AIDS May Threaten Global Security

RAY SUAREZ:

A new report from the CIA highlights what it calls five "major regional or global players," countries where surging rates of HIV and AIDS could affect political and economic stability.

The next wave of AIDS, according to the report, will affect: China, the world's most populous country of 1.3 billion people, the CIA report highlighted its importance to the regional economy of East Asia. India, where the population of one billion will soon surpass that of China. The Indian AIDS numbers are projected to be the worst in the world: 25 million patients by 2010. Russia's numbers will be significantly lower, but the intelligence agency worries the epidemic could hurt Russia's transition out of the Soviet era. Nigeria is a major oil source and home to 130 million. Africa's most populous country has been a frequent contributor to regional peacekeeping in places like Sierra Leone and Liberia. The CIA also cited Ethiopia in East Africa. The agency worries that a growing AIDS crisis make ethnic and regional tensions worse in a country adjacent to Eritrea, Somalia, and the Sudan.

In all those countries, the report says, cumulative AIDS cases will triple over the next decade from an estimated 23 million today to as many as 75 million by 2010. By then, prevalence of the disease will eclipse that of Central and Southern Africa.

The CIA report notes that while these "next stage" countries are in early- to mid-stages of the epidemic, HIV/AIDS has not been made a sustained high priority. What's more, the five countries have weak health care systems to combat the disease. The report follows a similar warning two years ago, when the Clinton administration first called the global epidemic a national security threat, adding AIDS to a list that includes terrorism and nuclear weapons.

RAY SUAREZ:

For more on the report we're joined by Nicholas Eberstadt, a researcher with the American Enterprise Institute, a Washington-based think tank — he was an independent reviewer of the CIA Report; and Princeton Lyman, the executive director of the Global Interdependence Initiative at the Aspen Institute, a research and policy organization.

Nicholas Eberstadt, if we start taking the focus away from Sub-Saharan Africa, small countries with very high rates of infection, and start looking at these super-sized of countries, some of them nuclear powers, how does that change the discussion of AIDS and security?

NICHOLAS EBERSTADT:

Well, so far in Sub-Saharan Africa we've had a catastrophe of world historical proportion. It's been treated as a tragedy, but mainly a humanitarian tragedy. And that's because Sub-Saharan Africa has been essentially marginal to the international economy and the international balance of power.

Eurasia is not marginal to either of those things. It's the center with the majority of the world's population, and with a growing fraction of the world's economic output. The HIV epidemic as it expands and goes through Eurasia will be taken en much more seriously by so-called real politicians.

RAY SUAREZ:

Princeton Lyman, are you okay with this definition of AIDS as an international security threat, or should we keep the emphasis on public health, humanitarian aid?

PRINCETON LYMAN:

I think the dimensions of this disease rate it as a potential security threat, because it attacks the military and therefore undermines the capacity of countries and their ability to engage either in peacekeeping or their own defense. It undermines stability as people compete for resources. It undermines the economy. And in areas as Nicholas has said of strategic importance to the United States, this becomes a serious issue.

RAY SUAREZ:

Is there something more than a difference in scale that we're talking about — when we look away from a place like Botswana that has roughly the same number of people as Brooklyn, to a place like China, with over a billion people?

PRINCETON LYMAN:

Well, scale matters, because just with the low prevalence rate as the report points outs, you're talking about millions of people. But also, take China, for example. We know from the way AIDS has to be addressed that you really need to engage society, it becomes very quickly a human rights issue. Is China going to be able to engage civic society, allow for people to organize and mobilize? If it doesn't, it won't be able to deal with this issue, but it could become a serious internal political issue.

RAY SUAREZ:

And in a place like Russia, Nick Eberstadt, where you're talking about so far prevalence among intravenous drug users, but the possibility of the disease moving into the general population, you've written an awful lot about Russia and public health in the last couple years.

NICHOLAS EBERSTADT:

Russia has a very unlovely feature of this HIV problem, which is their prison population. Russia has about one million convicts in jail at any given moment. There is virtually no public health infrastructure in the jails. The prisons have become sort of an incubation ground for drug resistant TB and HIV and unlike the good old days of Stalin, people are let out of jail in Russia now, they go back to the places from which they came. You have a virtual carburetor system pumping HIV and drug resistant TB around the country.

RAY SUAREZ:

And an already health compromised general population?

NICHOLAS EBERSTADT:

Absolutely, absolutely. Russia is already undergoing a health crisis. I think that every several years Russia loses World War One's worth of males to excess mortality. And this is an additional factor in that delicate situation.

RAY SUAREZ:

Even if all these countries involved, Princeton Lyman, were going to start today putting in new education methods putting in new public awareness methods, would we see the numbers still peak as sort of those who are already ill or about to be ill have to sort of move through the stages of HIV and AIDS?

PRINCETON LYMAN:

Well, I think if governments really mobilized, and some governments have, and really went all out, they could hold down these projections. They couldn't stop them entirely, but they could hold them down, but it takes a tremendous amount of mobilization. Take the country of Senegal. Senegal has held the projection down from the beginning, but it mobilized all elements of society, mobilized the military, mobilized the religious leaders. They set standards; they had discipline in the military. And they use their religious leaders. Uganda also mobilized everyone. But if you don't do that, if these countries can't do that or won't do it, they're going to have a very hard time controlling this.

RAY SUAREZ:

Well, wasn't China even reluctant to admit it had an AIDS problem?

PRINCETON LYMAN:

Only quite recently within a year did China admit that they had a serious problem, that they had about a million people infected, some people rate it much higher — and they have come to the United States to ask for assistance. But they're a long way from developing the kind of national program that they need to really get at this problem.

NICHOLAS EBERSTADT:

And there are still parts of the Chinese problem and the Chinese government is arresting people and detaining people even for talking about, such as their tainted blood problem, and the reason for that is that the government fears that they will be blamed for this particular problem, having been arguably complicit in its development.

RAY SUAREZ:

You know, these countries are very different from each other, Nigeria, Ethiopia, Russia, China, India, but are there some things they have no common — social upheaval in the recent past, heading to the cities, lots of new mobility that makes AIDS more of a near-term problem?

NICHOLAS EBERSTADT:

I suppose you can say that. I'm struck by the difference in the particular epidemiologies in the different countries. I'm struck by the prison problem in Russia, by the blood aspect in China, which is only part of it, by the trucker routes in India. IV drug use does not seem to be so much a part of the Ethiopian or the Nigerian problem, but very much the problem for the Eurasian countries. There are differences I think one can appreciate.

RAY SUAREZ:

Are there models for having the future be otherwise from the fairly grim projection made by the CIA Report?

PRINCETON LYMAN:

There are models. Thailand has also controlled the level of infection. Again reaching out to all elements of society, dealing with prostitutes, dealing with religion, et cetera; they've been relatively successful. Botswana now has a very comprehensive program it should have started much earlier. Brazil has also kept the rate under control — with again a comprehensive program of testing, of treatment of outreach, et cetera. So, yes, there are models out there, but it takes a lot of work and it takes resources.

RAY SUAREZ:

And given what you know about these countries, are you optimistic that anybody will grab the nettles?

PRINCETON LYMAN:

I would give India the highest possibility. I don't know about you, Nicholas.

NICHOLAS EBERSTADT:

I think that's a very reasonable assessment. Even if you look at a success story like Thailand, you have to keep in mind that between the onset of the really pro-active policies around 1990 and now, there's been more than a doubling of the number of HIV carriers — of the HIV population, which is because there's a stock of people, but there's also an inflow of new patients, new victims. It's very hard for me to imagine at this moment China replicating the successful aspects of the Thailand program, active civil society, NGO's going everywhere, fairly good trust in the government. I don't see those components in a place like China.

RAY SUAREZ:

Keeping in mind that this is a human tragedy of mind bending size, is there also some worry that when you've got countries that are like Ethiopia surrounded by already unstable countries, that losing a big slice of your men suddenly creates danger, instability — Nigeria, a place that will been trying to keep the peace in its neck of Africa, suddenly undone by this kind of thing –

PRINCETON LYMAN:

Oh, there's a lot of speculation and some good research on the correlations between this kind of dissolution of society if you want to call it and instability. Take the question of orphans: The projection in Africa of 40 million orphans by 2010 — now we know that children are incorporated as child soldiers into rebel groups; they become sources of instability, communities break down. The potential for instability from this and the breakdown of social life and the ability to contain and maintain normal lives can be very disabling. There's one more issue if I can –

RAY SUAREZ:

Quickly.

PRINCETON LYMAN:

Quickly. The cost, if we are facing 75 or 100 million or just 75 million people infected, even if you keep the cost at $500 a year, which is difficult, you're talking about a treatment bill of over $30 billion. That's going to be an international issue.

RAY SUAREZ:

Suarez: Princeton Lyman, Nicholas Eberstadt, thank you both.