The next wave of AIDS

Posted: 17 March 2003

The focal point of the HIV/AIDS epidemic will shift in the next few years from Central and Southern Africa to five populous countries - Nigeria, Ethiopia, Russia, India, and China - according to a report by the US National Intelligence Council.

In these five countries, 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 epicentre 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 behaviours are driving infection rates upward at a precipitous rate, according to the report.

Growing momentum

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 per cent infection rates.

But 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, says the report. 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.

High cost

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.

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. 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 labour.