Asian HIV epidemic major threat to global security and economy, says policy thinktank

The HIV epidemic in Asia will have far greater human, economic and geopolitical effects than the African AIDS epidemic within two decades, according to a review published last week in the journal Foreign Affairs.

The article, which contains the most alarming projections to date on the impact of HIV in Asia, is another sign that America's intelligence and foreign affairs community are beginning to take AIDS seriously.

"As we focus, quite properly, on ways to prevent the use of infectious diseases as instruments of war, we may be paying insuffient attention to a terrifying phenomenon unrelated to terrorism. It is a phenomenon potentially more destablising than terrorism" said Newsweek columnist George Will last week.

The review was written by Nicholas Eberstadt, a fellow of the American Enterprise Institute, a neo-conservative Washington think-tank. The AEI's past track record includes critiques of attempts to limit population growth, but the Foreign Affairs review betrays no political biases. Instead, the article appeals to policymakers to take seriously the emerging Asian epidemic, which Eberstadt argues will vastly overshadow the African epidemic whilst exerting significantly greater effects on global economic prospects. The emerging epidemic will also affect three of the world's major military powers. Among the impacts projected are:

• Russia's economy might be no larger than it is today by 2025
• Even a `mild` epidemic (HIV prevalence of 1.5% by 2025) would cut currently projected Chinese economic growth of 80% between 2000 and 2025 by one-third.
• Growth in India will be cut by three-quarters over the next two decades if the country faces the most likely prospect, an epidemic of `intermediate severity` (5% prevalence by 2005)

• Governments in countries at this level of economic development are unlikely to spend money on ARVs, even when generics are available, because, in the context of a stagnating economy, the cost of treatment will "be greater than the economic value of the lives thus saved"
• "From a geopolitical standpoint, the most pertinent question is whether the unfolding HIV/AIDS epidemics in China and India will be sufficiently powerful to alter the future economic or political balance between these two rising and ambitious states...relying on these simulations, the balance of risks presently appear to weigh more heavily against India than against China".

How sound are these projections?

Eberstadt's methodology for projecting the impact of the HIV epidemic is based in part on software developed by the Futures Group, a Washington-based consultancy with extensive experience in modelling the impact of HIV.

However, in the absence of substantive data from any of the three countries on behavioural risks, the author has relied on data regarding the age and sex distribution of the epidemic in sub-Saharan Africa. In the context of African HIV infection rates, his definitions of severe, intermediate and mild epidemics are relatively conservative: a severe epidemic would affect 10% of the population in Russia, 7% in India and 5% in China, an intermediate epidemic 6%, 5% and 3.5% respectively, and a mild epidemic 2%, 1.5% and 1.5%.

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India

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Russia

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