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AIDS Infection Rates at Crucial Stage in Many Countries

The head of the U.N. AIDS program says HIV epidemics in some of the world's most populous countries are close to a turning point. UNAIDS Executive Director Peter Piot warns that societies in China, India, and the former Soviet bloc could collapse as they have in some African countries if their HIV epidemics are not slowed.

The latest UNAIDS report on the global HIV pandemic says infection rates are low in China, India, Central Asia and Eastern Europe compared to Africa. But Peter Piot reminded a Washington audience Tuesday that these rates can explode in a relatively short time.

In South Africa, for example, HIV took five years to double from half of one percent of the population to one percent. But it took only another seven years to jump to 20 percent.

"That is the essence of the dynamics of the kind of epidemic. Clearly, once a tipping point is reached, then you trigger a major explosive spread of the virus," said Dr. Piot.

Dr. Piot says China, India, Russia and former Soviet bloc countries are on the verge of this turning point, similar to the situation Africa faced 20 years ago.

"If it reaches that point, it could transition from a series of concentrated outbreaks in sub-populations in these countries into a generalized explosion across the entire population," he added. "If it reaches a prevalence rate, HIV, of even a small percentage of what is seen in some nations of Africa, it would mean at least tens of millions of people newly infected."

If that happens, Dr. Piot warns that the consequences could spill over to the rest of world. China and India are among the world's fastest growing economies, but the UNAIDS chief says the sickness and death of millions of their citizens in their most productive years would slow their economic growth and hurt their trading partners, too.

"If AIDS stalls economic growth there, as it has in the hardest hit countries, no country on Earth will escape the impact," he noted.

The signs are already evident. UNAIDS and the Asian Development Bank estimate that HIV cost Asian economies more than $7 billion in 2001. At present infection rates, they say, the cost could soar to $17 billion by the end of the decade.

Dr. Piot and others warn that as economies crumble, instability and insecurity increase. The U.S. National Intelligence Council, a public-private body advising the government, says the AIDS epidemic aggravates social fragmentation and competition for resources in the hard hit countries, with disease-ravaged security forces helpless to do anything.

Again, South Africa provides precedent. One-fourth of its adult population is infected. Analyst Martin Schonteich of the Institute for Security Studies in Pretoria says AIDS is worsening the nation's already high crime rate, as an increasing number of orphans migrate to cities to fend for themselves.

"There is a greater competition for resources within a small geographic area, a city, as compared to a rural area, there is greater autonomy in a city, there is less supervision by elders or by parents," he said. "Juvenile gangs and criminal gangs develop much more easily within a city context than in a rural area."

As the need for policing rises, however, an increasing number of South African constables are dying from AIDS.

"If one accepts that quite a large proportion of police officers will be infected with HIV, the kinds of services that the police will be able to supply to the public in South Africa will invariably decline," he added.

With a similar prospect facing Asia and Eastern Europe, UNAIDS chief Piot says he is calling for intensified attention to the HIV epidemic there. He points out that if it gains a foothold and spreads in even a few provinces of China and India, global resources to continue fighting the disease could shrink and perhaps vanish.

"If we hope to have the resources to treat the epidemic in the hardest hit countries, we must prevent major epidemics in the most populous countries," said Dr. Piot.