The Future of AIDS

GRIM TOLL IN RUSSIA, INDIA, AND CHINA

HIV/AIDS is a disease at once amazingly virulent and shockingly new. Only a generation ago, it lay undetected. Yet in the past two decades, by the reckoning of the Joint UN Programme on HIV/AIDS (UNAIDS), about 65 million people have contracted the illness, and perhaps 25 million of them have already died. The affliction is almost invariably lethal: scientists do not consider a cure to be even on the horizon. For now, it looks as if AIDS could end up as the coming century's top infectious killer.

At present, the HIV/AIDS pandemic, though global, is overwhelmingly concentrated in sub-Saharan Africa. Although this situation has exacted a terrible human cost, the rest of the world has been largely unaffected by Africa's tragedy. Things will be very different, however, in the next major area of HIV infection. Eurasia (which for the purposes of this essay is considered to be the territory encompassing the continent of Asia, plus Russia) will likely be home to the largest number of HIV victims in the decades ahead. Driven by the spread of the disease in the region's three largest countries -- China, India, and Russia -- the coming Eurasian pandemic threatens to derail the economic prospects of billions and alter the global military balance. And although the devastating costs of HIV/AIDS are clear, it is unclear that much will be done to head off the looming catastrophe.

WORLDS APART

Today HIV/AIDS is decimating sub-Saharan Africa. According to UNAIDS, as of late 2001 more than 28 million of the world's roughly 40 million HIV carriers lived in that region, and about 9 percent of all sub-Saharan inhabitants between the ages of 15 and 49 were HIV carriers. (In parts of the continent, the rate is far higher: adult infection exceeded 30 percent in four countries last year, and in Botswana it was near an almost unimaginable 40 percent.) UNAIDS' best guesses put AIDS-related mortality in sub-Saharan states at over two million in 2001 -- suggesting that the disease accounted for every fifth death. So far perhaps 20 million sub-Saharan people have perished in the pandemic.