SUB-SAHARAN AFRICA: IMPLICATIONS OF THE AIDS PANDEMIC

Created: 6/1/1987

OCR scan of the original document, errors are possible

^iiiiiii kiii- trv-.

this estimate is issued by the director of central intelligence.

the national foreign intelligence board concurs.

The following intottgenee cegcmiiolioris. portkipated in Ihe preporotion of Ihe Estimate;

the centralagency, the defense intefcgence agency, the nosenol security agency, end thecwiotioe ot the department ol slate

Also Parikipoting:

ine aisislanl chief o( staff for intelligence. department of The army ihe director ol naval intelligence, deportment of ihe novy the assistant chiel ef staff, intelligence, department of ihe An force the director of intelligence.arine corps

Warning Notice Intelligence Sources or Methods Involved (WNINTEl)

NATIONAL SECURITY INFORMATION Unauthorized Disclosure Subject to Criminal Sanctions

dissemination control abbreviations

reteosable lo foreign national)

nocontract- not reiecaoble io conirodori or

contractor/mar mat-on irmmvtd

and eittoctton o' inlarmatkn

controieel byhot been auihoriied lor

re'*oie so

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

CONTENTS

Page

KEY

Introduction

Factors Contributing to the Rapid Spread ol

Sexual Mores and Cultural

Inadequate Health Systems

Effect of Other Endemic

A Second Virus

Prospects for 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 abrmiim pictureeadly disease spreading rapidly throughout the region The volume of reporting increased immenselyriven by growing concern over the spread of the disease In the VVcsl 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 conclusions that follow Despite the lack of widespread scientific research, the reporting confirms that this deadly epidemic is spreading oul of control In Sub-Saharan Africa.

Rather than await more information, wc feel sufficient material is available to serveasis for broad conclusions in examining the serious implications of the AIDS pandemic for African, Soviet Bloc, Western, and US interests. This paper projects through ihe 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, (amines,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.

isccause 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 unlil 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 gain widespread acceptance. |

/OftCON

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

Affluence, mobility, and lifestyle haveisproportionate number of urban elites al risk of infection The World Health Organization has informally estimaled that Africa stands to lose at leaslercent of its educated people in the nextears. Most in the small elite establishment, if they escape the disease themselves,ouched personally by the death of family, relatives, and friends. For example. Zambian President Kaunda recentlyon to AIDS, and Ugandan President Museveni's brother, Army Cdr. Salim Saleh, is dying of AIDS. Leaders are helpless to prevent AIDS or treat the victims, nnd their sense of frustration may bring some to lash out at Western count i

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 outside ideits and methods, could become excessively isolated and embittered over treatment they see as singling out Africans unfairly. Those who survive the AIDS crisis may carry these negative views into future dealings with the countries that rejected them and their peers.

Rural areas in most countries have been thought to have lower infection rates, but these areas may simply be three to fivehind the cities rather than somehow at loss 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 the extent of the spread of the disease There are anecdotal accounts of nearof some isolated communities in Uganda and Rwanda J

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

*

and political managers, agrarian and urban workers, and military personnel. The future may also show thai neurological damage among the HIV infected is one of the virus's most dest motive aspects Increasing numUrrs 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 lie rs and their newborn babies are suffering relatively high rates of infection, and their loss could seriouslythe traditional family, which svill have to bear the brunt of caring lor the ill and dying |

Almost all African economies are under severe strain already Tbe impact of AlDS-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 JH

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 hate 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 maintains0 militaryivilian personnel in Angola alone AIDS will raise- the cost for Havana and Moscow, and could eventually weaken their resolve lo maintain current levels of troops and advisers in Africa, although there is no indication that tbe Soviet-Cuban commitment is wavering at this time Military and civilian personnel will face rigorous testing upon return from Africa|

The United States and other Western countries will probably be asked to increase greatly their assistance toefusal to divert or create new development funds to 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.

AeOrWN/NQ0#flnMCr/ORCOrJ

DISCUSSION

Presence of AIDS

to rw wotr HmM

cases or more"'

Australia

Braidanada

Cftoirai Alrlcen Republic

Coo ffo

France

Hatn

Italy

Ivory Coasl

Kenya

Meuco

Holands

Rwanda

Spain

Switzerland

Trinidad and Tobago

Uganda'

United Kingdom

United Slates

T anion ia

West Germany

<emb#

Ziml>jb-^

Countries reporling fewerases(

Angola

Antigua and Ba'build

Argentina

Austria

Batiamas.lftc

Barbaooe

Ro "iir

Bermuda

Bolivia

Botswana

Cameroon

Cayman Island*

i.iid

CtiUa

Chine

Colombia

Costa Rtca

Cuba

Cyri'os

Czoenosiovaliift Denmark

OonHnican Rcputync Ecuador East Get many FI Salvador

French Guiana

Gambia. Tbe

Gnana

Greece

Grenada

Guadeloupe

Guinea

Honduras

Hong Kong

Hungary

IrCarvJ

Jl

Japan

Lesotho

Liberia

Luxembourg

Malawi

Malta

Vtafinioue

Moiambiijue

Maw Zealand

Norway

Panama

Paraguay

Peru

Poland

Portugal

Romania

Sa>nt Chfiitophor and Nevis Saint Lucia Saint Vincent and ihe Grenadines Singapore Sou in Miicn

Soviet Union

Sri Lanta

Sunname

Swoon

Taiwan

Ttiaiiafd

I unisia

Tursfly

nd Ceicos it'anosenezuela 'ugojia'.*

'Sambn el curt rtpvite/rem toO

' Co* loo' noenlto aiif

ii

poorrtdam. H* MlWaiiMprslCMH Si muiB

nclasiifk-d

Presence of AIDS in Sub-Saharan

as in (jingo. kenya, burundi, ucandi. and others, recommend limiting sexual contact to one partner openly addressing seiual behavior is new and eontro-versial however, and personal sensitivities. relatively low literacy levels, and very limited media access will limit the impact of ihe campaigns among thosethat adopt them in kenya, the releasev scries early this year depicting the hazards of casual sextorm of disapproval in parliament and the series was cancelledeordering of lifestyles, will come in time to change the worsening health crisis

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

Inodequate 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,blood transfusion services alone is likely to cost approximatelyimes tbe annual per capita public health budget, accordingtudy. in uganda, annual pet capita spending on health care isoughly the cost of one preliminary blood test for11am

ven though the costs of upgrading may be prohibitive ia many countries, contaminated blood supplies rank as an important contributor torad of the virus in zaire, where blood screenings iwgun onlya study at one hospital found thatercent of all blood donatederiod ol one month tested positive;inimumransfusions per month, hundreds of new hiv carriers could have been generated in contrast, tbe rwanda government ordered ihe screening of all blood donations innd 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 that roost will remain untreated african governments and physicians will have lo makechoices that are rooted in ethics an official in

zaire recentty said on an internationally lelcvised program thai treatment of aids victims was out at the question if treatinenl ol curable diseases *eie io continue the cost of caring forids patients in the untied states is greater lhan ihe entile budgetarge hospital in zaire fl

gains realized through vaccinationund ihc acq nisi! mti of medicines bybe pul in jeopardy the lear that dirtythe virus may lead lo reiectior of theseunless the lack of sterilecanin regional health clinns inmedical personnelthai "educaled"aware of the aids problem. insist onfor theirhile syringes forare dipped in boiling waler and reusedthe short supply |

effect of other endemic diseoses

ihe fundamental aids problem isdeficiency caused by hiv. infection byleadsorsening of endemic diseasestime after diagnosis has been shorter inin western counlrict.to limitedstudies this is probably because mostlo the virus arc ulreody medicallyby malnutrition and various diseases,malaria, schistosomiasis, tuberculosis,transmitted diseases, and because iheyhelp in the late sl-ges ot the discaiethat tuberculosis epidemics are occiiriingwhere there are hiv epidemics acute malariatreated by bloodnfusion because olraising the risk of hiv infection someslowly progressing cancers long known inasarcoma, 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 was

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

A Dcicriplion of AID5 and HIV

geographic and biologic origins ol Acquired Immune Deficiency Syndrome (AIDS) are no! clear 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 carinii pneumonia andsarcoma, diseases usually seen only In persons with well-documented immune system compromise, occurred in previously healthy young male homosexuali in New York and California in ihe. Early hypotheses on the cause of the syndrome centered on certain aspects of the lifestyle ol male homosexuals, including use of recreational drugs and promiscuity HoweveT, as more AIDS victims other dian malebecame known, circumstantial evidence pointed to an infectious agent, suchirus, as being the cause of AIDS (ul

Research conducted in the United States 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" (ItTLV-IM) by the Americans. Since that time, ihe agent aim ha* been known as "AIDS Associated Retrovirus" (AIWJ. and mrot recently. "Human Immunodeficiency Virus"IV now has been accepted as standardW moil workers in the field. The nomenclature became more confused8 by (he discovery of two more human retroviruses in Africa One. now called HTLV-1V. wasealthy Senegalese, and the other, first calledowason! AIDS patients in West Africa.ppears lo cause AIDS,oes not. However, not all researchers arc in agreement as to the relationship between these fwo viruses and AIDS Also, other viruses base been isolated from monkeys in Central Africa, 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 thew viruses is encoded in single-Strand ribonucleic acid (RNA* In order for the virus to replicate and lo become integrated into the chromosomes of an Infected cell, the viral HNA firrl must be Iranscribed into double-strandacid (DNA) by means ol an eniyme. reverseThis RNA-DNA flow of information is thef most genetic message movement, and is ibe source ol the virus' family name. "Rclroviri-dae"(vi

This retrovirus family currently contains threewith HIV piovisioiully placed in ihelowhe lenllviiiDae (and HIV) are characterizedengthy latent (Incuballon) period between initial infection and expression of symptoms. In Ibe case of HIV. this incubation can last for years The best current estimate is thatoereenl of HIV-infected individuals will progress to AIDSeari ol Initial infection wilh HIV, and time will tell whether HIV infection invariably progresses lo AIDS. Some authorities believe thai an individual infected with either HIV oremains Infective fot life, regardless ol whether AIDS symptoms are ever(u)

Although no consensus exists at lo what actually triggers AIDS disease progression, mm! 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 (he United Stales and heterosexual males In Zaire! also were found toeryhepatitis B, eytomagclovlrus, and Epstein-Barr virus Cc-infectlon also could trigger AIDSvia (he immune system'r own chemical cam-muniesnon system HIV sequesteredympliocylei could become activated when tbe lymphocytes respondhemical message indicating attack by another agent, (ul

Human genetic variability also could affect any AIDS activation hypothesis Recent research indicates that an inherited factor may enhance either one's susceptibility or resistance to progression from HIV in) eel Ion IO AIDS, (ul

Prospects for development of either an effectise cure for HIV infection or an AIDS vaccine in Ihe near term are not good The very nature of HIV makes theifficult target. Not only does HIV sequester itself intimatelyital portion of (he human Immune system, il ii also genetically unstable. Although the situation is not hopeless, even optimistic medicalbelieve that any effective AIDS vaccine or therapy is al least five toears away. Until then, prevention ol AIDS will depend almost entirely on the effectiveness of public education programs and Otheresigned to reduce risk of exposureIV

is possible thai mure hiv strains mayor other transmission vectorswill add neww>mplcslties to control andefforts. h

Prospects lor Epidemic Spread

aids has an apparentno preventive vaccine, and no cure.menace is crowing and out of control incountries. it wld ravage the populationseastern, 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 next decade,among high-ilsk male groups. air force officer blood donon wereercent infected, mtdlevel bank professionals wereercent infected, and, in one sizable study of infected men in the urban eoppcrbclt.ercent of those infected weie skilled professionals

kigali rwanda, the infection rale isercent, up fromearalf jun. j

h' in-

^oT^TTigures will mean astounding urban mor-txbty in five toears, and ihey further note the iikelihood of increasing deaths fromhepatitis, and other diseases

testing in zimbabwe's cities lesulted in estimates lor urban populatiutis rangingonservativeercent mfecled lo highs ofercenl in some areas overercent ofmen, randomly selected fiom all armywere found to be fllv-lnfected in

the number of hiv-infected people could grow to several tens of millions by the end of tbr lentmy the educated urban class is at high risk who has informally calculated that africa stands lo lose at least is percent of its educated people to aids and aids related tllncsaes in the nextears. estimated rates for the cities and some high-risk groups indicate the intensity of the growing catastrophe

one out of five residents of dar its salaam. tanzania, are estimated to be carriers,!

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

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

ocnoercent

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

he countryside, where infection rates arcthought lo be lower, may simply be three to bve 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 mermen ts the lackapability to diagnose aids or test for tbe virus may lead to low recognition of the extent of the epidemic. in remote regions of rwanda, the rateercentear ago has risenercent today, and along major roadsighercent. other countries also report an acceleration in ihe urban to rural spread, while anecdotal reports tell 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 hall of newborns of infected mothers will be themselves infected, and thai most will die within two years older children, previously thought to be relatively safe, are also at riskorthern zambianestern doctor estimatesercentar-olds treated for cerebral malaria were infected by blood transfusions irom relatives dirty needles used at clinics and for ritual naning purposes also endanger i

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

TONWACr/ORCON

will start soon in mozambique's provincial capitals and in all of swaziland. some refuse to acknowledge tbe magnitude of the problem. for example, zimbabwean officialsercent 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 palternv 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 andlittle is medically known about rural areas, where the majority of africans live and where large numbers of cases could reasonably be expected 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 welloothold in aids-weakened populations and spread quickly to others, raising the death toll immeasurably i

iblyB

: popular W

he massive spread of aids into populous west africarobability, given the presenceew virus strain, contact wilh 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 ll is no more preparedor economicallyealth disaster titan is central or eastern afr

o far, west african countries have reported 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 future may si sow lhal neurological damage, which mav occur without other symptoms of clinical aids, is one of ihe virus's most destructive aspects. infection of the central nervous system seems lo be responsibleariety of(hat 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

llwnce, 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 litlle leaders can do in the short run lo prevent aids oi treat ils victims. some may lash out al the west for whai they view as inadequate assistance, or become even more vulnerableoviet 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 thrcalcncd 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. soviel bloc, and western countries. to avoid the perceived disgrace, leaders may curtail sending students abroad. the next genera-lion of african leaders, cut off from wide exposure lo outside ideas and methods, could become excessively isolated and embiltered and carry these negative views into future dealings wilh (he rest of the world the attempl by some countries lo restrict free international movement or dlsproporlionately test 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 its 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:

bestrictiom on the young male manpower pool

loss of trained, experienced officers and technicians.

restrictions on military students going abroad for training

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

with fo

low morale and disci pi in<

restrictions on training and eign 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 slates ii aids breaks outarltcular area, travel restrictions could be imposed and certain regionsountry could become isolated, even quarantined potential border closings could result in tense political relations,isolation, and the disruption of key trade and commercial links, all of which mightilitary response

he long range impact of aids will beas the loss of today's productive population stunts future development the draw scraplncsthat heavily infected countries will experience significant losses of economic and political middle managers, much of the urban and agrarian work force in some countries, and high proportions of their military personnel young mot hen who have deliv-eied in urban clinics and their babies have very high infection rates. 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 for the ii) and dying as overburdened and underfunded health services struggle with ihe crisis 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 africanit 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 thev 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 lo step up assistance to beteagured africa. however, development assistance resources are already scaice and ihe costs of upgrading low-level health systems in most counlrics 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 of hard data will provoke african leaders, who believe such data arc used against them

us tourist, government, and business pcrsonisel are likely to face increased health dangers. safe sexual practicesajor safeguard against HIV, bul the risk of infection by contaminated blood transfusion or underlie 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 anti-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, led by ihecampaign, tha! 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 the future hopeaccine or cure, while currently denying ihe massive assistance that would be needed to care for tbe victims and raise health services to developcd-worid standardsh

is sup

ANNEX AIDS Disinformation Campaign

Drawing on ils worldwide campaign, which claims that the United Sum developed and caused the spread of AIDS. Moscow's first African effort was an6 radiobrnadcasl In English warning of the danger of AIDS-lnfectrd US servicemen from ships and an bases visiting Mombasa.ariation of this theme appeared In conjunctith an7 US-Zairiao military eaereisc in which an English-language Moscow Radio broadcast to southern Africa reported that the United States was deliberately spreading AIDS in southern Zaire toew biological

Exploiting blade 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 youth6 that resulted in "letters to the editor'" of Kenyan. Senegalese, and Ugandan newspapers warning of AIDS-lnfecied blood supplies from North America and Western Europe andthat AIDS came from Fort Derrick. Man-land. The appearance of these letters before the July OAU summit may lave been intended to add to the anti-US lone of the meeting.

- The most enduring contribution to theandranipaign hasH'udoM lentitic' study byermain Jakobl' Segal and Ronald Demhlow. which appeared in Zimbabwe shortly before ihe Non-aligned Movement summit convened in Harare at tlie end of6 The study awerted that AIDS could not have originated in Africa and wai in fact the product of laboratory letting al Fort Detrick Made availablearge Third World audience in Harare, this Icnglliy creation has since appealed in dozens of countriesand lieen serialized for weeks in Tanranlun. Ghanaian, and other African newspapers despite frequent and repeated US denials of the Segal allegations

A Chenlan rarwspaper reported Id7 lhat the United Sutes intended to use Africans as guinea pigs lo lest AIDS vaccine*

A Ugandan weekly newspaper in the same month alleged thai CIA agents disguised asand Journalists were claiming thatercent'.un. have AIDS in order In prove lhat Africa, tather lhan the Uniteds the source of

Implications

Tbe Soviet AIDS disiniormatkmmost Soviet activebeen highlyIn addition to Introducing ils ownoscow* also plays back to Third World audiences events like the UK declaration of Kenya as off-hmils to British military personnel on leave, ihls reinforces Soviet claims of Western racism and Imperialism Although ihern Is no evidence that ihe AIDShave had any serious effect on African relations with the Unitedew prew reports this year have focused on US military personnel and American tourists as sources of AIDS- We believe tbat the United Slates is vulnerable to an African backlash, much ss Britain and others have been, not simply because of Moscowampaign, bul because of the high potential that US policy stalemenls and media report* on AIDS will be seen by African audiences a* being racially motivated bbbbbbbI

National Intelligence Council

7

FOR:

Stephen Oanzansky

, Old Executive Office Building

National Security Council

nbassador 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:

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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