Washington, DC — Deadly virus outbreaks can vary from region to region, country to country

The situation the world now faces in China, India, Russia and its surrounding countries "bears alarming similarities to the situation ... faced 20 years ago in Africa," with the HIV/AIDS rate coming "perilously close to a tipping point," at which tens of millions of people could soon be infected with the deadly virus, warned the executive director of the Joint U.N. Program on HIV/AIDS (UNAIDS), Dr. Peter Piot.

Speaking November 30 at the Woodrow Wilson Center for International Scholars on the eve of World AIDS Day, Piot said that if the tipping point is reached, HIV/AIDS "could transition from a series of concentrated outbreaks in subpopulations in these countries ... into a generalized explosion across the entire population, spreading like a wildfire... .

"If HIV reaches a prevalence rate -- even if a small percentage of what is seen in some nations in Africa -- it would mean at least tens of millions of people newly infected," he said, because the population bases in these countries are so much larger than those in Africa.

To explain how a tipping point can be reached in a country, Piot cited HIV/AIDS trends in South Africa. "It took five years for prevalence rates of HIV to move from 0.5 percent to 1 percent. ... Then in only seven years, it jumped from 1 percent to 20 percent. That is the essence of the dynamics of this kind of epidemic. Clearly, once a tipping point is reached you trigger a major, explosive spread of the virus."

Once a tipping point is reached -- a process that Piot said can vary from country to country -- several things begin to happen simultaneously, all of them ominous: a marked increase in heterosexual transmission; a jump in the number of HIV-positive pregnant women and infected infants and children; and a sharp rise in the number of infected women and girls as the virus accelerates. "When the very act essential to furthering the human race threatens it, we are in a very precarious space," he warned.

Piot reminded his audience that there is no single or universal HIV/AIDS epidemic worldwide. "What happens in countries like Russia, China, India and Indonesia ... will undoubtedly be different from what I saw taking hold in Kinshasa," he said. He cautioned, however, that "if we don't prevent this breakout, and full-blown epidemics take hold in these large, populous states, there will be dire consequences not only for these countries but each of our own" countries as well.

Citing a UNAIDS/Asian Development Bank study on the impact that HIV/AIDS has had and will have in Asia, Piot said that in 2001 alone, Asia lost $7.3 billion, with most of that borne by households that lost income because of sickness and death due to AIDS. "If the current rate of infection continues in this region, by 2010, economic losses will more than double, reaching more than $17 billion annually," he predicted.

India and China, he reminded everyone, are not only two of the world's most populous countries, but also two of the world's emerging international economic powerhouses. "They are engines of global economic growth," he said. "Today China is the third most active trading nation in the world. ... India's trade is also growing by billions of dollars every year. If HIV/AIDS stalls economic growth there as it has in the hardest-hit countries, no country will escape the impact."

An HIV/AIDS epidemic in China, India and Russia would also have "dire implications" for global security, Piot predicted, producing high numbers of orphans and stalling economic growth, which in turn will create chaos and instability. For this reason, he said, Chinese authorities have declared fighting HIV/AIDS a major national priority.

The UNAIDS director went on to praise President Bush's five-year, $15 billion Emergency Plan for AIDS Relief, saying, "The leadership and generosity of America in investing in prevention and treatment for HIV/AIDS in Africa, the Caribbean and Vietnam is one of the most promising and heartening developments in years in our common fight against HIV/AIDS.

"When the history of our fight against this epidemic will be written," he said, "President Bush's State of the Union speech last year [in January 2003, in which the initiative was first announced] will figure prominently ... because it meant a qualitative jump in terms of the resources and the level of political commitment in the global fight against HIV/AIDS."

Piot called for "intensified attention" to what he called the "next-wave countries," China, India and Russia. Such an effort, he said, is not to be "at the expense of Africa, but on behalf of Africa" because "if the epidemic gains a foothold in even a few states or provinces in China or India and spreads there as it has in some African countries, the global resources that are now available to Africa could easily diminish and perhaps even vanish."

But despite the bad news, he said, there is "plenty of reason for hope, not just because the United States, Canada, Europe and Japan have been able to increase awareness, reduce stigma, and make prevention and treatment available, but because nations like Thailand, Cambodia, Brazil, Senegal, and Uganda have done so as well, with fewer resources."

He said that countries can choose from two models in their fight against HIV/AIDS: one leads to a devastating epidemic, the other to containing and reversing the spread of AIDS.

The world's most populous nations, which are now at risk, have the advantage in choosing which path to follow, he said, because they have seen what HIV/AIDS has done to other countries and what societies can do to fight the virus through good leadership, prevention and effective implementation of anti-HIV/AIDS programs.

More good news, Piot said, is that the $200 million available to fight HIV/AIDS in developing countries when he first started with UNAIDS about seven years ago -- most or all of which came from donor nations -- has now swelled to $6.1 billion, with half the funds coming from the domestic budgets of developing nations.

"That is also progress," he said, "because it is about the survival of the nation -- because they cannot survive on foreign aid alone to tackle this epidemic."

Also appearing with Piot was Randall Tobias, the U.S. global AIDS coordinator. Tobias outlined the progress being made under President Bush's five-year, $15 billion Emergency Plan for AIDS Relief, which, he said, has the goal of "saving the lives of men, women and children."

Tobias said broad-based data from the field has just come in regarding treatment numbers: "We are currently working with staff at the Global Fund [to Fight AIDS, Tuberculosis and Malaria], the United Nations Joint Program on AIDS and the World Health Organization to take that data and calculate numbers so we can announce comprehensive, accurate and coordinated treatment numbers at the end of January 2005.

"That level of close cooperation on common data, between and among the bilateral and international partners in this fight, is probably without precedent," he said.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)