The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China 
(Summary) 
National Intelligence Council ICA 2002-04D Sep02

[ Report Summary below AP article ]

CIA: Russia, China, India Face HIV Crisis

AP 1oct02

McLEAN, VA -- The spread of HIV is expected to accelerate in Asia and Africa over the next decade with 75 million cases likely in five of the world's most populous countries by 2010, a U.S. intelligence report predicts.

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High and Low Estimates of Current and  
Future HIV/AIDS-infected Adults in  
Next-Wave Countries, 2002 and 2010  

The rapid growth of HIV as well as AIDS cases will heavily tax the economies and public health systems of such countries as China, India, Russia, Ethiopia and Nigeria, according to the report, prepared by the National Intelligence Council, a group of senior analysts who report to CIA Director George J. Tenet.

Those countries -- which have 40 percent of the world's population among them -- are estimated to have between 14 and 23 million cases of HIV now, says the report entitled ``The Next Wave of HIV/AIDS.''

``Their governments are at a critical phase of determining their response,'' said David F. Gordon, a principal author of the report, during a briefing at CIA headquarters on Monday. ``The disease is building up a significant momentum in each of the five countries.''

The growth in the five countries is expected to outstrip the number of cases in central and southern Africa, where the disease currently is most widespread, according to the report.

The report says the governments of Uganda, Thailand and Brazil have made HIV and AIDS awareness a priority and have slowed the disease's spread. In contrast, South Africa, beset with other issues, did little, and infection rates skyrocketed in the 1990s.

Because so many people in those countries are already infected and dying, the net number of HIV-positive people in the region is only expected to increase from 25 million to 35 million.

The report projects each country will see a significant increase in HIV cases in the next decade:

• India: The country is expected to have between 20 million and 25 million HIV-positive people by 2010, the highest estimate of any country. India's public health institutions have taken some steps to combat the disease.
  
  Heterosexual activity is the key driver of the disease in India and Indians have little awareness of the disease, said the report. In Bombay and some other areas, as many as half of the prostitutes are believed to be infected.
  
  
• China: The government has raised its official estimate of the number of HIV cases in the country to one million, but some experts say the total is likely twice that. The report projects, China, the world's most populous nation, will have between 10 million and 15 million people infected by 2010.
  
  
• In rural areas, the practice of blood brokering is spreading the disease, although the government has ordered a stop to the practice. In the cities intravenous drug users are they key problem.
  
  
• Russia: Sharing infected drug needles is the main cause of spreading HIV in Russia, where drug use is widespread. Experts estimate Russia may have as many as 2 million HIV-positive people now. The number is project to between 5 million and 8 million by 2010.
  
  
• Nigeria and Ethiopia: The disease is already taking hold in the general population. Family breadwinners, as well as key leaders in government and industry, are at substantial risk, and their loss could devastate the two countries' economies. Heterosexual activity are driving the spread in both countries.
  
  The government of Nigeria, a regional power in western Africa, has tried to raise public awareness about HIV and AIDS. The current 4 million to 6 million cases are expected to increase to 10 to 15 million, and impact one-fourth of the adults in the country.
  
  In Ethiopia, a key driver of the spread of HIV has been the demobilization of the military after wars with neighboring Eritrea. Soldiers and prostitutes from military encampments are returning to their homes and spreading the disease. The current 3 million to 5 million cases is expected to increase to between 7 million and 10 million.
  
  
• CIA: www.cia.gov

The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China
(Summary)

National Intelligence Council ICA 2002-04D Sep02

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 2010.1 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.

1 These estimates reflect the expected number of HIV and AIDS cases at that time—not a cumulative total of all cases over the entire period.

• 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.

• 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.

HIV Statistics: Official and Unofficial Estimates

Reliable statistics on HIV/AIDS are difficult or impossible to get for many countries. UNAIDS maintains the most comprehensive databases of information in the world on AIDS, but the UN organization relies on official government statistics from each country—which experts believe sometimes understate the number of infected people. Our estimates of infection rates and their likely trajectories go beyond the official statistics by incorporating the assessments of academics and NGOs with field experience. As a result, all of the numbers in this assessment should be viewed as rough estimates, and our projections employ ranges to convey the general magnitude of the disease within a relatively high margin of error.

Governments often do not spend enough money to get quality infection surveillance because they have other budget priorities, do not want to acknowledge the extent of the epidemic, and the drug users and prostitutes at high risk of infection are not key political constituencies.

• Other hidden pockets of infection include TB patients—some of whom have contracted TB because they are HIV positive—and patients with venereal diseases and reproductive tract infections.
• It is difficult to get data on HIV prevalence rates in foreign military ranks, which harbor significant numbers of infected men. Even if testing is available, many people do not get tested because of denial, stigma, discrimination, or resignation.
• Intravenous drug users, prostitutes, and homosexuals usually are reluctant to identify themselves for fear of punishment.
• Some avoid testing when healthcare and treatment for the disease is unavailable. Infection surveillance of women attending prenatal clinics is considered the most reliable indicator of adult HIV prevalence in the general population. But even these statistics can be affected by poor clinic attendance when fee for services or mandatory HIV testing is instituted.

Table 1 		               Current                                    2010           .
Current and 		Number 		Number 		Adult 		Number 		Adult
Projected 		Infected 	Infected 	Prevalence 	Infected 	Prevalence
HIV/AIDS 		(Government 	(Expert 	Rate 2002* 	(Expert 	Rate
Infected Adults 	Data) 		Estimates)	(percent)	Estimates) 	2010*
			(millions) 	(millions) 			(millions) 	(percent)
Nigeria 		3.50 		4–6 		6.00–10.00 	10–15 		18–26
Ethiopia 		2.70 		3–5 		10.00–18.00 	7–10 		19–27
Russia 			0.18 		1–2 		1.30–2.50 	5–8 		6–11
India 			4.00 		5–8 		0.90–1.40 	20–25 		3–4
China 			0.80 		1–2 		0.14–0.27 	10–15 		1.3–2

*Estimates of percent are based on population data from the US Bureau of the Census. 


The National Intelligence Council
The National Intelligence Council (NIC) manages the Intelligence Community’s estimative process, 
incorporating the best available expertise inside and outside the government. 
It reports to the Director of Central Intelligence in his capacity as head of the US Intelligence Community 
and speaks authoritatively on substantive issues for the Community as a whole.

Acting Chairman Stuart A. Cohen
Vice Chairman for Evaluation Mark Lowenthal
Acting Director, Senior Review, Production, and Analysis William R. Heaton

National Intelligence Officers
Africa Robert Houdek; At-Large Stuart A. Cohen; Conventional Military Issues John Landry; 
East Asia Arthur Brown; Economics & Global Issues Karen Monaghan Acting; Europe Barry F. Lowenkron; 
Latin America Fulton T. Armstrong; Near East and South Asia Paul Pillar; Russia and Eurasia George Kolt; 
Science & Technology Lawrence Gershwin; Strategic & Nuclear Programs Robert D Walpole; Warning Robert Vickers

Prepared under the auspices of David F. Gordon, formerly National Intelligence Officer for Economics and Global Issues.

Additional copies of this assessment can be downloaded from the NIC public website at www.odci.gov/nic or obtained from Karen Monaghan, Acting National Intelligence Officer for Economics and Global Issues.