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Africa Policy E-Journal
Africa: Next Wave of HIV/AIDS 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 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: 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 UN
Secretary-General on HIV/AIDS. See +++++++++++++++++end profile++++++++++++++++++++++++++++++
The Next Wave of HIV/AIDS: 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.
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.
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 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.
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
... 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.
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.
... 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.
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 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.
Documents previously distributed in the e-journal are
available on the Africa Action website: To be added to or dropped from the e-journal subscription list, write to e-journal@africaaction.org. For more information about reposted material, please contact directly the source mentioned in the posting.
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Africa Policy E-Journal
