SUB-SAHARAN AFRICA: IMPLICATIONS OF THE AIDS PANDEMIC

Created: 6/1/1987

OCR scan of the original document, errors are possible

:mn> i k

this estimate is issued by the director of central intelligence.

the national foreign intelligence board concurs.

ho wing intelligence cegani'iationi porficipated in Ihe preparation of the Estimate!

Ihe Central IrHefhqincohe Defense Irtefcgence Agency, remSecurity Agency, and the intefcgenct rxgcriUation of Ihe Deportrnenl o' State

A/so Participating-.

.he Assistant Chief o< Staff tc* intelligence. Deportment of tne Army The Director ol Naval Intelligence, Deportment ol the Navy The Assistant Chiel of Stoff, Intelligence, Department of Ihe An Force Ihe Directct of Intelligence.arine Corps

Worniog Notice Intelligence Sources or Methods Involved (WNINTEl)

NATIONAL SECURITY INFORMATION Unauthorized Disclosure Subject to Criminal Sanctions

DISSEMINATION CONTROLReteotable lo Foreign Nottanah

NOCONTKACT- Not Reteosoble lo Coniroctori or

Contractor/Morrnohon Involved

and EiVcKhon of In'orma'kiri

Controled byhforrnertion Hen Been Aufhoriied for

to

Sub-Saharan Africa: Implications of the AIDS Pandemic Jo>

fVO'O*!

CONTENTS

Page

KEY

Introduction

Factors Contributing to ihc Rapid Spread ol

Sexual Mores and Cultural

Inadequate Health Systems

Effect of Other Endemic

A St-cond Virus

Prospects lor Epidemic Spread

Complicating Factors

The Soviet

The West

The United States

ANNEX: AIDS Disinformation

NOfCWN/i

PREFACE

Thi> initially sporadic and anecdotal reporting of the AIDSinimportant aspect of the increasing global AIDSan alannintt pictureeadly disease spreading rapidly throughout (he region The volume of reporting incieased immenselyriven by growing concern over the spread of the disease In ihe West as well as in Africa, andodest degree byfor this paper. Most of the reports remain anecdotal or based on small medical research programstrong epidemiological basis. We nonetheless feel confident in the conclusiom that follow Despite the lack of widespread scientific research, the reporting confirms that this deadly epidemic is spreading out of control In Sub-Saharan Africa.

Rather than await more information, wc feel sufficient material is available to serveasis for broad conclusiom in examining tbe serious implications of the AIDS pandemic for African, Soviet Bloc, Western, and US interests. This paper projects through the next five years, although some tentative judgments extendrucial assumption made here is that no vaccine or cure will be developed and distributed to Africa during this period. Medical opinion is that the virus will not mutateenign form.|

NOFORN.

TKACT/OBCON

tNipttlONTSAC

key judgments

ttica endured and continues to experience wars, insurgencies, drought, desertification, insect plagues, famines,diseases, dysfunctional economicnow the aids pandemic. the combination of these adversities with aids will devastate generations of africans. over the next several years, millions will succumb to infection and disease, and the physical and intellectual development of the next generation will be severely stunted an0 Africans already have died from AIDS Ofilium Africans currently infected with theinimumighillion could develop the clinical symptoms of AIDSith death to follow soon after.edical breakthrough in prevention, suppression, ot cure,enign mutation of the disease are unlikely, annual african dentlis from aids2 are likely to continue to climb into the millions. i

we believe that several identifiable factors contribute to the ongoing, rapid spread of aids across sub-saharan africa:

heterosexual transmission is the major mode of spreading the human immunodeficiency virus (hiv) in africa.

health systems are, and will continue to be. grossly inadequate. the use of unstcrile needles at healthwidespreadcountries' inability lo guarantee safe bloodwill facilitate transmission of the virus.

because the fundamental aids problem is the immunecaused by hiv, infection by the virus leadsorsening of endemic diseases.

the recent medical confirmation that thereecond aids virus, hivastly complicates the huntaccine and will require new blood-screening tests the second virus wasin aids patients in west africa, an area thought to be relatively untouched by aids until now, raising the posslbilty of an epidemic in this populous region.

the current western strategy of combatingandunlikely to be effective in most of africa. condom use, perhaps the single best hope for lessening the catastrophic spread of the virus, is culturally unpopular and unlikely to gam widespread acceptance, pjj

SECRET^gjSt*^

AIDS has anercent mortality, no preventive vaccine, and no cure. The disease is spreading rapidly and is out ofespecially among some urban African populations ll hils hardest at the healthy,ge group which composes nearly one-half of Sub-Saharanillion population. Rates of infection, already estimated to be as high asoercent in some urban groups, are rising, with little prospect that any method ol intervention within Ihe next few years will slow the epidemic. The numbers of HIV-infected people could grow to several tens of millions in ten yrursj^

Affluence, mobility, and lifestyle haveisproportionate number of urban elites al risk of infection The World Health Organization has informally estimated lhal Africa stands tn lose at leastercent of ils educated people in (lie nextears. Most in the small elite eslabltshment, if they escape the disease themselves, will be touched personally by the death of family, relatives, and friends- For example. Zambian President Kaunda recentlyon lo AIDS, and Ugandan President Museveni's brother. Army Cdr. Salim Salch, is dying ofaders are helpless to prevent AIDS or treat the victims, and their sense of frustration may bring some to lash out at Western count rit

Young elitesurtailment in educational opportunities as West European, Soviet Bloc, and some Third World countries insist on blood tests for African students and visitors, and expulsion if found to be HIV infected. Such expulsions have already occurredrowing list of Western, Communist, and Third World countries. The next generation of African leaders, cut off from wide exposure to outsidc ideas and methods, could become excessively isolated and embittered over treatment tbey see as singling out Africans unfairly. Those who survive tbe AtDS crisis may carry these negative views into future dealings with the countries that rejected them and tltcir peers.

Rural areas in most countries have been thought to have lower infection rates, but these areas may simply be three to five years behind the cities rather than somehow at less risk Already, urban-to-rural spread of HIV is being traced through increasing rates of infection along major transportation routes- The lack of surveillance and diagnostic capability in rural areas may lead to low recognition of ihe extent ol the spread of the disease. There are anecdotal accounts of nearof some isolated communities in Uganda and Rwanda |

The long-range impact of AIDS will be devastating. Heavily infected countries will suffer irreplaceable population losses in those groups rnost essential to their future development- midlevel economic

and political managers, agrarian and urban workers, and military personnel. The future may also show thai neurological damage among the HTV infected is one of the virus's most destructive aspects Increasing numlters of seemingly healthy people may be lost to the work force, or the managerial and decisionmaking abilities of leaders may be seriously impaired by progressive memory loss, motorpsychiatric symptoms, chronic dementia, or other central nervous system disorders. Young mot Iters and their newborn babies are suffering relatively high rates of infection, and tbeir loss could seriously under mine the traditional family, which will have to bear tin- brunt of caring for the ill and dying |

Almost all African economies are under severe strain already The impact of AIDS-rclatedof trained managers and technicians, loss of tourism, and increasing disinclination of foreigners lo reside inalmost certainly reinforce current capital flight and growing decline of foreign capital investment

Soviet Bloc countries are likely to alienate young African elites by their policies towards AIDS The testing and deportation of infected African students from Soviet Bloc countries have brought allegations of racial and political bias from African media. These actions may also undermine the Soviet disinformation campaign blaming the spread of AIDS on the United States. African visitors who come from countries where AIDS is rampant will face increased social segregation, even if they test free of AIDS, as host country populations react to public information accounts of the magnitude of the disease in Af

The Soviet Bloc faces an additional serious problem.60 Soviet economic technicians in Africu andilitary advisers Cuba mainluins0 militaryivilian personnel in Angola alone AIDS will raise the cost for Havana and Moscow, and could eventually weaken their resolve to maintain current levels of troops and advisers in Africa, although there is no indication that the Soviet-Cuban commitment is wavering at this time Military and civilian personnel will face rigorous testing upon return from Africal

The United States and other Western countries will probably be asked to increase greatly their assistance toefusal to divert or create new development funds lo take on the enormous costs of upgrading health infrastructures will open the doors to harsh criticism bv beleaguered African countries. The Soviets will probably step up their anti-US disinformation campaign in the wake of an African backlash, and the United States will continue toigorous counter to such propaganda. Renewed Soviet accusations that US military personnel spread AIDS could lead lo more troublesome and contentious negotiations for military basing agreements and other military activities. Donors' calls for more openness and publication of data will provoke African leaders who believe data outlining the extent of the epidemic tarnishes their image and is used against themall in tourist revenues, mandatory testing of African students, and theof visa and immigration restrictions will inflame anti-Western rhetoric and negatively affect bilateral relations.

SECRH^ ArOrWN/NQpf^flnMCr/ORCOrJ

DISCUSSION

AIDS could Ccti.sc mi-Jin dislocation, death, and Illness In Africa ihan any combination of famine, drought, or war The World Health Organization estimates that so lai at0 Africans have died ol Ihe disease, andillion are infected with the human immunodeficiency virus (HIV) and are capable of transmuting the virus throushoutfr-ti-it |

Ol thee* currentlyinim umigh ofillion could develop AIDSears, with death lo follow soon after the clinical symptomscrvative estimates are thatoeroral of carriers will develop AIDS within five years of Initial inleition. Data suggest that the risk of progression from HIV in lection to AIDS increases with time; an eat iniutedoercent will progress to AIDS withinears of infection Only lime will tell whether infection Invariably leads to

fie progression of broadly outlinedimited number of small surveys and published medical stud-

rapid Increase in AIDS and HIV earners in ihe last five years Is unqunMioned For instance. If we rely only on statistics from established medicalattotB where scientific testing is available, thein diagnosed eases and carriers among only those patients with access to medical care is deeply troubling and represents only the tip of the iceberg

In Uganda, hospital uhystcuns in Kampala did not see any AIDS eases in IWI.4 tbey saw one or two eases per month on average,ne or two cases per week, and in ihe first sis monthsne ot two cases per6 data from blood donorsampala hospital showercentoung male donors wrre HIV Infected, as5 percentomenaternity clinic Early indications7 studies show that well overercent of Kampala blood donors wereand among prenatal women (lie rate was aboutercent

Al University Hospital in Lusaka.5 and6 the number of referrals for persons suspected ofAIDS doubled every eightotalatients over Ihc period Hospitalestimate that there will beatients per month with clinical AIDS during the first half7

In Kenya, blood tests confirmedase*4 amonn patients suuitilcd of havingonliimed easesases In ihe llisl eiahl months6 outatients tested Among blood donors al Nairobi hospital, the number of HIV carriers increasedercent5eicentocumented study ofigh-risk group, found thaiercent were HIV infectednd that the same group is nowercent infected Indications are that 4of pregnant women atUrge Nairobi maternity hospital were carriers

andful of Zairtans sought treatment for AIDS in Europeut today the gnwecp-menl eileWiihed revwrch group. Projectstimatesercent of the urban population are HIV infected,ercent Infection rate in the general population

Factors Contributing to the Rapid Spread of AIDS

Sexual Mores and Cultural Factors

eterosexual transmission is lite major wav the virus is spread In Allien, and lite culturally traditional behavior of haviniiual partners increases the risk. Educational programs lu some countries, such

Presence of AIDS

lo rwraoom'-to'.

cases or mote"'

Australia

Braidanada

Cftntrji Alrlcen Republic

Con ffo

France

Haiti

Italy

Ivory Coasl

Kenya

Mexico

IMands

Rwanda

Spain

Switzerland

1'iniOaO and Tobago

Uganda'

United Kingdom

Omied States

T anion ia

West Germany

Zaire0

<emb#

Zirnbab-*

Countries reporting fewerases'

Angola

Antigua and Ba'buda

Argentina

Austria

Bane

Barbados

Ro "iir

Bermuda

Bolivia

Botswana

Cameroon

Cayman Islands

ciid

CMia

China

Colombia

Costa Rtca

Cube

Cywos

Crecnosiovaliift Denmark

Oominican Rcpubx Ecuador East Germany FI Salvador

French Guiana

Gambia. Tha

Ghana

Greece

Grenada

Guadeloupe

Guinea

Honduras

Hong Kong

Hungary

Jl

Japan

Lesotho

Liberia

Lutemoourg

Malawi

Malta

UafiniQue

Morambiaue

Kaw Zealand

Norway

Panama

Paraguay

Peru

oland Portugal Romania

Sa>nt Chfittophor and Ne-is Saint lucia Saint Vincent and ihe Grenadines Singapore South A'rica

Soviel Union

Sri Lanka

Surinam*

Sweoon

Taiwan

Thailand

I unisia

Turkey

Turks and Caioos Is'anas

1 cj i.1

venerueu 'uaosiav-*

'Sambn e't*in rtpvite/ram roo0

ii

vrl in:-.

' Co* lo IKt o' noenlto aiif poorrtdam.atlrr'nvjnei'olutfi

dull

nclasiilk-d

s

Presence of AIDS in Sub-Saharan

as in (jingo. kenya, burundi, uganda, and others, rnommrnd limiting sexual contact to nnc partner openly addressing scsual behavior is new andhowever, and personal sensitivities, relatively low literacy levels, and very limited media aeons will limit the impact of ihe campaigns among thosethat adopt ihem. in kenya, the releasev scries early ihis year depleting the hazards ol casual sextorm of disapproval in parliament and the senea was cancelledeordering of lifestyles, will come in time to change the worsening health crisis ffj

ondom use is perhaps (he single hest hope for lessening the catastrophic spread of the virus today. in many countries, however, condoms are associated withot with family relationships, making their universal acceptance difficult in the next five years.ercent of the world's use of coodomi is in africa. even where thereemand, they are often in short supply or unavailable idhriving black market in condoms has started, along with the sale of several "hc-memade'* products of dubious reli-

Inodequote Health Systems

ealth systems are already grossly inadequate, and the further economic drain from the aidson financially strapped african governments will be profound for most african countries, upgrad-inn blood tiansfusion services alone is likely to cost approximatelyimes the annual per capita public health budget, according6 study. in uganda, annual per capita spending on health caie isoughly the cost of one preliminary blood test for11iH

ven though the costs of upstrading may ben many countries, contaminated blood supplies rank as an important contributor toead of the virus in zaire, where bloodgan onlyroject sida study at one hospital found thatercent of all blood donatederiod of one month tested positive;inimumransfusions per month, hundreds of new hiv earners could have been generated in contrast, tbe rwanda government ordered the screening of all blood donationsnd it nowheoretically clean stock- I

9 the costs of controlling tlie spread could be dwarfed by the bill of treating aids patients, and so it is probable lhat most will remain untreated african governments and physicians will have lo makechoices that are rooted in ethics an official in

zaire recently said on an internationally leleviscd program thai treatment of aids victims was out of the question if treatment ol curable diseases weie io continue the cost of caring forids patients in the united stales is greater lhan ihe entile budgetarge hospital in zaire fl

gains realized through vaccinationund ihc acq nisi him of medicines bybe pul tn jeopardy the lear that dirtytbe virus may lead lo resecuoc of iheseunless the lack of sterile needles canin regional health cllnns inmedical personnel say thai "cducaled"aware of ihe aids problem. instil onfor theirhile syringes forare dipped in boilingand reusedthe short suppl> |

effect of other endemic diseoses

ihe fundamental aids problem isdebciency caused by hiv. infection byleadsorsening of endemic diseasestime after diagnosis has been shorter inin western counlries. tueording to limitedstudies this is probably because mostlo the virus are ulreadv medicallyby malnutrition and various diseases,malaria, schistosomiasis. tuberculosis,transmitted diseases, and because iheyhelp in the late statics ot the diseasethat luberculosii epidemics are occurringwhere there are hiv epidemics acute malariatreated by bloodnfusion because olraising the risk of hiv infection someslowly procressine; cancers loos known inas kaposi's sarcoma, take an aggressive fatalaids patients sexually transmitted diseases,widespread in african cities, mayof hiv by allowing tbe virus tu enterthrough open genital sores

A second virus

econd aids virus identified asould contribute io the wider spread of the aids epidemic, particularly in wert africa french researchers have confirmed infection by0 west african patients, of whomad aids although genetically different from tlie hiv virus found in other countriess related and can cause aids. the enieigence ofastly complicates vaccine development, and blood-screening tests will have to be modified to pinpoint (it newjaaaaeja

ECRET

a dcicriplion of aid5 and hiv

geographic and biologic origins ol acquired immune deficiency syndrome (aids) aie no! dear although serological evidence indicates ihat aids could have been present in africa as earlynd in the united stateshe disease now known as aids was first noted in ihe medical literatureeveral outbreaks ot pneumocystis carlnii pneumonia andsarcoma, diseases usually seen only in persons with well-documented immune system compromise, occurred in previously healthy young male homosexuals in new york and california in ihe early ifhos. early hypotheses on the cause of the syndrome centered on certain aspects ot the lifestyle ol male homosexuals, including use ol recreational drugs and promiscuity however, as mure AIDS victims other dian male honio-sciuali became known, circumstantial evidence pointed to an inlectlous agent suchirus, as being the cause of aids (u)

research conducted in the united slates and france culminated in nearly simultaneous announcements from both countries3irus causing AIDS had been found. the agent was termed "ivmphadcno-pathy associated virus" (lav) by the french,eil lymphotropic virus type iii'*y the americans. since that lime, ihe astern alio ha* been known as "AIDS associated retrovirus"nd mrot recently. "human immunodeficiency virus"iv now has been accepted as standardby mosl workers in the field. the nomenclature became more confused8 by the discovery of two more human retroviruses in africa one. now called htlv-1v. wasealthy senegalese, and the other, first calledowas isolated from aids patterns in west africa.ppears lo cause aids,oes not. however, not all researchers ate in agreement as to the relationship between these fwo viruses and aids also, other viruses have been isolated from monkeys in central afitca, and genetic similarities noted between these monkey (simian)and htlv-tv point to die possible evolution of hivimian virus, (o)

all agents associated with aids are retroviruses. the genetic information of these viruses is encoded in single-strand ribonucleic acid (rna* in order for ibe virus to replicate and lo become integrated into the chromosomes of an infected cell, the viral hna firrl must be transcribed into double-strandacid (dna) by means ol an enzyme, reversethis rna-dna flow ol information is tbef most genetic message movement, and is ibe source of the virus' family name. *'retrovir!-dac"(v!

this retrovirus family currently contains threewith hiv provisionally placed in ihelowhe lenllviiiDae (and hiv) are characterizedengthy latent (incubation) period between initial infection and expression of symptoms. in ibe case of hiv. this incubation can last for years the best cut tent estimate is thatoerceni of hiv-infected individuals will proems lo aidsear* of initial infection wilh hiv, and time will tell whether hiv infection invariably previews lo aids. some authorities believe thai an individual infected with either hiv oiemains infective for life, regardless ol whether aids symptoms are ever(u)

although no consensus exists as lo what actually triegers aids disease progression, roort hypothesesco-infection by another agent. co-infection could activate the aids virus through continual immune stimulation. for example, samples of two groupsigh prevalence of aids {homosexual males in the united stales and heterosexual males in zaire! also were found toeryhepatitis b, eytomaaclovlrus, and epstein-barr virus co-infectlon also could trigger aidsvia the immunewn chemical eom-munkcatton system hiv seciuesleredympliocyles could become activated when tbe lymphocytes respondhemical message indicating attack by another agent, (ul

human genetic variability also could afted any aids activation hypothesis recent research indicates that an inherited factor may enhance either one's susceptibility or resistance to progression from hiv infection io aids, (ul

prospects for development of either an effective cure for hiv infection or an aids vaccine in ihe near term ate not good the very nature of hiv makes theifficult target not only does hiv sequester itself intimatelyital portion of the human immune system, il is also genetically unstable. although the situation is not hopeless, even optimistk medicalbelieve that any effective aids vaccine or iberapv is al least five toears oway. until ttien, prevention of aids will depend almost entirely on the effectiveness of public education programs and oliver measures designed to reduce risk of exposure io hiv

is possible (hat mure 1uv strains mayor other transmission vectorswill add newcomplcxlties to control andefforts. h

Prospects for Epidemic Spread

aids has an apparentno preventive vaccine, and no cure.menace ts crowing and out of control incount no. it wid ravage (he population'eastern, and southern africa, and probably

will spread disastrously through relatively untouched

west africa

threatens sexually activemales and females, nearly one-halfillion population rates of infectionwith little prospect that any method ofwithin the next few years willthe epidemic tim magnitude and progressionaids disaster are alarming, and the future, atthe nest decade,among high-risk male groups. air force officer blood donors wereercent infected, midlcvel bank professionals wereercent infec(cd, and, in one sizable study of infected men in the uilian copperbelt.ercent of those infected wete skilled professionals

kigali rwanda, (he infection rale isercent, up fromearalf jun. j

h' in-tttwe^mri^ffl^igures will mean astimnding urbanin five tond ihey further note the iikelihood of increasing deaths fromhepalitis, and other diseases

testing in zimbabwe's cities lesulted in estimates lor urban populatiutis rangingonservativeercent mfecled lo highs ofercent in some areas overercent ofmen, randomly wlcclod fiom all armywere found to be hiv-infected in

tho number of hiv-infected people could groweveral tens of millions by the end of the lentniy the educated urban class is at high risk who has informally calculated tbat africa stands lo lose at least is percent of its educated people to aids and aids related illnesses in the neatears. estimated rates for the dikes and some high-risk groups indicate (he intensity of the growing catastrophe

one out of five residents of dar ct salaam. tanzania, are estimated to be carrier*,!

researchers in kampala. uganda, warn lhat hiv infection has probably doubled every year for (be past three years withillion ugandans infected; (he sexually active urban population is estimatedercent infected; the army testedercent hiv infected, and hiv and aids prevalence may be the same in (he countryside asn the cities.

in bujumbura, burundi. infection rates have risen over the pas! year5 percent.

ornoercent

- in zambia, approximately IS toercent of the urban population may be hiv-infected,tor infected as wereercent of their newborn

he countryside, where infection rates arcthought to be lower, may simply he three to five yean behind the cities rather than somehow at less risk. there is little doubt that aids will advance into the rural areas. the advance will follow transportation routes and refugee and military rnosements. the lackapability to diagnose aids or test for the vims may lead to low recognition of the extent oi the epidemic. in remote regions nf rwanda, the rateercentear ago has risenercent today, and along major roadsighercent. other countries also report an acceleration in ihe urbanural spread, while anecdotal reports (ell of some isolated communities in uganda and rwanda that have been nearly depopulated by aids h

ncreases in aids among infants and children can be expected who estimates lhat at least one-half of newborns of infected mother* will be themselves infected, and thai most will die within two year* older children, previously thought to be relatively safe, are also at riskorthern zasnbtanestern doctor estimatesercentar-olds treated for cerebral malaria were infected by blood transfifrom relatives dirty needles used at dimes and for ritual irariing purposes also endangeri

t is unlikely that any country will be spared, and most are tentatively trying to address the problem aids has already spread south to soulh africa andhe islands of madagascar and cape verde blood

secap-pa**^

will star) soon in Mozambique's provincial capitals and in all of Swaziland. Some refuse to acknowledge the magnitude of the problem. For example, Zimbabwean officiabercent of blood donors infected, while medical officers privately estimate rates as high asercent in some urban areas;ercentample of Zimbabwean Army enlisted men tested HIV-infected AIDS patients in Cape Verde and among Soulh Africa's whiteare primarily homosexual or bisexual, mirroring AIDS patterns in Western countries rather than their African neighbors, little is known of AIDS Incidence In South Africa's black population.

Complicoting Factors

resent conditions are grim, and theretrong probability that the scope of the epidemic Is understated Infection rates and cases of clinical AIDS could be much higher than have so far been estimated because of the lack of technical expertise andLitllc is medically known about rural areas, where the majority of Africans live and where large numbers ol cases could reasonably be eipecled lo go undetected, both in countries wilh high incidence of the virus as well as in others that consider themselves so far unaffected Epidemics of measles, tuberculosis, and other endemic diseases could welloolholdDS-weakened populations and spread quickly to others, raising the death toll immeasurably I

iblyH

: populous W

he massive spread of AIDS Into populous West Africarobability, given the presenceew virus strain, contact with people from heavily infected areas, similar sexual mores,ack of urgency to start educational campaigns. The number of carriers and victims could be enormous in Its large population and teeming cities, and it Is no more preparedor economicallyealth disaster titan is cciilral or eastern Afr

o far, West African countrieseported few AIDS cases, and little is known about possible HIV carriers Ivory Coast has published the most sweeping data so5 studyercentersons from all geographic regions were infected,ercentrostitutes,onfirmed AIDS cases Nigeria Is opening blood screening centers in seven cities, and Niger, Ghana, Burkina, and others wilh few or no confirmed cases acknowledge the need for educational campaigns

f increasing concern is the serious risk ofelaled neurological disease- The luture may si sow ihat neurological damage, which mav occur without other symplorru of clinical AIDS, is one of ihe virus's most destructive aspects. Infection of the central nervous system seems to be responsibleariety ofIhat can be severe, Including progressive memory loss, motor impairment, meningitis, encephalitis,symptoms, and chronic dementia. Eventhe full development ol AIDS, Increasing numbers ofmay otherwise appearbe lost to the work force, and the managerial and decisionmaking ability of the bureaucracy and leaders could be seriously

Implications Africa

ffluence, mobility, and lilestylc haveisproportionate number of elites at risk of infection Most of the compact establishment in countries where AIDS is epidemic will be touched personally by the death of family or acQuaintanecs. There will be little leaders can do in the short run lo prevent AIDS oi treat ils victims. Some mav lash out at the West for whai they view as inadequate assistance, or become even more vulnerable lo Soviet disinformationAIDS on the United Stales. Governments' inability to stem the crisis and desire tooreign scapegoat could result in the rise of anti-Western, xenophobic religious or political movements.

or youngoreign education Is now threatened by the AIDS epidemic sweeping through the African upper classes Military and civilianIroiri Kenya, Uganda. Tanzania, Zambia.Malawi, and Zaire have been tested and sent home from Third World. Soviet Bloc, and Western countries. To avoid the perceived disgrace, leaders may curtail sending students abroad. The nextof African leaders, cut off from wide exposure lo outside ideas and methods, could become excessively Isolated and embittered and carry these negative views Into luture dealings wilh (he rest of the world The attempl by some countries lo restrict free international movement or disproporlionately tesl Africans for AIDS will increase bilateral misunderstandings and add to leaders' concerns lhal Africans are being unfairly

eneral commercial disarray could follow rising death tolls or incapacity in management sectors and further depress the economy The concentration of AIDS in important mining, industrial, and population centers, and ils probable spread to rural areas, will adversely affect trade, commercial activity, andproduction. The diminution of

already down byercent in kenya after the western media warned of the aidscause extensive economic damage in countrieson tourist revenues. i

he rapid spread of aids also has important security implications for many african countries. the mission and capabilities of both the armed forces and internal security forces will be adversely affected by aids because of:

bestrictlom on the young male manpower pool.

loss of trained, experienced officers and technicians.

restrictions on military students going abroad for training;

restrictions on the number of foreign military advisers in-country.

with fo

low morale and disci pi in<

restrictions on training and etgii forces-

aggravation of problems

problems with the military civic action role ol somecould actually contribute to the spread of aids to rural,

n addition, the rising incidence of aids could lead to both heightened tensiontale's borders and between african stales ii aids breaks outarticular area, travel restrictions could be imposed and certain regionsountry could become isolated, even quaiantined potential border closings could result in tense political relations,isolalion. and the disruption of key trade and commercial links, all of which mightilitary response

he long ranee impact of aids will beas the loas of today's productive population stunts future development the derm Fgraplncsthat heavily infected countries will experience significant losses of eeonwnk and political middle managers, much of the urban and agrarian work force in some countries, and high proportions of their military personnel young mothers who have deliv-eied in urban clinics and their babies have very high infection rales. if these estimated levels arc found to apply lo large numbers of women, the ensuing widespread illness and death could seriouslytraditional families, which will need to bear ihe brunt of caring lor the ii) and dying as overburdened and underfunded health services struggle with ihe crisis kali dents, media stories that warn tourists of ihe dangers of aids in africa, and putting high-risk cities off-limits

NO".

Western military personnel have already strained relations between some Western and African coun-Iries. It has been mostly Western researchers who have released detailed studies of the disease, often denied bv African official spokesmen. African leaders have protested the tarnished image and economic penalties they say follow release of dau on the prevalence of AIDS. With the crisis deepening, the intensity of such misunderstanding will probably in-

The United States

he United States, along with other Western countries, will be asked to slep up assistance to beteagured Africa. However, development assistance resources are already scaice and Ihe costs of upgrading low-level health systems in most countries arehigh. The supply of basic health resources, such as condoms, syringes, and other medical goods will probably meet with cries for more far-reaching aid Donors' calls for more openness and ihe collection ol hard data will provoke African leaders, who believe such data arc used against them

US tourist, government, and business personnel arc likely to face increased health dangers. Safe seaual practicesajor safeguard against HIV, bul the risk of infection by contaminated blood transfusion or imsterile equipment during emergencies will be high Some businesses may decide to cut risks to their personnel by curtailing or suspending operations in Africa.

Attempts to insulate Western societies from Africa's experience will serve to inflame ami-Western rhetoric, and mayong-lasting effect on every aspect of Western-African relations Negotiations by ihe West for military basing agreements, port calls, and aircraft landing privileges may become, more contentious amid accusations, fed by ihecampaign, that Western and US militarycarry and spread AIDS. The life and death struggle in Africa will push leaders to keep the loyalty of their populations bycapegoat In the short term at least, the United States and Western countries appear to offer only Ihe future hopeaccine or cure, while currently denying ihe massive assistance that would be needed to care for the victims and raise health services to devclopcd-world standardsH

IS SUP

ANNEX AIDS Disinformation Campaign

Drawing on ils worldwide campaign, which claims That ihe United Slain developed ind caused the spread ol AIDS. Moscow's first African effort was anG radiobroadcast in English warning of the danger of AIDS-infected US servicemen from ships and airbuses visiling Mombasa. Keariation of this theme appeared in conjunction with an7 US-Zairiao military eaereise in which an English-language Moscow Kadlo broadcastouthern Africa reported that the United Stales was deliberately spreading AIDS in southern Zaiie loew biological

Exploiting black African sensitivities to racism and so-called Western imperialism, Moscow has taken full advantage of regional fears, ignorance, and some careless Western statements in its efforts to provoke anti-US sentiment. For example.

We believe Moscow probablyandampaignadical Nigerian youth group in6 that resulted in "letters to ihe editor'" of Kenyan. Senegalese, and Ugandan newspapers warningul supplies from North America and Western Europe andthat AIDS came from Fort Derrick.The appearance of these letters before the July OAU summit may have been intended to add to the anti-US lone of ihe moot lam

- The most enduring contribution to theandcampaign hasseudo-Kirn title study by East Germain JAohl' Segal and Kcnald Demhlow. which appeared in Zimbabwe shortly before ihe Non-aligned Movement summit convened in Haiaie at the end ol6 The study awerted thai AIDS could not have originated in Africa and was in fact the product of laboratory letting al Fori De-trick. Made availablearge Third World audience In Harare, this lonelily creation has since appealed io dozens of countriesanil lieen serialized for weeks in Tanranlan. Ghanaian, and other African newspapers despite frequent and repeated US dentals of the Segal allegations

A Chanian riewspaper reported in7 lhal ihe United Stales intended to use Africans as guinea pigs lo lest AIDS vaccines

A Ugandan weekly newspaper in the same month allegod that CIA agents disguised atand Journalists were claiming thaiercent of Ugandans have AIDS in order In prove ihat Africa, tather ihan ihc United States, is the source of

Impliccrtioen

The Soviet AIDS disinformationmost Soviet activebeen highlyIn addition lo introducing ils own allegations Moscow also plays back to Third World audiences events like ihe UK declaration of Kenya as off-hmils lo British military personnel on leave, this raioloroM Soviet claims of Western racism and Imperialism Although ihere Is no evidence that ihe AIDShave had any serious effect on African relations with Ihe Untiedew prcs* reports this year have focused on US military personnel and American tourists as tourers of AIDS- We beboe that Ihe United States is vulnerable to an African backlash much as Britain and otheri have been, not simply because of Moscow's campaign, bul because of Ihe high potential thai US policy statements and media icpotl* on AIDS will be seen by African audience* as bctna racially motivated kaaaaaaafl

National Intelligence Council

7

f'M:

Stephen Oanzansky

, Old Executive Office Building

National Security Council

Herman J. Cohen, Old Executive Office Building National Security Council

Mr. Eric Melby

Special Assistant to the Undersecretary for Economicsew State Department of State

SUBJECT:

ssistant National Intelligence Officer for Africa

, Sub-Saharan Africa: ImplicationsAIDS Pandemic I

1. Attachedraft of the captioned Special National Intelligence Estimate that was coordinated by Intelligence Community Representatives on The National Foreign Intelligence Board is scheduled to approve this draft on 2some minor changes areI thought that an advance copy might be of use to you because AIDS is on the agenda for the Venice economic summit.

2.

Att: As stated

ORCON

Original document.

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