(EST PUB DATE) SUB-SAHARAN AFRICA'S WORSENING AIDS CRISIS

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• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 01508395
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 37
• Document Creation Date: December 28, 2022
• Document Release Date: September 7, 2017
• Case Number: F-2015-02015
• Publication Date: August 1, 1990

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Director of
Central
Intelligence
This Special National Intelligence Estimate represents
the views of the Director of Central Intelligence
with the advice and assistance of the
US Intelligence Community.
0046 021
SNIE*70*90
NI*0010*90
0434-0434
DDI REGISTRY
ODD STAFF S NIC DISSEMINATION
HQS �
,
Se
SNIE 70-90
August 1990
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iIMIMIMIllame Immiumanammuni
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Director of
Central
Intelligence
SNIE 70-90
Sec
Sub-Saharan Africa's
Worsening AIDS Crisis
Information available as of 16 August 1990 was used
in the preparation of this Special National Intelligence Estimate.
The following intelligence organizations participated
in the preparation of this Estimate:
The Central Intelligence Agency
The Defense Intelligence Agency
The National Security Agency
The Bureau of Intelligence and Research,
Department of State
also participating:
The Deputy Chief of Staff for Intelligence.
Department of the Army
The Director of Naval Intelligence,
Department of the Navy
This Estimate was approved for publication by the
National Foreign Intelligence Board.
e31�6 jt,
August 19
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Sub-Saharan Africa's
Worsening AIDS Crisis
� Short of a cure or a vaccine, which are unlikely by the mid-1990s,
there appears to be little opportunity to slow the African AIDS
epidemic. It engulfs all countries of Sub-Saharan Africa and is
spreading at such an alarming rate that we expect 20-30 million
Africans will be infected by the mid-1990s,
� The economic and social consequences for countries that lose
significant portions of their urban adult populations to AIDS will be
debilitating. In some countries, economic productivity will probably
be on a downturn by 1995 and severe stress on the extended family
network will be evident
� Growing international concern with the epidemic may complicate
Western ties� to Africa. Africans will expect the United States and
the West to provide increased assistance to cope with the disease,
and failure to do so may result in harsh criticism and charges of
racism
UI
SNIE 70-90
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Figure 1
Global Human Immunodeficiency Virus (HIV) Estimates: Rates of Infection per 100,000 Persons
lo.,m0t04.5q,
(0.4*Pr
SOO to 1,000' :
Barbados
Djibouti
Gambia. The
Honduras
Kenya
Martinique
Nigeria
St IGtts ft Nevis �
Swaziland
945
532
751
784
556
754
500
898
690
'IAN to S.000
Angullla
Bahamas. The
Bermuda
Burkina
Burundi
���
1168
3536
4,635,-�
3,000
1.122
Caineroon
1,001.' �
sceiltref.4c...Dep;�
4,000:::
200 to 500
Congo
41300''
''..130*Appohho.';1.126
French Guiana 3169
Australia
222
Gabon
1.200
Belize
349
Ghana"';
3;008.;
Benin
322
Guadoloupe
1,006
Botswana
231
Haiti
1,591
Brazil
332
Mozainbique
3,300�."
Cayman Islands
421
Boum:120 representelion it
not novennatily authoritative.
Colombia 200-500
Denmark 230
Dominica 239
France 374
Grenada 450
Guinea 400
Guyana 251
Italy 261
Monaco 411
Montserrat 331
Namibia 453
Neth. Antilles 285
Panama 400
Qatar 209
South Africa 208
Spain 269
St. Lucia 227
St. Via. and Gron. 477
Suriname 239
Switzerland 455
Uruguay 485
Venezuela 260
United States 413
Loss than 200
All other countries
719528 1801009) 8-90
iv
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Key Judgments
Short of a cure or vaccine, which are unlikely by the mid-1990s, there
appears to be little opportunity to slow the African AIDS epidemic.
Africans are not changing sexual behavior patterns enough to affect the
course of the disease, even though most know more about AIDS/HIV
(human immunodeficiency virus) transmission as a result of education
campaigns.
The epidemic engulfs all countries of Sub-Saharan Africa and is spreading
at an alarming rate through the central and southern regions. We estimate
that between 6 and 8 million Africans are already infected, a figure we
expect to increase to 20-30 million by the mid-1990s. The combination of
AIDS with the myriad of natural and manmade adversities could funda-
mentally change African societies and their relationships with others
during this decade. Humanitarian and health issues will become increas-
ingly important to international and regional leaders struggling to save
future generations from illness and premature death.
African Response
All African countries participate in the anti-AIDS program of the World
Health Organization (WHO) and eagerly accept bilateral aid; nevertheless,
few African political leaders now put the full force of government into the
fight and fewer still share the medical professionals' sense of urgency. The
relatively low political priority accorded the crisis has meant that the
creation of national AIDS committees and the startup of education
campaigns has been excessively bureaucratic and only slowly implemented,
even though external funding has been generous. In South Africa, for
instance, only when a 1-percent infection rate was found among the adult
black population did the government appeal for international assistance in
slowing the epidemic.
Increasing illness and death among elites during the early 1990s may
prompt more aggressive action, but, in view of hard economic times and a
lack of resources, frustrated leaders are likely to seek scapegoats among
unpopular ethnic or regional groups or blame the West for inadequate
assistance. Costs of upgrading health systems to even minimal standards,
however, are beyond the reach of stretched assistance budgets of Western
donors.
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Consequences
The economic and social consequences for countries that lose significant
portions of their urban adult populations to AIDS will be debilitating.
Infection rates in African cities range between 1 and 18 percent or more,
and are rising. Of particular importance for future stability will be the
depletion of the small number of political, military, and economic elites, of
whom a disproportionate share are prone to high-risk sexual behavior,
Unless Africans overcome cultural antipathies to the only means of
prevention currently available�abstinence from casual sexual encounters
and condom use�the resources of governments and economies will be
sapped:
� Although we cannot as yet document AIDS-induced economic change,
we believe that the first indicator will be a reduction in the size of some
labor forces because of increased morbidity and mortality. Preliminary
results from an epidemiological-demographic model suggest that such
declines in the working-age population will be noticeable by 1995 in
Kenya, for instance. But given data shortcomings, we can only speculate
that after 1995 workers will be younger, less experienced, and less well
trained and that productivity will probably be on a downturn.'15F7
The rising incidence of infection among children and mothers is setting the
stage for a new set of problems, including severe stress on the extended
family network in some countries. International health officials predict
conservatively that by 1992 some 200,000 African children will have AIDS
or be infected. African governments rely on the extended family to care for
orphans, sick and dying AIDS patients, and the elderly whose adult
children succumb to the disease. But many families are too poor to assume
these multiple burdens, and, coupled with the fear and prejudice still
surrounding the disease, many victims are shunned by family, expelled by
villagers, and left to fend for themselves.
The disease has made inroads into rural areas, and it is probable, although
undocumented, that current low HIV infection rates there are increasing.
Much of the increase is fueled by urban migrants who, during returns to
the countryside, infect rural residents. There are high rates of infection in
populations along major transportation routes, because of transmission
from truckdrivers and the prostitutes who haunt the truckstops. Regions
beset by warfare are particularly at risk.
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Data Shortcomings
Despite an increase in information on AIDS in Sub-Saharan Africa over the
last several years, data remain fragmented, inconsistent, and, in many, cases,
unreliable. Health care systems remain both rudimentary and inaccessible
to the majority at people. Diagnostic ability in most countries is still
inadequate, survey taking to assess behavioral change has just begun, and
some governments remain defensive and unwilling to release data that do
become available. Modest improvements in testing and information collec-
tion, however, have enabled some refinement of infection and disease
estimates and allowed preliminary projections of the potential spread of
AIDS. We believe that further improvements in data collection will
probably reveal a crisis of even greater magnitude than is portrayed in this
Estimate.
High prevalence of other endemic diseases, and a limitless demand for
AIDS care and control programs will overwhelm already weak health
systems. The cost of upgrading health systems will probably be prohibitive
for governments as well as for foreign donors who foot much of the bill
even now
External Involvement
The USSR, Eastern Europe, and Cuba will probably play minor roles in
Africa's anti-AIDS campaigns. The Soviet Union's AIDS disinformation
campaign has wound down under pressures from the United States and its
own desire to be seen as more cooperative internationally. East European
countries will most likely remain preoccupied with internal changes and
newly recognized AIDS epidemics within their own borders. Although
Cuban doctors and technicians are acceptable to African countries, no
African government has been willing to embark on a policy of lifelong
quarantine of infected persons similar to that in Cuba. Requirements
denying entry to infected African students are likely to remain in effect as
they have not disru ted bilateral relationships between Africa and Com-
munist countries.
Growing international concern with the epidemic may complicate Western
ties to Africa. Africans will expect the United States and the West to
provide greatly increased assistance to cope with the disease. African
disappointment may result in harsh criticism and charges of racism. The
withdrawal of Western business assets or investments because of AIDS
would add to tensions and African frustrations. Finally, ethical questions
raised by any drug or vaccine testing on African populations by Western
researchers may also strain relations.
VII
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Contents
Page
Key Judgments
Discussion
1
Retrospective
1
A Worsening Epidemic
1
Geographic Scope
1
AIDS Among Selected Population Groups
4
Education and Prevention Campaigns
7
Health Infrastructures
8
Cultural Changes
8
Outlook for the 1990s
12
External Involvement
16
The USSR, Eastern Europe, and Cuba
16
The United States and the West
16
Annex: Country Profiles
19
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1-e-eri"-------N777NOFORN-NOCO ACT
The AIDS Virus in Africa
Origins. The origins of the viruses that cause
. AIDS remain a matter of probably unprovable
�� hypotheses. Those who propose African. origins of
the AIDS epidemic presume that a mutant variant
alone or more of sim. tan retrOviruses was accident-.
� ly passed to humans, Where it underwent further
spOntaneous:adaption before emerging as Human
Immunodeficiency Virus (HIV). A more recent.
hypothesis is that human retroviruses have long
� existed and may have mutated repeatedly, eventu-
ally emerging as HIV.: In any �case, Africans
. remain extremely resentful of any implication that
they were responsible for the emergence Of AIDS
� as a global diseaser*,
�
� Virus Variants. HIV is highly mutable. HIV-1,. the
� first virus recognized in the epidemic, has been
found in retrospective examinatiOn of samples
from both. the United States and Africa that had
been collected and preserved in the 1950s. A
second major variant; HIV-2, was. recognized in
West Africa in 1986. It is also prevalent in Angola
and Mozambique. Other variants may emerge in.
: Africa during the span covered by this Estimate,
but solar nonehave been recognized. The ability
�:�:of to produce human disease seems similar
to HIV-1, but further study will be needed to '
� determine if there are major differences in the.
inathatiOn Period or lethality of the two strains.
If54
Modes of Transmission. Heterosexual and perina-
tal transmission dominate the African epidemic.
No matter how effective preventive education and
condoms may come to be, the number of persons
already infected will result in rapidly rising num-
bers of deaths of adults and children for the next
decade:7'0.s
The rate of infection through blood or blood
products is falling as the technology for screening
blood has been successfully exported to Africa.
Blood-borne transmission will :be significantly cur-
tailed in the coming decade provided4he external
assistance for screening continues to be available. :
Homosexual transmission and transmission by
needles shared for drug abuse are probably of
Minimal significance in the African epidemic, ex-
cept among whites in South Africa.
Cofactors. Probably there are multiple cofactors
that either facilitate infection or accelerate the
progression to AIDS. Especially significant in Af-
rica are other sexually transmitted diseases
(STD); particularly those that cause ulceration of
skin or genital:mucoSal surfaces. Also, men who
are uncircumcised have risk of infection
than thOse Who are circumcised.
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Discussion'
Retrospective
SNIE 70/1-87, Sub-Saharan Africa: Implications of
the AIDS Pandemic, published in June 1987, properly
warned of the spread of AIDS to all Sub-Saharan
countries and correctly called attention to an intensi-
fying urban epidemic that puts a disproportionate
number of Africans in the modern sector, including
the military, at high risk. The Estimate also correctly
warned of the possibility of increasing AIDS in rural
areas, especially along major transportation routes, a
rise in AIDS cases among mothers and infants, and of
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numbers of the terminally ill.
The Estimate underestimated the degree of accep-
tance by most African countries of internationally
backed campaigns for public education efforts to
change high-risk sexual behavior. It overestimated a
backlash against the West, East European countries,
and the USSR resulting from mandatory testing and
expulsion of HIV-infected civilian and military stu-
dents, as well as a backlash against African govern-
ments' inability to combat the disease. On the other
hand, although few of the adverse economic and
political trends forecast have occurred, it is probably
too early in the course of the epidemic to measure
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Despite an increase in information since 1987, the
scope and intensity of the epidemic are still difficult to
precisely assess because data remain fragmented,
inconsistent, and unreliable. The vast majority of
Africans do not come under the care of public health
systems, diagnostic ability in most countries is still
inadequate, survey taking to assess behavioral change
has just begun, and some governments remain defen-
sive and unwilling to release data that do become
available. Nevertheless, some modest improvements
in testing and information collection over the past
'This Estimate was initiated by the National Intelligence Officer
for Africa in light of growing concern about the AIDS epidemic in
Africa. It estimates the scope and impact of the disease through the
mid-1990s
1
three years have enabled some refinement of infection
and disease estimates and allowed preliminary projec-
tions of the potential spread of the epidemic.'
A Worsening Epidemic
A rapid increase in reported AIDS and HIV carriers
since 1987 is undisputed. The World Health Organi-
zation (WHO) estimates that by mid-1990 at least 4-6
million Sub-Saharan Africans (one of every 50 adult
men and women) were infected, more than half the
global total. Our own estimate is even higher�
between 6 and 8 million Africans infected, a figure we
expect to increase to 20-30 million by the mid-1990s.
The epidemic still is predominantly urban (about 30
percent of Sub-Saharan Africa's 540 million people
are urban) and hits hardest among the economically
productive 15 to 50 age group. Although infection
rates are usually lower in rural Africa, the epidemic is
beginning to make inroads there as well, and, because
so many women carry the virus, the number of infants
born infected is rising.
Geographic Scope
The epidemic is spreading unabated throughout cen-
tral, southern, and eastern Africa. HIV infection rates
are sure to rise in most countries during the 1990s.
Virtually all of those now infected will develop the
clinical symptoms of AIDS and die within five to 10
years and will be capable of infecting others. Al-
though infection rates are rising almost everywhere,
they are particularly high in certain countries and
cities:
� On the basis of 1989 surveys, 7 to 8 percent of the
population of Bangui, Central African Republic,
were estimated to be infected, as many as 50,000
people. Smaller towns in the north and east are
experiencing rates nearly as high.
'See annex for details and a discussion of data sources and
shortcomings......�
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Figure 2
Human Immunodeficiency Virus (HIV)
Concentrations in Sub-Saharan Africa as of July 1990
Cape
Verde
MiantiC:
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/,-
Mauritania
*Nouakchott
Odle,/ �
Banjul
The Ge Bisiev'te-�
GUill!)a-81Vatikr.:4�Gtilliet)
Fromm
Siena M00/04/4
Ubfirtia.
*Bamako
South
Atlantic
Ocean
Mali Niger
*11 Jam. 11
Nigeria
*tar
Poi". Caaeoofl
:.1)ryi0i0
Equatorial Glair
Sao Tome & Principe*,
Sic Toot'
Infection rates
per 100,000 persons
Mi 5,000 and above
1,000 to 5,000
500 to 1,000
200 to 500
Less than 200
An
Landoll
; Angola
\Namibia
Walvis See., vor*dha
Khartoum*
Sudan
Pretoria
Mb
,Mastre
\ South c_Lesotflo
\ Africa /
Botswana
Gabarens
*Maputo
'land
Ethiopia
Victoria*
Dar as Salaam Seychelles
*Motoni
C01/10TOS .1\
�1,
*Anittinartariuo
M7ciagascar
it
MatoithIS
, o Part
Raurtasa LAM
(FratICO)
Ocean
0 1000 Kilometers
0 1000 MiNs
SW/HWY 1110114011
%
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Research Progress on AIDS in Africa
The West is conducting major research efforts on
molecular virology, anti-HIV drug development,
and HIV vaccines, while African research is con-
centrating on documenting the epidemic, describ- �
ing the natural history of the disease, and studying
the social and cultural context of the African
epidemic. In many instances, African scientists
have collaborated with Western counterparts,
most notably in multinational centers such as
Project SIDA in Zaire. There have been, however,
two exclusively African efforts to develop drugs.
EgYptian and Zairian doctors developed the drug
MM-1 and in 1087 announced it as a cure, al-
though by 1989 they said its benefits had been
overstated. The ingredients of MM-I, and of the:
follow-on version MM-2, have never been revealed
nor made available to other scientists for con-
trolled testing and evaluation. On the other hand,
the drtig KEMROIV, developed by Kenyanlre-
searchers, is undergoing evaluation tests sponsored
by WIleitti.
. Available drug therapies only temporarily slow the
progression to AIDS. Each eventually loses effec-
tiveness, and none is curative. The drugs have
Typical of most countries, interviews of civilian and
military personnel in Congo showed that the majority
of people knew AIDS was fatal and that it was
transmitted sexually and through blood products but
still characterized multipartner sexual liaisons as ac-
ceptable demonstrations of male virility; they said
condoms were too expensive, culturally undesirable,
and rarely used. Even in hard-hit Uganda, President
Museveni condemns condom use for AIDS prevention
as leading to moral degeneracy and prohibits distribu-
tion, calling instead for a return to traditional monog-
amous marriage. Moreover, in most countries, women
who insist on condom use are often accused by
husbands and family of ignoring traditional values in
an effort to limit fertility and are at added risk of
beatings, divorce, or expulsion from the extended
11
� proved too Costly for use in African medical.
settings. Success in vaccine development remains
uncertain and any practical results are at least 10
years into the future. Nevertheless, in anticipation
that ultimately both drugs and vaccines of sujfi-
dent promise to justify feting in humans will be
found, WHO and governmental agencies have done
advance planning as to where such testing can be
done most Ociently: Medically, tests of African
populations With their very high rates of new
infect iOns could provide clear answers years earli-
er than tests al Western populations with much
lower rates of infections., No'matter how well
justified scientifically or Carried out with informed
consent of governments and participants Under
WHO protocols; however, such testing could be
viewed by some Africans as exploitation of impov-
erished blackSfor the benefit of wealthy whites.
Even after a vaccine that prevents infection is
developed and Used, there .Would be 10 to 15 years'
of wind down while the disease ran its course in
those already infecteer7*-..�
family. Finally, the status of motherhood far out-
weighs the risk of HIV infection, and women typically
assess the risk of bearing infected children who will
soon die as no greater than the risk of infant death
from one of a myriad of childhood diseases.
Unable to care for the burgeoning caseload of pa-
tients, authorities rely on the extended family to take
over the burden. Many families accept the financial
and psychological obligation, but others expel the sick
from family and village because of economic hardship
and the fear and prejudice that surrounds the disease.
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A study of the area around Rakai in Uganda of a
newly recognized outcome of the epidemic�thou-
sands of orphans�illustrates the breakdown of tradi-
tional coping mechanisms. The area is nearly bereft of
young men. and women, and about half of those who
remain are infected. Some 24,500 children are or-
phaned in the town of Rakai and 13,800 in nearby
Hoima. Nearly half of the surviving caretakers are
either too young or too old to provide both child care
and farm labor, resulting in a food shortage in a once
fertile area. On the basis of data from Rakai and the
estimated rapid spread of AIDS throughout the coun-
try, researchers estimate that Uganda will be grap-
pling with the needs of 600,000 to more than 1 million
AIDS-related orphans in coming years. Problems of
near this magnitude can be expected in neighboring
Tanzania as well as Burundi, Malawi, Rwanda, Zam-
bia, and Zimbabwe
With little help coming from modern medicine, many
Africans turn to traditional healers. While some
healers do little more than squeeze money from the
poor and credulous, others are seriously confronting
the disease. The leaders of the 200,000-strong Pan-
African Traditional Healers' Association recently
consulted with Western medical practitioners and
then issued guidelines for AIDS protection. They
directed members to urge Africans to follow tradition-
al sexual behavior, identified as abstinence before
marriage and a monogamous marriage relationship,
and included permission for condom use. Many AIDS
experts believe that more interaction between tradi-
tional healers and AIDS educators could help in
control efforts.
To help fill the gap left by overburdened health
services and traditional structures, community based
self-help and support groups are springing up in many
countries, although they so far reach only a minuscule
portion of those in need, are grossly underfunded, and
occasionally meet strong local opposition. Internation-
al organizations are beginning to lend their expertise
to these struggling groups, but few local or national
governments have as yet offered assistance to such
private-sector initiatives.
Outlook for the 1990s
Social, economic, and political repercussions from a
soaring AIDS epidemic will confront all Sub-Saharan
African governments and populations before the mid-
dle of the decade. The upward spiral of AIDS cases
and deaths are but the leading edge of the disaster--
soon to follow will be hundreds of thousands more
victims, most already on the brink of death. As grim
as the situation is, the epidemic is probably understat-
ed by available data because of the lack of expertise
and resources to conduct systematic evaluations. We
believe that improvements in data collection will
reveal a crisis of even greater magnitude than is now
appreciated by most African leaders.
The impact of the epidemic in populous West Africa
is beginning to be felt. Most governments ideally are
in a better position to stem the rapid spread of
infection than were countries hit several years ago as
the disease is better understood and WHO's preven-
tion strategies are already defined. Nevertheless,
West Africa's leaders lack a sense of urgency, and the
pattern of lackluster response seen in other regions is
likely to be repeated. Thus, the number of carriers
and victims in West Africa's large population and
teeming cities could become enormous
Urban youth, military personnel, and the more afflu-
ent classes have shown little inclination to change the
high-risk sexual behavior that fuels the epidemic.
Such elite groups are as culturally opposed to strict
monogamy or condom use as are powerless and less
well-educated citizens. As the epidemic spreads, how-
ever, and depletion of their numbers increases, the
elite are likely to insist on government attention to
their personal and class crises.
Although we have not yet observed important political
effects of AIDS in Africa, we believe they will be
evident in the hardest hit countries by the mid-1990s:
� Increasing instability. A worsening AIDS crisis will
add yet another burden on already fragile govern-
ments struggling with intractable problems such as
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rat,
debt, economic stagnation, population growth, envi-
ronmental degradation, and sharpening conflicts
over a range of domestic issues stimulated by great-
er pluralist expression.
� Scapegoating. Under pressure to do more on AIDS
despite scarce resources, African leaders are likely
to search for scapegoats. This may lead to repressive
or discriminatory policies toward unpopular ethnic
or regional groups, or AIDS victims themselves, and
fuel anti-Western sentiment.
� Manpower losses. Death rates among political lead-
ers will probably reach levels that begin to impair
capabilities to govern. In addition to sheer loss of
trained manpower, rulers and civil servants may
come to share a growing fatalism within their
societies about AIDS that overwhelmingly favors
short-term noals and satisfactions over long-term
solutions.
The effects of AIDS on African militaries and inter-
nal security forces in the next few years will have
important security implications. Although we have
not yet observed degradation of military capabilities
from AIDS, serious problems will impair readiness
and effectiveness in the future:
� Reduced performance and loss of trained manpow-
er, experienced officers, and technicians.
� Restrictions on military students going abroad for
training; foreign military advisers in country; and
training and exercises with foreign forces.
� Aggravation of morale and discipline problems.
� Strains on military medical systems.
� Poor civil-military relations if the armed forces are
perceived by the populace as contributing to the
spread of AIDS
The growing epidemic could also lead to heightened
tensions within and between African states. If infec-
tion levels are high or AIDS cases numerous in a
particular area, travel restrictions that might be im-
posed could result in tense political relations, diplo-
13
matic isolation, the disruption of key trade and com-
mercial links, border closings, and expulsion of for-
eigners
It is not yet possible to document an AIDS-induced
economic decline, but analysis of populations most
affected by the disease----15- to 50-year-old urban
dwellers�strongly implies that the economic and
political elites, and the youths who are training to
enter their ranks, are likely to fall victim to the
disease in large numbers. The possible loss of a
significant portion of the already small cadre of
skilled workers and professionals could result in de-
clining productivity and less capable management
within five or six years. Replacements will, of necessi-
ty, be less well trained and experienced, which could
further aggravate economic difficulties
High prevalence of other endemic diseases, and an
limitless demand for AIDS care and control programs
will overwhelm already weak health systems. The
overall quality of health care is poor and has declined
under the hard economic conditions of the 1980s.
Governments are unlikely to recover the ground lost
and will falter badly as AIDS cases skyrocket. The
cost of upgrading health systems will probably be
prohibitive for governments as well as for foreign
donors who foot much of the bill even now. As a
result, AIDS patients will remain untreated and the
myriad of other diseases could gain new strength.
No African population is likely to stop growing
altogether, although in some countries growth will
slow by the end of the decade as rates decline by a
percentage point or more. The populations of cities
and heavily infected rural provinces, however, could
well experience outright decline.
Slowed population growth will not ease social or
economic problems in the short term. The highest
disease rates and greatest number of deaths are
already occurring in the productive, economically
active 15 to 50 age group, with maximum rates in the
group 20- to 30-years-old. The result of losses in this
group could be fewer teachers for even reduced
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student numbers; surviving health professionals over-
whelmed by increased patient loads; or a slowing of
business activity and a further reduction of economic
resources.
The costs of shoring up institutions to meet the health
crises will deplete the already shrinking pool of resources,
goods, and money for economic and social development.
As competing needs are sorted out, political stability
could be threatened if those parts of society that lose in
the resource struggle become disaffected enough to be-
(b)(3) come the locus of serious political dissent.
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External Involvement
The USSR, Eastern Europe, and Cuba
The initial flurry of anger and resentment shown by
African countries over the testing and deportation of
infected African students from the USSR, East Europe-
an countries, and Cuba has died down and resulted in
only negligible political fallout; similar policies in West-
ern countries are also not contentious. New student
groups are arriving in Cuba on schedule, and any
reductions in African training slots in the USSR or East
European countries will have more to do with, political
changes in those countries than with the AIDS epidemic
in Africa. The Soviets, besieged with domestic problems
and a rise in its own epidemic, have recently begun to
seek cooperative research efforts with the United States,
but have so far made no dramatic overtures to aid
Africa's anti-AIDS campaigns. Fast European countries
are also struggling with changed domestic situations and
newly recognized epidemics in some, such as in Roma-
nia, and are unlikely in the near term to be significant
players in Africa's AIDS struggle.
Cuba continues its decades-long policy of using medical
assistance to maintain involvement in Africa. But we
expect Cuba to be only a minor actor in the AIDS
struggle. Although countries eagerly accept Cuban
medical experts, Cuba's stringent policy of lifelong
quarantine for its infected population has not been
(b)(3) copied in Africa
The United States and the West
Growing international concern with the epidemic may
complicate Western ties to Africa. Western countries
will continue to consider ways of limiting the exposure
Soviet Disinformation Campaign
Over the past two years, Moscow has backed
away from its allegations in the Soviet and
international media that the United States is
responsible for inventing and spreading AIDS.
Since the end of 1987, there have been only
about a half dozen replays of AIDS disin-
formation in the Soviet press. US protests and
exposure of Soviet involvement seem to have
convinced the Soviets that such operations may
harm their new, more cooperative international
image. In an October 1987 news conference,
representatives of the Soviet Academy of Sci-
ences discredited the AIDS stories, stating that
"no serious scientists" believed the allegations.
Furthermore, when a Radio Moscow broadcast
in early March 1988 claimed that AIDS was
manufactured in the United States and Western
Europe, Moscow�following a strong US pro-
test�stated the official Soviet position that
AIDS was not manmade. Radio Moscow offi-
cials blamed the broadcasts on a "low-level
nut" and bureaucratic inertia.
The AIDS disinformation campaign was always
strongest in Africa, where Soviet placements
found a ready audience. Over the past two
years, replays of AIDS stories have steadily
declined in Africa and elsewhere, and, although
they will continue to receive some attention in
Third World media for many years to come, we
believe that Moscow will refrain from providing
any new stories or replaying old ones
of their military personnel to the disease without
offending host governments. US and Western busi-
ness interests could curtail or suspend operations in
fear of health risks to their personnel or because of
highly infected indigenous labor forces and further
depress African economies. Pushed to respond to an
increasingly difficult domestic situation and a per-
ceived loss of prestige internationally, African leaders
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may in frustration lash out at the United States and
the West, even though the major hope for a cure or a
vaccine appears to lie with Western research
The cooperative relationships forged between the
West and Africa over the past three to four years to
combat the disease may begin to falter. The value of
internationally assisted prevention programs, bilateral
aid for condom distribution and technical training,
and cooperative research efforts may come to seem
insignificant in the eyes of Africans as the rising toll
of illness and death engenders a sense of isolation and
panic. Africans will expect the United States and the
West to underwrite broader and more costly assis-
tance programs to cope with the disease. However, the
massive assistance needed to raise health care pro-
grams to even minimum standards are probably out of
the question in days of stretched assistance budgets.
African disappointment may result in bitter criticisms
and charges of racism. Moreover, the ethical ques-
tions raised by any drug or vaccine testing on African
populations by Western researchers may also strain
relations.
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Annex
Country Profiles
The profiles give an overview of AIDS cases, HIV
infections, and information on the institutional re-
sponse of Sub-Saharan countries to the epidemic
AIDS cases reported to WHO are the cumulative
cases most recently reported by the countries to the
World Health Organization (WHO) and entered
March 1990 in WHO's monthly compilation of cases
worldwide. These numbers grossly underrepresent ac-
tual AIDS cases in Africa because of rudimentary
health systems and their inaccessibility to the major-
ity of people, the inadequacy of health surveillance
and reporting systems, and political sensitivities about
the intensity of the epidemic
HIV prevalence is estimated from the results of the
testing of blood samples from selected population
groups such as blood donors and those considered at
high risk of HIV infection. The reliability of these
screenings as the basis for estimating infection rates
for similar larger populations or countrywide is limit-
ed; the size of the tested population is usually small or
nonrepresentative of larger populations, testing proce-
dures are sometimes medically inadequate, and analy-
sis and recordkeeping is often methodologically
flawed amd incomplete. Test results cited here are
illustrative of the accumulating body of HIV infec-
tion data, but they are not a definitive compilation of
screening results
AIDS program components within the Plans promot-
ed by the World Health Organization/Global Pro-
gram on AIDS (WHO/GPA) include education and
information campaigns, protection of the blood sup-
ply, and care for the infected and ill. Nearly all Sub-
Saharan countries developed a Short-Term Plan
(STP) that institutionalized AIDS activities�orga-
nized National AIDS Committees, identified health,
communications, and research resources�and then
advanced to a Medium-Term Plan (MTP) strategy for
19
multiyear prevention and care programs. Bilateral
and multilateral donors and the WHO/GPA provide
the bulk of funding. There are also AIDS activities
outside the WHO/GPA umbrella, such as bilateral
technical and commodity assistance, national and
international medical and behavioral research, and
counseling and education initiated by private volun-
tary organizations
Health budget gives the amounts allocated to general
health care by the country�rarely are country funds
added to the WHO/GPA and donor AIDS projects.
Budget figures are often unreliable as a gauge of
health care spending; actual expenditures or monies
misdirected or wasted are unknown; and projects
funded outside of Health Ministries such as military
medical care for civilians are not included, nor are
foreign donor projects that often comprise a substan-
tial share of delivered health care. Health care as a
percentage of the national budget and per capita
spending are also suspect but are provided as indica-
tors of the government's priorities and its ability to
deliver health services
Angola
AIDS cases reported to WHO: 104 (1.22 per hundred
thousand population) as of December 1988.
AIDS program: MTP adopted
Benin
AIDS cases reported to WHO: 60 (1.29 per hundred
thousand population) as of September 1989
HIV prevalence: no data available
AIDS program: MTP adopted in June 1989 at an
estimated $5.3 million, with pledges for the first year
of $1.7 million.
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Health budget: in 1986, 6.9 percent ($3.1 million) out
of a total budget of $43 million was allocated for
health care; per capita spending was estimated at
$2.15 per year
Botswana
AIDS cases reported to WHO: 87 (7.06 per hund
thousand population) as of January 1990
HIV prevalence: in March 1990 there were 650
confirmed infections. Surveys found two infected out
of 200 to 300 tested at a mining hospital; 4.3-percent
infected out of 257 hospital patients; 1.2 percent out
of 500 tested at an STD clinic
AIDS program: MTP adopted, with $3.5 million
pledgrcent of the funding for the first two
years
Health budget: the 1988/89 estimated health budget
was $23.5 million, 5.6 percent of total budget
Burkina Faso
AIDS cases reported to WHO: 555 (6.37 per hundred
thousand population) as of March 1989.
MV prevalence: blood tests from 1,300 donors at the
Ouagadougou blood bank between November 1988
and March 1989 yielded HIV infection rates of about
10 percent. A study of 310 pregnant women from
Ouagadougou showed 10-percent infected; 6 percent
of 100 prostitutes in Ouagadougou; and 12 percent of
70 prisoners in the capital were infected. A survey in a
remote northeastern town showed 2.9 percent of 184
people selected from the general population infected
with 1-IIV-1 and 3.6 percent with HIV-2, and 6.2-
percent infected of 242 hospital inpatients. Approxi-
mately two-thirds of all infections are reported to be
dual HIV-1 and HIV-2 infections, the rest are HIV-1
infections.
AIDS program: MTP adopted in October 1989, with
donor pledges of $2.1 million for the first year of a
(b)(3) multiyear $3.9 million program
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Health budget: 1987 figures show the health care
budget was 6.6 percent ($17.7 million) of a total
budget of $268.8 million; estimated annual per capita
spending was $2.10.
Burundi
AIDS cases reported to WHO: 2,355 (43.16 per
hundred thousand population) as of June 1989.
HIV prevalence: tests of 6,000 people in Bujumbura,
and in 15 other towns and rural areas in May-June
1989 showed that for the age group 15 to 24, 10.2
percent were infected in Bujumbura and 9.1 percent
in other urban areas; in ages 25 to 34, 19.5 percent in
Bujumbura and 17.3 percent in other urban areas;
and in ages 35 to 44, 18.9 percent in Bujumbura and
17.5 percent in other urban areas. In rural areas in
the age group 15 to 44 the infection rate was 0.71
percent. Blood donor candidates were 10.6-percent
infected in 1989
AIDS program: MTP adopted.
Cameroon
AIDS cases reported to WHO: 78 (0.72 per hundred
thousand population) as of March 1989.
AIDS program: MTP adopted in 1988
Cape Verde
AIDS cases reported to WHO: 28 (7.69 pe hundred
thousand population) as of December 1989
AIDS program: STP adopted.
Central African Republic
AIDS cases reported to WHO: 662 (23.59 per hun-
dred thousand population) as of December 1988.
HIV prevalence: April 1989 surveys: 8 percent of 186
pregnant women at Bangui hospital were infected; 7
percent of 243 surgical and trauma patients; and 30.8
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percent of 37 TB and gastroenterology patients. In
April 1989, 7.9 percent of 139 people in the northern
town of Birao were infected and 7 percent of 212
persons in eastern Zemio.
AIDS program: MTP adopted in July 1988 with a
budget of $5.6 million, with $1.6 million for the first
year.
Health budget: the 1988 health budget of $12.5
million is 9 percent of the total budget of $138.1
million. Foreign assistance accounted for $9.1 million.
Per capita 1988 government expenditures were $4.50;
government plus foreign aid per capita expenditures
were $7.70.
Chad
AIDS cases reported to WHO: 21(0.42 per hundred
thousand population) as of November 1989.
HIV prevalence: an October 1988 to February 1989
study among 15- to 45-year-olds in three major cities
found infection rates for N'Djamena of 1.1 percent;
Sarh, 0.5 percent; and Moundou, 1.6 percent
AIDS program: MTP adopted in November 1989
with $2.2 million pledged for the first year.
Comoros
AIDS cases reported to WHO: one (0.22 per hundred
thousand population) as of January 1990.
AIDS program: STP adopted.
Congo
AIDS cases reported to WHO: 1,250 (56.11 per
hundred thousand population) as of December 1987.
HIV prevalence: sporadic blood testing at Brazzaville
blood bank shows infection rates of 6 to 7 percent;
prostitutes in Pointe-Noire estimated to be 50- to 80-
percent infected. At the end of 1988, the population in
Brazzaville was estimated to be 4-percent infected,
Pointe Noire, 8 percent
21
AIDS program: MTP adopted.
Djibouti
AIDS cases reported to WHO: seven (2.13 per hun-
dred thousand population) as of February 1990.
AIDS program: STP completed; work ongoing for
MTP.
Health budget: in 1989, $11.5 million was allocated to
health services, 8.5 percent of the total budget. WHO
estimates that health spending per capita is $55 when
all sources�including health spending under social
services allocations, military spending, and bilateral
and multilateral assistance�are considered.
Equatorial Guinea
AIDS cases reported to WHO: three (0.85 per hun-
dred thousand population) as of June 1989
HIV prevalence: survey of 400 persons in Bata Rio
Muni) in late 1988 found one infection.
AIDS program: STP adopted.
Ethiopia
AIDS cases reported to WHO: 320 (0.64 per hundred
thousand population) as of February 1990.
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Health budget: during the period 1981-82, health care
was approximately 4 percent ($90 million) of total
government expenditures including foreign assistance,
or $2.10 per capit
Gabon
AIDS cases reported to WHO: 51(4.81 per hundred
thousand population) as of January 1990
HIV prevalence: blood samples from an unrepresenta-
tive sample population in Franceville (soldiers, prison-
ers, and mothers with complicated births) showed a
12-percent infection rate
AIDS program: MTP being formulated
Health budget: per capita spending is $3.30 annually.
The Gambia
AIDS cases reported to WHO: 66 (8.26 per hundred
thousand population) as of August 1989.
HIV prevalence: a 1988 survey of 5,569 people over
the age of 15 in 27 locations found an infection rate of
1.7 percent; 1-IV-1 accounted for 6 percent of infec-
tion and HIV-2 for 94 percent. A survey of prostitutes
showed 30-percent infection rates
AIDS program: MTP adopted in August 1989; donors
pledged $558,000 for first year support
Health budget: the 1986 health budget was $1.53
million; per capita spending an estimated $3.50 annu-
ally
Ghana
AIDS cases reported to WHO: 1,077 (7.28 per hun-
dred thousand population) as of October 1987.
HIV prevalence: figures from several small surveys
suggest infection levels between 1.5 and 5 percent.
About 1.5 percent of blood from 1,000 donors (some
of whom may have provided more than one sample)
were infected, while 4.5 percent of prostitutes and
truckers tested were infected.
AIDS program: MTP adopted September 1989 esti-
mated to cost $9.6 million over 5 years.
Health budget: the 1989 health budget was $57,300,
8.4 percent of a total budget of $683,400. Per capita
health expenditure was 37 cents.
Guinea
AIDS cases reported to WHO: 82 (1.16 per hundred
thousand population) as of October 1989
HIV prevalence: tests of blood donors�all relatives of
hospital patients�showed an infection rate of 0.4
percent
Guinea-Bissau
AIDS cases reported to WHO: 76 (7.8 per hundred
thousand population) as of May 1989.
HIV prevalence: 7.6 percent of 707 pregnant women
in Bissau tested between May 1987 and March 1988
were infected; a blood donors survey revealed infec-
tion rates of 11 percent; and health workers in an
obstetric clinic in Bissau had a 40-percent infection
rate in 1989. Most infections are for HIV-2.
AIDS program: MTP adopted in mid-1989 with
pledged funding of $1.4 million
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Ivory Coast
AIDS cases reported to WHO: 3,647 (31.39 per
hundred thousand population) as of February 1990.
HIV prevalence: four national surveys, excluding Abi-
djan, of 4,899 persons between 15- and 65-years-old
showed 7.3-percent urban and 5-percent rural people
infected. A July-November 1988 survey of 1,500
admissions to Abidjan's two largest hospitals revealed
43- and 28-percent infection rates
AIDS program: MTP developed for 1988-95 pro-
gram.
Health budget: the health budget has been 7 percent
of the total budget for the past decade, but, in
midyear 1989, a 25-percent cut was imposed. The
medical supply budget, including drugs, was nearly 18
percent of the total health budget in 1977, but was
less than 1 percent in 1989.
Kenya
AIDS cases reported to WHO: 6,004 (24.66 per
hundred thousand population) as of June 1989
HIV prevalence: of a total 241,448 blood samples
screened through December 1988, the cumulative
overall infection rate was 1.4 percent; Nyanza and
Coast Provinces were 4.5-percent and 3.7-percent
infected, respectively; Nairobi about 0.3 percent; and
rural samples 2-percent infected.
AIDS program: MTP adopted, funding pledges for
September 1989 through December 1990 were $5.4
million.
Health budget: 1989190 health budget is $157,518,
7.1 percent of the total budget
23
Lesotho
AIDS cases reported to WHO: eight (0.47 per hun-
dred thousand population) as of September 1989-7
HIV prevalence: several small studies of high-risk
groups show an infection level of 0.05 percent
AIDS program: MTP adopted with a $2 million
budget
Health budget: 1989/90 health budget is $12.2 mil-
lion, 9.3 percent of the total budget
Liberia
AIDS cases reported to WHO: two (0.087 _hundred
thousand population) as of March 1988.
HIV prevalence: between 1986 and mid-1989, 2,400
blood tests from pregnant women, prostitutes, or
hospital patients yielded 20 infections.
AIDS program: MTP adopted in September 1989
Health budget: in 1989, health services accounted for
approximately 5 percent (LDOL19 million) out of a
total national budget of LD01,362 million. (Conver-
sion LDOL I =US $1.)
Madagascar
AIDS cases reported to WHO: none as of February
1989.
HIV prevalence: screening of small numbers of high-
risk groups since 1987 showed five infected blood
samples by mid-1989.
AIDS program: MTP for 1990 has a $367,000 bud-
get.
Health budget: 1988 health budget was $19.2 million.
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(b)(3) AIDS cases reported to WHO: 2,586 (29.6 per hun-
dred thousand population) as of June 1988
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HIV prevalence: tests of women at an antenatal clinic
showed 16-percent infected in Lilongwe, and 18.6
percent of 247 women at a similar clinic in Blantyre.
A 1989 study estimated 18.8-percent infected
throughout Malawi. Malawian miners in South Afri-
ca had 21-percent infection rates in 1989
AIDS program: MTP adopted June 1989 with a
budget of $11 million.
Health budget: 1989/90 health budget is $31.5 mil-
lion, 7,4 percent of the total budget; per capita
spending is $3.66. A large portion of funding goes to
curative services, only 25 cents per capita is spent on
primary care
Mali
AIDS cases reported to WHO: 178 (two per hundred
thousand population) as of October 1989
HIV prevalence: an estimated 2 percent of the urban
sexually active population is infected, on the basis of
several small surveys, with HIV-2 infections the most
numerous
AIDS program: MTP adopted in November 1989
with pledges of $2 million for the first year
Mauritania
AIDS cases reported to WHO: none as of July 1988.
HIV prevalence: 10 infections were found in 2,635
blood samples since 1985.
AIDS program: MTP formulated.
Mauritius
AIDS cases reported to WHO: four (0.36 per hundred
thousand population) as of December 1989.
AIDS program: MTP adopted
Health budget: 1988/89 health budget was 7.1 per-
cent ($31.9 million) of a total budget of $452.6
million; per capita allocation is $446
Mozambique
AIDS cases reported to WHO: 64 (0.45 per hundred
thousand population) as of January 1990.
HIV prevalence: surveys completed in January 1988
showed 1.7-percent infected in Maputo, an estimated
3.3-percent countrywide. Mozambican miners in
South Africa at STD clinics were 4.7-percent infect-
ed.
AIDS program: MTP adopted April 1988 with a $7.2
million budget for three years.
Health budget: in 1989, 5.4 percent ($41.6 million) of
the total budget was for health care
Namibia
AIDS cases reported to WHO: Namibia gained the
right to membership in WHO after its independence
in March 1990 but has not yet officially reported
cases. The Department of Health and Welfare Ser-
vices confirmed 224 cumulative cases by April 1990.
Niger
AIDS cases reported to WHO: 80 (1.07 per hundred
thousand population) as of December 1989
HIV prevalence: blood donors were found to have a
1.1-percent infection rate in 1989; 12.5 percent of
1,200 Niamey prostitutes were infected.
AIDS program: MTP adopted in January 1990 with
$1.35 million pledged for first year programs
Nigeria
AIDS cases reported to WHO: 35 (0.03
thousand population) as of August 1989
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HIV prevalence: as of early September 1989, a compi-
lation of data from university hospitals and private
clinics showed 40,060 blood tests yielded 138 HIV-1
and 27 HIV-2 infections (HIV-2 tests began in mid-
1989). By late November, 4,500 more tests found an
additional 101 infections
AIDS program: MTP is nearing completion
Health budget: the health budget for 1989 was ap-
proximately $60 million�less than 60 cents per capi-
ta
Rwanda
AIDS cases reported to WHO: 2,285 (31.21 per
hundred thousand population) as of December 1989.
AIDS program: MTP adopted.
Sao Tome and Principe
AIDS cases reported to WHO: two (1.65 per hundred
thousand population) as of April 1989
AIDS program: STP adopted
Senegal
AIDS cases reported to WHO: 307 (4.09
thousand population) as of March 1990
r hundred
AIDS program: MTP adopted
Health budget: of a budget of $34.4 million for 1989,
about 6 percent is dedicated to health care
Seychelles
AIDS cases reported to WHO: none as of January
1990.
AIDS program: MTP adopted.
Sierra Leone
AIDS cases reported to WHO: 21(0.52 per hundred
thousand population) as of June 1989
AIDS program: STP in effect, but the MTP although
formulated, has not been officially adopted.
25
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AIDS cases reported to WHO: 15 (0.18 per hundred
thousand population) as of February 1990.
HIV prevalence: tests of 34,000 high-risk persons
revealed only 22 infected in 1987-88; in 1988, 1,300
high-risk samples showed no infection.
AIDS program: STP adopted
Health budget: 4 percent of the total budget allocated
to health care for the past eight years.
South Africa
AIDS cases reported to WHO: 353 (0.92 per hundred
thousand population as of February 1990
HIV prevalence: 4.7 million people had been tested by
the end of 1989, with about 55,000 people found
infected. The 1989 testing in Natal/KwaZulu: 3.4
percent of prostitutes infected; 8.8 percent of homo-
sexuals; 0.47 percent of women at antenatal clinics;
and 2.9 percent of STD clinic patients. The 1989
testing in Johanne,sburg/Soweto: 1.7 percent of STD
clinic patients; and 0.25 percent of women at antena-
tal clinics. The 1989 testing at STD clinics in Bo-
phuthatswana and Venda STD clinics, 0.2 percent
and 0.92 percent were infected, respectively.
AIDS program: the South African Government allo-
cated about $2.16 million in 1989 for prevention
programs. It does not participate in WHO/GPA
programs, as of June 1990.
Sudan
AIDS cases reported to WHO: 188 (0.77 per hundred
thousand population) as of February 1990
HIV prevalence: 800 prostitutes were screened during
1987/88 throughout Sudan: in northern cities one was
infected in Port Sudan and seven in Khartoum; in
southern cities 25 percent were infected in Juba, and
35 percent in Maridi and Yei.
Ell
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(b)(3)
(b)(3)
I I
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b13)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
(b)(3)
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AIDS program: 1988 SIP extended to 1989/90 with
donor funding; MTP formulated and being amended.
Swaziland
AIDS cases reported to WHO: 14 (1.85 per hundred
thousand population) as of June 1988
AIDS program: MTP adopted.
Tanzania
AIDS cases reported to WHO: 5,627 (22.32 per
hundred thousand population) as of December 1989.
AIDS program: three-year STP adopted in 1987 and
funded for $9 million; MTP adopted November 1989.
Health budget: 4 percent of total expenditures was
allocated for health care in 1987/88
Togo
AIDS cases reported to WHO: 56 (1.62 per hundred
thousand population) as of December 1989.
HIV prevalence: blood donor testing in 1989 showed a
2-percent infection rate for HIV-1 and 1 percent for
HIV-2. Blood (about 6,000 units per year) is shipped
to the United States for testing and an additional
3,000 units per year are tested by the National
Hospital in Lome
AIDS program: MTP was adopted in January 1990
with $1.4 million pledged for first year programs
Health budget: nearly 5.3 percent (about $15.5 mil-
lion) of the total budget was allocated to health care in
1988.
Uganda
AIDS cases reported to WHO: 7,375 (43.36 per
hundred thousand population) as of April 1989
HIV prevalence: a survey conducted between Septem-
ber 1987 and January 1988 tested 11,000 blood
samples from 68 rural and urban populations (exclud-
ing northern and western regions because of civil
instability). The overall infection rate in surveyed
areas was 6 percent. Regional infection rates were:
Central Province-12.1-percent rural and 21.1-per-
cent urban; Western Province-5.7-percent rural and
29.1-percent urban; West Nile Province-6.6-percent
rural and 7.7-percent urban; and the capital, Kampa-
la-17 percent. Overall, adult women were 15.9-
percent infected and adult men 12.2 percent. These
numbers projected to 1990 population totals show an
infected population of 765.272 people over the age of
15 and 25,520 children
AIDS program: MTP adopted
Health budget: the estimated recurrent and develop-
ment budgets of the Ministry of Health have ranged
between 3.5 and 6.1 percent of the total budget since
1985. Foreign assistance provides 60 percent of the
medical care
Zaire
AIDS cases reported to WHO: 11,732 (34.22 per
hundred thousand population) as of January 1990
HIV prevalence: estimates from surveys of selected
populations indicate that 2.9 percent of Zaire's popu-
lation is infected. Surveys of 1987 show 4 to 8 percent
of Kinshasa general population infected (9.3 percent
of those over 15 years); 7.1 percent of pregnant
women; and 40 percent of prostitutes. A 1988 Kinsha-
sa study of workers and wives found infection rates of
4 percent in a textile factory and 5 percent in a
commercial bank, with most infections among manag-
ers in middle- and upper-income brackets. Rural area
rates have been stable for several years at 0.5 to 1
percent.
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AIDS program: MTP adopted
Health bud
cents.
et: 1989 per capita spending was 15
Zambia
AIDS cases reported to WHO: 2,709 (34.4 pe
dred thousand population) as of January 1990
AIDS program: MTP adopted
Zimbabwe
AIDS cases reported to WHO: 1,632 (16.13 per
hundred thousand population) as of February 1990.
27
ret
HIV prevalence: 5 percent of blood samples collected
during July-September 1989 by the Blood Transfu-
sion Service (BTS) were infected. In 1987, BTS blood
samples were 2-percent infected overall, with 15-
percent rates in selected populations. The Red Cross (b)(3)
Blood Donor Program figures showed recently that 32
percent of 20- to 29-year-olds and 28 percent of 30- (b)(1)
39-year-olds were infected (b)(3)
(b)(1)
(b)(3)
AIDS program: MTP adopted in 1988 with a budget
of $13 million
Health budget: 6.8 percent of the 1987
budget was allocated to health care
88 total
(bI)(3)
(b)(3)
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