGTON - The AIDS pandemic will rapidly worsen, with the number of cases possibly doubling in sub-Saharan Africa in five years, according to an analysis by US intelligence officials.

The conclusion by analysts at the National Intelligence Council, an arm of the Central Intelligence Agency that studies issues of long-term strategic interest to the US government, is largely based on worrisome figures in Nigeria and Ethiopia, which together account for nearly a third of the people in sub-Saharan Africa.

Both countries, with a combined population of nearly 200 million, have surpassed 5 percent infection rates among adults, a tipping point in several other African countries after which the rate of prevalence soared into double digits.

The analysts are particularly concerned about possible sharp increases in HIV and AIDS in India, the second most populous nation in the world. India has a large percentage of uneducated people and political leadership that hasn't adequately begun to destigmatize the disease, the analysts said.

That same mix of factors was deadly in the first wave of the crisis in Africa. India already has an estimated 3 million people infected with HIV or AIDS.

The AIDS pandemic is entering a ''stage of substantial increases in size and scope,'' said a senior US intelligence official last week in an interview at CIA headquarters in Langley, Va., speaking on condition of anonymity.

Another senior intelligence official described the crisis as entering ''a larger breakout phase.''

About 40 million people are infected with HIV or AIDS, which already is the deadliest disease in human history. About 23 million people have died from the disease - far more than even Europe's Black Death in the 14th century, according to medieval scholars.

In Africa, roughly 23 million people were infected with the disease in 1997, according to UNAIDS, the joint United Nations program for HIV/AIDS. The figure is 30 million now, a 30 percent increase over the previous five-year period. A doubling of cases in Africa in the next five years would push the number of people infected there to 60 million by 2007, analysts from the National Intelligence Council said.

Those dying are mostly people in the prime of their lives, a fact that has disastrous impact on economic growth, education and health systems, and the security infrastructure of the world's most vulnerable continent.

The new projections almost surely will be given considerable weight among leading global health officials because the National Intelligence Council has a strong track record in forecasting trends about HIV and AIDS.

The council was the lone voice in the US government a decade ago that called attention to the disease. In 1991, it predicted 45 million infections by the year 2000.

Senior policymakers at the World Health Organization, World Bank, and UNAIDS said last week that while they had not heard about US intelligence's new projections, they believed the forecast could be on target.

The Bush administration will focus on global development and combating the African crisis at the G-8 summit in Alberta, Canada, on June 26. The biannual international AIDS conference follows early next month in Barcelona.

The information about a spike in HIV prevalence in Africa was first revealed April 16 in a wood-paneled room at The National Academies in downtown Washington.

In the first day of a two-day Institute of Medicine seminar on the impact and globalization of the disease, David F. Gordon, a National Intelligence Council officer on economics and health issues, delivered the news in a 20-minute talk.

Addressing the nation's leading health experts, he said ''Nigeria and Ethiopia may be at the takeoff point, where the epidemic becomes much, much, much more serious in the next five years,'' according to a tape recording of the meeting.

''If, indeed, that is the case, if we are in a situation in Nigeria and Ethiopia parallel to that in 1992, '93, '94 [to that in southern Africa], and we do have a big run-up in prevalence rate, it's not inconceivable that the number of HIV infections could double in the next five years'' in Africa, he said.

Though Nigeria claims an official 6 percent HIV infection rate, Gordon said, ''A lot of people believe the numbers are closer to 10 percent already and might be on a much higher trajectory.''

Ethiopia's infection rate, he said, also was roughly 10 percent, or higher. Ethiopia acknowledges those figures.

Jim Yong Kim, a Harvard infectious disease specialist, attended the meeting.

''His talk blew me away,'' said Kim, a founder of Partners in Health, a Cambridge-based group running several international projects serving the health needs of the poor.

''The NIC is the best at looking at HIV prevalence rates and projecting into the future,'' he said, ''and if these guys are right about Nigeria and Ethiopia, it's more shocking news about the pandemic. I think it puts much more urgency to moving quickly on the Global Fund.''

The Global Fund to Fight AIDS, Tuberculosis and Malaria, initiated 14 months ago by Kofi Annan, UN secretary general, has received pledges of $1.9 billion, including $500 million from the United States. (The United States also is the world's largest bilateral AIDS donor, earmarking $790 million this year, or 44 percent of direct giving to developing countries.)

In April, the fund's board approved $378 million over two years for projects, and plans to finance another $238 million if certain conditions are met.

A WHO estimate has found that about $2.8 billion will be spent this year to fight AIDS. Annan estimated that $7 billion to $10 billion needs to be spent annually.

In the April talk, Gordon also addressed a second wave of the AIDS pandemic, particularly in India, China, and Russia. China has an estimated 1 million cases, which UNAIDS said could grow to 20 million by 2020.

Russia also has more than 1 million people with HIV or AIDS, and its Health Ministry estimates that 5 million to 10 million boys and men between the ages of 15 and 20 will have contracted HIV or AIDS in five years.

China, Gordon said, has taken the important step of accepting that it has a problem. ''The focus on AIDS, far from suggesting bad news, suggests positive news,'' he said. But he added, ''China has a long ways to go in acknowledging the scope of the problem and getting on top of it.''

He said there was ''relative cause of optimism'' for Russia, despite its fast-growing rates of infection. He cited Russia's ''high rates of literacy, extensive media links, active education program,'' and older population as factors that could blunt the impact of HIV or AIDS.

In Nigeria, however, few analysts believe the very low reported rates of HIV and AIDS, which range from 1 percent to 16 percent. The US intelligence official scoffed at the reported 2 percent infection rate for Lagos, Nigeria's largest city.

Peter Piot, the Belgian-born director of UNAIDS, said last week that the National Intelligence Council estimates were close to his thinking about the progression of the disease, especially in Africa.

''When I look at the epidemic, I see that even southern Africa has not reached a natural limit,'' he said of the six southern African countries where more than 20 percent of sexually active adults are infected with AIDS, including Botswana's 42 percent rate. ''In Nigeria and Ethiopia, there should be the start of massive programs.''

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



This story ran on page A1 of the Boston Globe on 6/16/2002.

© Copyright 2002 Globe Newspaper Company.