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Contributions from
the Column
Focus
Combating HIV/AIDS – the German input
US study warns of dramatic rise in the HIV infection rate
People living with HIV as target group counsellors in Argentina
Empowerment of girls in Africa
Russia's underrated epidemic
Big sales, little education
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Work on the development of vaccines
02/2003
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The next wave is rolling
US study warns of dramatic rise in the
HIV infection rate
Katja Roll and Christoph Benn
A new wave of HIV/AIDS infections is threatening the world. In September 2002, the US National Intelligence Council (NIC) presented a study titled "The Next Wave of HIV/AIDS", which predicted the spread of the disease to 2010. The study, initially not intended for the public, was declassified surprisingly rapidly because the US government wanted to draw attention to the great risks it sees for the stability of the countries affected, some of which are nuclear powers and permanent members of the UN Security Council.
To date, Africa, with currently the world's highest infection rates, has been the main regional centre of the AIDS epidemic. But it would be a great mistake to focus only on Africa. The NIC study examined Nigeria, Ethiopia, India, Russia and China, which as strong "regional und global players“ have an important political and economic role. In all five countries, whose inhabitants account for a total of more than 40 per cent of the world population, large sections of the people are at risk of infection.
According to the NIC calculations, 50-75 million people in the "Next Wave Countries" will infect themselves with HIV/AIDS by the end of 2010. This estimate exceeds by about 50 per cent the forecasts for the spread of the disease in Southern and Central Africa, where 30-35 million new infections are predicted for the same period. Every such forecast is, of course, uncertain. But the NIC report is based on careful analysis of available data and is the best possible estimate of the risks according to the latest state of knowledge.
The "Next Wave" countries
In the five countries surveyed, the virus is spreading at different speeds due to their varying general social, economic and political conditions. In Russia, the report says, the proportion of infected adults will increase from a current 1.3 to 2.5 per cent to 6-11 per cent. The main means of infection so far has been the use of needles in intravenous drug use, although heterosexual transmission is increasing markedly. At present, up to one-third of Russian men liable for military service cannot be called up due to bad health. Hepatitis and AIDS, to which drugs users are particularly susceptible, are weakening the Russian armed forces.
It is true that in China and India the percentage of people living with HIV/AIDS is still relatively small. However, due to the great size of their populations as a whole the absolute number of people infected with HIV in these two countries in 2010 will be very high. The estimates put the figure for China at 10-15 million, and for India at 20-25 million, giving the latter country the greatest number of HIV infections in the world. In China, the trade in blood donations and sexual contacts between itinerant workers and prostitutes is in particular accelerating the spread of the virus. Cultural taboos and slow communication between the various administrative levels impede a detailed gathering of data on the spread of the disease and hinder thorough public education.
Currently, the AIDS epidemic in all five countries is in its secondary stage. Their governments have so far given no high priority to combating it. Social problems, domestic political difficulties and insufficiently expanded medical infrastructure hinder the implementation of effective programmes to prevent HIV and combat AIDS. That the spread of HIV/AIDS can be curbed is shown by its slowing in Uganda, Thailand and Brazil, which was enabled by far-reaching prevention and therapy programmes. The reverse conclusion is alarming: if the governments of the "Next Wave" countries do not take timely and firm action, the impacts of the disease will destabilise these nations on a lasting basis.
Impacts on the economy and society
Southern Africa is a tragic example of the consequences an advanced HIV/AIDS epidemic can have for a region. More than 15 million people there are in acute danger of dying of starvation. True, that has been caused mainly by wrong government policy, as the instances of Zimbabwe and Malawi show. But there are studies that identify HIV/AIDS as a decisive co-factor of this development . The virus and the disease result in the loss of workers and skilled people, particularly in a labour-intensive sector such as agriculture. Due to the death of teachers, traders and skilled workers, knowledge and experience are lost. That leads to exorbitant training costs and social security contributions, which lower a country's attractiveness as a business location.
The scale of the impacts depends on the countries' social, economic and demographic starting point. The latest NIC study foresees the worst consequences for Nigeria and Ethiopia. Disease and the death of government officials and entrepreneurs threaten to weaken both countries politically and economically. The absence of experienced business partners and skilled workers will result in a decline in foreign investment. The shortfalls in revenue resulting from a reduction in production and trade will compel the governments to cut spending on social services. If they can offer no programme to fight the disease, their political legitimation and capacity to act will be at risk. Since both countries are leading powers in their respective regions, their destabilisation could spread further in West and East Africa.
In Russia, the impacts of HIV/AIDS will be even more dramatically reinforced due to its special demographic situation. Even without AIDS, the death rate among men has increased greatly in recent years. Combined with an extremely low birthrate, this is leading to a rapid ageing of society and a marked gap in the middle generation. That differentiates Russia clearly from, for instance, the African countries. The spread of HIV/AIDS will now accelerate the decline in its population. The ensuing shortage of workers and exploding costs of public health services could ruin the country's modest economic successes of recent years. A World Bank study forecasts as a result of the AIDS epidemic a reduction of Russia's gross domestic product in 2010 by up to 4.15 per cent. The demands of millions of new HIV/AIDS patients would far exceed the capacity of the public health service, which is in need of reform. In view of the urgent need to cope with other pressing health problems, such as tuberculosis, making combating AIDS a priority would ensure domestic political dynamite.
Although the greatest number of HIV/AIDS cases in the world will occur in India and China, the report says, the impacts of the disease will have less effect on their economic and social systems than on those of smaller countries. In addition, the smaller percentage of the infected will mean that political pressure to check the disease will be relatively minor. The economic impacts will depend on which social groups are increasingly affected. If the virus should spread more strongly among young and well-educated people, whose loss would weaken the trust of foreign investors and drive up the companies' training costs, the political consequences would be much greater.
Pressure on the international community
Since the means to combat AIDS are very scarce around the world, the "Next Wave" of the epidemic will step up the pressure on the international community to make more resources available. Moreover, the question arises of what focal points are to be set in allocating the funds. Should they flow into the currently worst affected countries in Africa, or should the New Wave countries have higher priority on account of the potential risks? Must not, in view of the global dimension of the threat, multilateral approaches to fight this disease, such as the GFATM, be given greater importance?
At any rate, the US government report makes one thing clear: a so far apparently inexorably downhill mechanism must be broken through. To date, the deathly disease has struck one country after another and the reactions have almost always run to the same pattern. At first, the disease is suppressed and kept quiet about, and the victims are slandered and discriminated against. Cultural peculiarities are cited as alleged impediments to one country being able to learn something from another. Thus, this disease, which is relatively easy to prevent and treat, has now reached some of the most populous countries of this earth. Further delays in appropriate global efforts to stop this pandemic would cost the world dearly in every respect.
Katja Roll, Campaign Office, Action Alliance Against AIDS in Germany, Tübingen (roll@difaem.de).
Dr Christoph Benn, German Institute for Medical Mission, Tübingen, member of the Board of Directors, Global Fund to Fight AIDS, Tuberculosis and Malaria (benn@difaem.de).
1) National Intelligence Council: The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China. Washington, September 2002. www.cia.gov/nic/pubs/index.htm
2) Save the Children and Oxfam: HIV/AIDS and Food Insecurity in Southern Africa. London, December 2002. www.oxfam.org/eng/pdfs/pp021127_AIDS_safrica.pdf
3) Ruhl, C; Pokrovsky, V; Vinograd, V: The Economic Consequences of HIV in Russia.. Washington, World Bank Group 2002. www.worldbank.org.ru/eng/group/hiv/
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