Latest US Intelligence Estimates of HIV/AIDS Situation in India

[Guest guest]

Dear AIDS INDIA Friends:

The following article appears in today's Washington Post, and paints a

difficult picture for India. Regards, Bobby (bj@...)

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Intelligence Study Raises Estimate of AIDS Spread: Worst Scenarios for India,

China, Russia, Nigeria and Ethiopia Project Over 50 Million Cases by 2010

a Washington Post Staff Writer. Tuesday, October 1, 2002; Page A07

A government intelligence panel estimates that by the end of this decade

the growth of AIDS infections in five populous countries, including

India and China, may dwarf the current epidemic in sub-Saharan Africa

and outstrip current worst-case scenarios for the global burden of the

disease.

The National Intelligence Council predicts that by 2010 there will be

between 50 million and 75 million cases of human immunodeficiency virus

(HIV) infection in India, China, Ethiopia, Nigeria and Russia. That is

double or triple the estimate of 25 million cases an international team

of experts projected for those countries as part of a study published

last summer.

There are now 42 million people living with HIV infection, according to

UNAIDS, the joint program run by the United Nations and World Bank. The

agency estimates there will be about 60 million cases worldwide by 2010.

Extrapolations from the intelligence report suggest that projection is

much too low, with the global HIV burden more likely to fall between 80

million and 110 million cases by then.

The five nations together contain about 40 percent of the world's

population. In each, the AIDS epidemic has barely started or not yet

peaked. The experience in these nations -- and the response of the five

governments -- hold the key to the next phase of the pandemic, most

experts believe.

The unusually bleak estimates were reached by experts inside and outside

the government who agreed that current projections are too low. No new

data were gathered. Epidemiologists at UNAIDS and the World Health

Organization questioned the validity of the council's projections, while

acknowledging that most demographers in the past underestimated the

scope of the epidemic.

" They are applying a worst-case scenario systematically through all of

these countries, " said Neff , an epidemiologist at UNAIDS, which

is headquartered in Geneva. " I wouldn't rule out these projections.

They could be right, but they're not probable. "

Nevertheless, the focus of the report " is right on target " said

G. A. Feachem, director of the Global Fund to Fight AIDS, Tuberculosis

and Malaria, which will have a major role in deciding where donor

countries' money will be spent to treat and prevent AIDS over the next

decade.

" Paying attention to these large next-wave epidemics is extremely

important, and has been a neglected subject in the international

debate, " Feachem said.

" India is certainly going to experience a massive epidemic, and so will

China. India is on an African trajectory, only 15 years behind. In both

countries, the national responses are grossly inadequate to begin to

confront the wave of devastation and death that is breaking over them. "

The National Intelligence Council is a panel of experts that performs

strategic analysis for the president, the CIA, the Defense and State

departments, the National Security Council and other government

agencies.

The new document, titled " The Next Wave of HIV/AIDS: Nigeria,

Ethiopia, Russia, India and China, " follows up a report the council

released two years ago assessing publicly for first time the issue of

the global AIDS pandemic as a threat to U.S. security.

The 28-page report doesn't discuss how the projections might affect U.S.

foreign policy. But it briefly notes possible effects on the five

countries themselves.

Because the disease is relatively new to India and China, and because

there is a lag of many years between infection and death in most

individuals, those two nations " can manage the impact of the disease

through the end of the decade, " the authors of the report wrote. The

epidemic " by itself will not pose a fundamental threat through 2010 to

the rise of China and India as major regional players. "

The assessment is bleaker for Russia, which had 700,000 cases at the end

of last year, the vast majority in drug users, according to UNAIDS

estimates. By 2010, the council projected there will be 5 million to 8

million cases -- a situation that will worsen Russia's shrinking

population and work force, and could cut annual economic growth by

one-half a percentage point.

" Russia faces so many other serious problems that HIV/AIDS is unlikely

to receive high-level attention for an extended period until the

economic and security costs of neglect become more tangible, " the

authors wrote.

Nigeria and Ethiopia " will be the hardest hit . . . decimating key

government and business elites, undermining growth and discouraging

foreign investment, " the report said. The council estimated there will

be 10 million to 15 million cases of HIV in Nigeria, with 18 percent to

26 percent of adults infected. The Ethiopian projections are for 7

million to 10 million cases, and a prevalence of 19 to 27 percent.

Epidemiologists from UNAIDS, WHO, the U.S. Census Bureau and two other

groups in July published in the medical journal Lancet estimates for the

epidemic's growth through 2010. Individual country projections were not

given.

However, one of the authors, Stover of the consulting firm Futures

Group International, said yesterday that the 2010 estimate for India,

China, Nigeria, Ethiopia and Russia was 25 million cases.

The National Intelligence Council's estimate of 10 million to 15 million

cases in China -- up from about 1 million now -- is not very different

from that of the group that wrote the Lancet article, Stover said. But

the other estimates are.

The head of the AIDS program for WHO, Bernhard Schwartlander, said he

doubts the India projections in the new report, which are for 20 million

to 25 million cases, up from about 4 million now. That would mean that 4

percent to 5 percent of adults would have the virus.

" India has almost twice the population of what there is in sub-Saharan

Africa. I can see such a scenario happening in certain cities and

perhaps even in states. But it would be difficult to see it happening on

a nationwide basis, at least with the data we have, " said Schwartlander,

an epidemiologist who has been responsible for much of the WHO and

UNAIDS estimates.

Similarly, he doubts the projection that 8 percent to 10 percent of

Russian adults will have HIV infection eight years from now. That would

require " massive spread in the heterosexual population " from the now

heavily infected drug users.

F. Gordon, formerly the head of economics and global issues on the

National Intelligence Council and now with the CIA, said 10 to 20

experts on each country were consulted and came up with the estimates,

using data gathered by other agencies as a starting point.

" We do not have a model that we are comfortable with to generate these

kinds of numbers, " he said. " The main methodology was to seek the

consensus of experts. These should not be seen as destiny. "

http://www.washingtonpost.com/wp-dyn/articles/A24869-2002Sep30.html

C 2002 The Washington Post Company

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