SUB-SAHARAN AFRICA: IMPLICATIONS OF THE AIDS PANDEMIC

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 00497979
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 22
• Document Creation Date: December 28, 2022
• Document Release Date: September 7, 2017
• Case Number: F-2015-02015
• Publication Date: June 1, 1987

Director of
Central
Intelligence
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NOFOR OCONTRACT-
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THIS ESTIMATE IS ISSUED BY THE DIRECTOR OF CENTRAL
INTELLIGENCE.
THE NATIONAL FOREIGN INTELLIGENCE BOARD CONCURS.
The following intelligence organizations participated in the preparation of the
Estimate:
The Central Intelligence Agency, the Defense Intelligence Agency, the National Security
Agency, and the intelligence organization of the Department of State.
Also Participating:
The Assistant Chief of Staff for Intelligence, Department of the Army
The Director of Naval Intelligence, Department of the Navy
The Assistant Chief of Staff, Intelligence, Department of the Air Force
The Director of Intelligence, Headquarters, Marine Corps
Warning Notice
Intelligence Sources or Methods Involved
(WNINTEL)
NATIONAL SECURITY INFORMATION
Unauthorized Disclosure Subject to Criminal Sanctions
DISSEMINATION CONTROL ABBREVIATIONS
NOFORN� Not Releasable to Foreign Nationals
NOCONTRACT� Not Releasable to Contractors or
Contractor/Consultants
PROPIN� Caution�Proprietary Information Involved
ORCON� Dissemination and Extraction of Information
Controlled by Originator
This Information Has Been Authorized for
Release to...
REL...�
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SNIE 70/1-87
Sub-Saharan Africa:
Implications of the AIDS
Pandemic
Information available as of 27 May 1987 was used in the
preparation of this Estimate, which was approved by the
National Foreign Intelligence Board on 2 June 1987.
SE
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CONTENTS
Page
PREFACE 1
KEY JUDGMENTS 3
DISCUSSION 7
Introduction 7
Factors Contributing to the Rapid Spread of AIDS 7
Sexual Mores and Cultural Factors 7
Inadequate Health Systems 10
Effect of Other Endemic Diseases 10
A Second Virus 10
Prospects for Epidemic Spread 12
Complicating Factors 13
Implications 13
Africa 13
The Soviet Bloc 14
The West 14
The United States 15
ANNEX: AIDS Disinformation Campaign 17
iii
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PREFACE
The initially sporadic and anecdotal reporting of the AIDS pan-
demic in Africa�an important aspect of the increasing global AIDS
problem�presented an alarming picture of a deadly disease spreading
rapidly throughout the region. The volume of reporting increased
immensely in 1987, driven by growing concern over the spread of the
disease in the West as well as in Africa, and to a modest degree by task-
ing for this paper. Most, of the reports remain anecdotal or based on
small medical research programs lacking a strong 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 out of control in Sub-Saharan Africa.
Rather than await more information, we feel sufficient material is
available to serve as a basis for broad conclusions in examining the
serious implications of the AIDS pandemic for African, Soviet Bloc,
Western, and US interests. This paper projects through the next five
years, although some tentative judgments extend further. A crucial
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 mutate to a benign form.
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KEY JUDGMENTS
During the 1980s Africa endured and continues to experience wars,
insurgencies, drought, desertification, insect plagues, famines, under-
nourishment, diseases, dysfunctional economic policies�and now 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. An
estimated 50,000 Africans already have died from AIDS. Of the 2 to 5
million Africans currently infected with the virus, a minimum of
400,000 to a high of 1.5 million could develop the clinical symptoms of
AIDS by 1992, with death to follow soon after. Because a medical
breakthrough in prevention, suppression, or cure, or a benign mutation
of the disease are unlikely, annual African deaths from AIDS after 1992
are likely to continue to climb into the millions.
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 unsterile needles at health centers�a widespread
practice�and countries' inability to guarantee safe blood trans-
fusions will facilitate transmission of the virus.
Because the fundamental AIDS problem is the immune defi-
ciency caused by HIV, infection by the virus leads to a
worsening of endemic diseases.
The recent medical confirmation that there is a second AIDS
virus, HIV-2, vastly complicates the hunt for a vaccine and will
require new blood-screening tests. The second virus was con-
firmed in AIDS patients in West Africa, an area thought to be
relatively untouched by AIDS until now, raising the possibilty of
an epidemic in this populous region.
� The current Western strategy of combating AIDS�information
and prophylaxis�is unlikely 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.
SCCRE-Ts,
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AIDS has an apparent 100-percent mortality, no preventive
vaccine, and no cure. The disease is spreading rapidly and is out of con-
trol, especially among some urban African populations. It hits hardest at
the healthy, productive, 15-to-50 age group which composes nearly one-
half of Sub-Saharan Africa's 466 million population. Rates of infection,
already estimated to be as high as 15 to 25 percent in some urban
groups, are rising, with little prospect that 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 years.
Affluence, mobility, and lifestyle have put a disproportionate
number of urban elites at risk of infection. The World Health
Organization has informally estimated that Africa stands to lose at least
15 percent of its educated people in the next 15 years. Most in the small
elite establishment, if they escape the disease themselves, will be
touched personally by the death of family, relatives, and friends. For
example, Zambian President Kaunda recently lost a son 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, and
their sense of frustration may bring some to lash out at Western
countries, or become even more vulnerable to Soviet disinformation
blaming AIDS on the United States.
Young elites face a curtailment 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 occurred from a growing
list of Western, Communist, and Third World countries. The next
generation of African leaders, cut off from wide exposure to outside
ideas 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 five years behind
the cities rather than somehow at less risk. Already, urban-to-rural
spread of HIV is being traced through increasing rates of infection along
major transportation routes. The lack of surveillance and diagnostic
capability in rural areas may lead to low recognition of the extent of the
spread of the disease. There are anecdotal accounts of near depopula-
tion of some isolated communities in Uganda and Rwanda
The long-range impact of AIDS will be devastating. Heavily
infected countries will suffer irreplaceable population losses in those
groups most essential to their future development: midlevel economic
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and political managers, agrarian and urban workers, and military
personnel. The future may also show that neurological damage among
the HIV infected is one of the virus's most destructive aspects.
Increasing numbers 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, motor impair-
ment, psychiatric symptoms, chronic dementia, or other central nervous
system disorders. Young mothers and their newborn babies are suffering
relatively high rates of infection, and their loss could seriously under-
mine the traditional family, which will have to bear the brunt of caring
for the ill and dying
Almost all African economies are under severe strain already. The
impact of AIDS-related consequences�loss of trained managers and
technicians, loss of tourism, and increasing disinclination of foreigners to
reside in Africa�will almost certainly reinforce current capital flight
and growing decline of foreign capital investmentLll
Government and societal inability to combat the disease will quite
likely result in a rapid rise of xenophobic and fanatic religious and
political movements. Such movements will gain further strength by host
government attempts to fix -blame- on exterior forces, by Communist
propaganda blaming the United States, and by further economic
deterioration. New leaders who blame the West for the pandemic may
rise to power
Soviet Bloc countries are likely to alienate young African elites by
their policies towards AIDS. The testing and deportation of infected
African students from Soviet Bloc countries have brought allegations
of racial and political bias from African media. These actions may also
undermine the Soviet disinformation campaign blaming the spread of
AIDS on the United States. African visitors who come from countries
where AIDS is rampant will face increased social segregation, even if
they test free of AIDS, as host country populations react to public
information accounts of the magnitude of the disease in Africa.
The Soviet Bloc faces an additional serious problem. In 1986 there
were 10,000 Soviet economic technicians in Africa and nearly 4,000
military advisers. Cuba maintains about 37,500 military and 6,000
civilian personnel in Angola alone. AIDS will raise the cost for Havana
and Moscow, and could eventually weaken their resolve to maintain
current levels of troops and advisers in Africa, although there is no
indication that the Soviet-Cuban commitment is wavering at this time.
Military and civilian personnel will face rigorous testing upon return
from Africa.
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The United States and other Western countries will probably be
asked to increase greatly their assistance to Africa. A refusal to divert
or create new development funds to take on the enormous costs of
upgrading health infrastructures will open the doors to harsh criticism
by 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 to need a vigorous counter
to such propaganda. Renewed Soviet accusations that US military
personnel spread AIDS could lead to 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 them economically. A fall in
tourist revenues, mandatory testing of African students, and the possi-
bility of visa and immigration restrictions will inflame anti-Western
rhetoric and negatively affect bilateral relations.
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DISCUSSION
Introduction
1. AIDS could cause greater dislocation, death, and
illness in Africa than any combination of famine,
drought, or war. The World Health Organization
estimates that so far at least 50,000 Africans have died
of the disease, and another 2 to 5 million are infected
with the human immunodeficiency virus (HIV) and
are capable of transmitting the virus throughout their
lifetime
2. Of those currently infected, a minimum of
400,000 to a high of 1.5 million could develop AIDS
within 5 years, with death to follow soon after the
clinical symptoms appear. Conservative estimates are
that 20 to 30 percent of carriers will develop AIDS
within five years of initial infection. Data suggest that
the risk of progression from HIV infection to AIDS
increases with time: an estimated 50 to 90 percent will
progress to AIDS within 10 years of infection. Only
time will tell whether infection invariably leads to
AIDS.
3. The scope and intensity of the AIDS pandemic in
Africa are difficult to assess precisely. The vast major-
ity of Africans do not have access to even the most
rudimentary health care; disease surveillance systems
and diagnostic equipment are grossly inadequate; and
African governments' defensiveness and unwillingness
to face the tragedy have so far largely overridden their
responsibility to collect and report those statistics that
do become available. Nonetheless, the progression of
the pandemic can be broadly outlined from a limited
number of small surveys and published medical stud-
ies
4. The rapid increase in AIDS and HIV carriers in
the last five years is unquestioned. For instance, if we
rely only on statistics from established medical organi-
zations where scientific testing is available, the in-
crease in diagnosed cases and carriers among only
those patients with access to medical care is deeply
troubling and represents only the tip of the iceberg.
� In Uganda, hospital physicians in Kampala did
not see any AIDS cases in 1981; in 1984 they saw
one or two cases per month on average; in 1985,
one or two cases per week; and in the first six
months of 1986, one or two cases per day. 1986
data from blood donors at a Kampala hospital
show that 12.6 percent of 2,000 young male
donors were HIV infected, as were 13.5 percent
of 1,000 women at a maternity clinic. Early
indications from 1987 studies show that well over
20 percent of Kampala blood donors were infect-
ed, and among prenatal women the rate was
about 24 percent.
At University Hospital in Lusaka, Zambia, be-
tween August 1985 and December 1986 the
number of referrals for persons suspected of
having AIDS doubled every eight months, a total
of 1,700 patients over the period. Hospital au-
thorities estimate that there will be about 1,000
patients per month with clinical AIDS during the
first half of 1987.
� In Kenya, blood tests confirmed 10 cases in 1984
among patients suspected of having AIDS; be-
tween 100 and 200 confirmed cases in 1985; and
400 cases in the first eight months of 1986 out of
1,200 patients tested. Among blood donors at
Nairobi hospital, the number of HIV carriers
increased from 1.2 percent in 1985 to 2.2 percent
in 1986. A documented study of 90 prostitutes, a
high-risk group, found that 54 percent were HIV
infected in 1985, and that the same group is now
80 percent infected. Indications are that 4 per-
cent of pregnant women at a large Nairobi
maternity hospital were carriers.
� Only a handful of Zairians sought treatment for
AIDS in Europe in 1982, but today the govern-
ment-established research group, Project SIDA,
estimates that 8 percent of the urban population
are HIV infected, with a 2-percent infection rate
in the general population.
Factors Contributing to the Rapid Spread of
AIDS
Sexual Mores and Cultural Factors
5. Heterosexual transmission is the major way the
virus is spread in Africa, and the culturally traditional
behavior of having multiple sexual partners increases
the risk. Educational programs in some countries, such
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Presence of AIDS Worldwide, 1 April 1987
r
� AIDS medically verified and voluntarily
reported to the World Health 'Organization.
The United States Government has not recognized
the incorporation of Estonia. Latvia, and Lithuania
into the Soviet Union. Other boundary representation
is not necessarily authoritative.
7
I I Countries reporting
Countries reporting
Finland
Philippines
100 cases or moreb.c
fewer than 100 casesc
French Guiana
Poland
Gambia. The
Portugal
Australia
Angola
Ghana
Romania
Belgium
Antigua and Barbuda
Greece
Saint Christopher and Nevis
Brazil
Argentina
Grenada
Saint Lucia
Burundi'
Austria
Guadeloupe
Saint Vincent and
Canada
Bahamas.The
Guinea
the Grenadines
Central African Republic
Barbados
Honduras
Singapore
Congo
Belize
Hong Kong
South Africa
France
Benin
Hungary
Soviet Union
Haiti
Bermuda
Iceland
Sri Lanka
Italy
Bolivia
India
Suriname
Ivory Coast
Botswana
Ireland'
Sweden
Kenya
Cameroon
Israel
Taiwan
Mexico
Cayman Islands
Jamaica
Thailand
Netherlands
Chad
Japan
Tunisia
Rwanda
Chile
Lesotho
Turkey
Spain
China
Liberia
Turks and Caicos Islands
Switzerland
Colombia
Luxembourg
Uruguay
Trinidad and Tobago
Costa Rica
Malawi
Venezuela
Uganda'
Cuba
Malta
Yugoslavia
United Kingdom
Cyprus
Martinique
United States
Czechoslovakia
Mozambique
b Number of cases reported range
Tanzania
Denmark
New Zealand
from 100 to 35,000.
West Germany
Zaire
Zambia
Zimbabwe
Dominican Republic
Ecuador
East Germany
El Salvador
Norway
Panama
Paraguay
Peru
c Due to lack of reporting and
poor reporting procedures, the
actual number of cases is much
higher.
dCollateral data suggests high
incidence of AIDS.
Unc a � ed
710423 (A02683) 6-87
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Presence of AIDS in Sub-Saharan Africa, 1 April 19871
North Atlantic
Ocean
Mauritania
Cape
_Verde
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