The Hidden Cost of AIDS
The pernicious plague, now spreading misery around the world at an alarming rate, may also plunder the global economy over the next decade
The grim reaper is always close at hand. But seldom has he swung his scythe so widely and brutally as in the AIDS epidemic, which is sending millions of victims to their death and may soon become the most costly and catastrophic plague in history. The Black Death killed about 25 million suffering souls in the 14th century. But by the year 2000, 30 million to 110 million people will be carrying HIV, the virus that causes AIDS, up from some 12 million today. In the absence of a cure, all face certain death. "At the present time," says William Haseltine, chief of the human retrovirology division at the Dana-Farber Cancer Institute in Boston, "there is nothing standing in the way of this happening."
The scourge of AIDS travels with impunity and without a passport--it respects no boundaries. Heterosexually transmitted HIV flows freely today in the sex parlors of Thailand, along the truck routes of India, around the sugar cane plantations of the Dominican Republic and in the copper mines of Zambia. A recent study by Harvard's Global AIDS Policy Coalition warns of 57 countries that risk major HIV outbreaks. In Southeast Asia, infections could surge from less than 10 percent to more than 40 percent of the world total by the year 2000.
The human pathos spawned by the AIDS pandemic is immediately apparent. But the worldwide economic cost of this vicious virus has been widely ignored. Until now. A team of U.S. News reporters, working with economist Nariman Behravesh of DRI/McGraw-Hill, has fed the latest epidemiological data for HIV and AIDS into a computer model of the global marketplace. The startling results show that by the year 2000 the epidemic could drain between $356 billion and $514 billion from the global economy. In the worst-case scenario, the dollar loss equals 1.4 percent of the entire world's gross domestic product. That's the equivalent of wiping out the economy of either Australia or India.
The devastating impact of AIDS will slam hardest the poor countries that can afford it least because their economies are already so small and their living standards so low. In the United States, for example, U.S. News estimates that the plague will siphon off between $81 billion and $107 billion by the year 2000--about 1 percent of gross domestic product. Africa and the Middle East, on the other hand, could be faced with AIDS-related losses ranging from 2.4 percent to 4.6 percent of GDP. And in Southeast Asia, the dread disease could slice 1.7 percent to 2.3 percent from GDP by the end of the decade. "AIDS is expected to retard much of the progress made in the late 1980s by countries like India," says DRI's Behravesh. "A 3-to-5 percent decline in their economies will be a significant setback."
Ravaged ranks. Behind these unsettling statistics lies a host of hidden costs not usually associated with AIDS--including lost labor and plummeting productivity. Thailand, for example, could lose up to $8.7 billion in income from people who are struck down by the virus in their prime productive years. India could forfeit a significant chunk of its adult male population to AIDS. And in Central Africa, the plague is now ravaging the scarce ranks of urban professionals. "Considering what it takes to make one neurosurgeon in a developing country and what it means to lose him is a very clear indication of the societalwide impact of AIDS," says Jonathan Mann, director of Harvard's International AIDS Center and chairman of this week's eighth annual international AIDS conference in Amsterdam.
Even while they are alive, AIDS victims produce less and demand more, especially as they wither and waste away in the latter stages of the disease. Productivity drops even further when relatives take time from work or school to care for family members afflicted with AIDS. "This is a particularly big problem in countries where there is an inadequate health-care system," says Behravesh. Other workers are straining to keep up with their daily duties because they must care for orphans left behind in the disease's wake. The number of youngsters orphaned by AIDS could more than double in the next three years to 3.7 million worldwide. And in Uganda's coffee industry, managers complain that work is held back as employees repeatedly are called away to mourn the deaths of friends and relatives taken by AIDS.
The virus also hurts stricken countries by forcing them to divert precious capital from investment to health care. Hard-pressed families that have to devote all of their resources to doctors and medicines have little left to put in the bank, contributing to lower national savings rates. In addition, governments that must shoulder the epidemic's fiscal burden over the next decade will almost certainly be faced with rising budget deficits and expanding levels of debt. Brazil, for example, would need to spend $600 million to adequately help its AIDS victims today. Because the number of cases in the country is expected to quadruple by 1995, treatment costs will undoubtedly soar. That's bad news for a financially strapped economy that is still struggling with a foreign debt load of more than $100 billion despite a recent loan restructuring with commercial banks.
If the human tragedy were not enough to spur a well-funded international crusade to defeat AIDS, economics alone suggest it would be a wise investment. But instead, the resources to attack the disease are meager and declining. In 1991, for example, less than $50 million was provided for the World Health Organization's AIDS program. That's more than 40 percent less than the 1990 total and the first drop since WHO began its AIDS effort. What's more, according to the recent Harvard study, only about $2.70 per person was spent on AIDS prevention activities in North America last year--less than a small bottle of vitamins. The problem in the developing world, which needs far more help, is even worse. In sub-Saharan Africa, for instance, AIDS prevention outlays amounted to only 7 cents per capita last year. Overall, just 6 percent of total global spending on HIV prevention in 1990-91 took place in developing nations, which account for more than 80 percent of worldwide HIV infections.
Weak responses. The U.S. government has come under fire for its timidity in fighting the disease, both at home and abroad. The General Accounting Office recently released a scathing report that criticized Congress for appropriating only $168 million to the State Department's HIV/AIDS program since 1986. The GAO study was followed by a blistering assault on the Bush administration by the bipartisan National Commission on AIDS. The commission ripped into the White House for providing "woefully inadequate" attention to the American AIDS epidemic, and it went on to point out that funding for AIDS prevention in the United States has declined from $497 million in 1990 to $480 million in 1992.
If the statistics leave the brain numb, the images of the world's AIDS victims breaking down bodily, one by one, are heart-rending. In an effort to survey the epidemic's human toll, U.S. News recently sent correspondents to several countries where AIDS has begun to wreak havoc on local societies. Their reports reveal the double-edged sword of the virus, which is cutting short both lives and hopes for future prosperity.
THAILAND Selling sex does not pay
When 21-year-old Suthin returned home after interviewing for a job at a prestigious bank, his village celebrated. The native of Thailand's poor northeast had already inspired pride by graduating from a university, and now he had been approved by the bank's managers for a career-track position. All that stood between Suthin and success was a blood screen. But when the test showed that Suthin--whose name has been changed to protect his privacy--carries the virus for AIDS, he lost the job.
An HIV plague is spreading across Thailand like a forest fire, sparking fear into the eyes of employers, workers and the government. Though the country's first official case of AIDS appeared only in 1984, three years after the disease struck the United States, roughly 1 percent of all Thais are now HIV-infected, twice the U.S. rate, according to estimates by the local Population Development Association. More than 7 percent of Army conscripts from the north tested positive last year. And every day, more than 1,000 additional Thais are infected. Researchers at the Harvard AIDS Institute expect that by the year 2000, the number of Thais afflicted with HIV will balloon to 2 million to 4 million out of a current population of 58 million, largely through heterosexual intercourse. "Already more people are condemned to die from AIDS in Thailand than were killed by the two atomic bombs dropped on Japan at the end of World War II," warns Mechai Viravaidya, a prominent crusader against AIDS.
The epidemic could eventually throttle the country's supercharged economy, which has exported its way to annual growth rates averaging 7.5 percent over the last decade. Since explosive economic growth has already created a shortage of technically skilled Thais, losses from AIDS will add still greater costs in worker training. And the medical bill for treating the afflicted could rise from around $1 million today to $20 million to $65 million a year at the turn of the century.
Tourism troubles. No sector of the Thai economy has more to fear than the $5 billion tourism industry. Though Taiwanese men still arrive by the busload at the Mona Lisa massage parlor, one of several huge sex businesses along Bangkok's Petchaburi Road, sex tourism is believed to be shrinking as foreigners begin to fear for their health. And with good reason. A nurse testing women in a Bangkok "tea house" reported that 80 percent tested positive for HIV--despite the fact that most had been certified free of the disease. "It has scared away tourists," admits Bill Black, general manager of Bangkok's Regent Hotel.
Neither the business community nor the Thai government is going to accept the epidemic without a fight. AIDS education has been placed on the school curriculum and all radio and television channels carry AIDS prevention commercials. Warning that "dead customers are bad customers," Mechai Viravaidya has brought the business world into the campaign. Avon sales teams hand out advice on AIDS with the cosmetics they sell. Automated teller machines at Bangkok banks flash warning messages before dispensing cash. And gasoline stations distribute condoms to combat the virus. American International Assurance has become one of the most active companies in the anti-AIDS campaign, distributing information to all policyholders. The company has more than a moral stake in the issue. To cover health benefits for Thai customers stricken with AIDS, AIA Vice President Suthee Rajitrangson estimates the company will have to spend tens of millions of dollars.
Despite the financial burden, AIA agrees with Thai AIDS experts that the screening of new hires by companies is a wasteful exercise. "What you spend on that you could spend more productively on education," Black argues. Heedless of such logic, more and more companies are vainly trying to insulate themselves from the problem by excluding entry-level workers like Suthin. Says Black, "One thing people are going to have to realize is that they have every chance of losing a managing director as well as a factory-floor worker."
INDIA Driving blindly into an epidemic
Shamsher Bahadur sweats buckets as he pushes his rig 873 miles between Delhi and Bombay on a sweltering 97-degree April day. Folklore among some Indian truckers like the 37-year-old Bahadur has it that the only way to dissipate the heat they pick up from the road and their engines is to release it with a prostitute. They don't have to look far. At nearly every roadside eatery, or dhabba, even at some state tax checkpoints, women await the truckers and their rupees. Some villages are entirely devoted to prostitution. And in this steamy climate, the trucking routes that radiate across India have become the fast lanes for the spread of AIDS in the subcontinent. Bahadur--whose name has been changed to protect his identity--learned this the hard way when he was recently diagnosed as HIV positive.
India, once convinced it could escape as little more than a footnote in the savage drama of the AIDS virus, today is about to become enveloped in a tragedy of epic proportions. Despite official statistics that calculate just 125 victims, an uncounted 6,000 people are now believed to be dying of AIDS in the country, with another 500,000 to 1 million people infected with HIV. And while most of India's economic and business leaders are ignoring the broader impact of the spreading disease, analysts at the World Bank estimate that 1 million AIDS deaths could cost the nation up to $1.6 billion in health care and $8.4 billion in lost income by the end of the century.
The Indian trucking industry, which is careening toward a human and economic calamity, has yet to grapple with the implications of the spread of AIDS. More than three quarters of the truck drivers in the country use prostitutes, and although nearly all of the truckers have contracted sexually transmitted diseases, few use condoms. As a result, in the first effort to randomly check India's truck drivers for HIV last February, nearly 6 percent turned up positive. Dr. S. Sundarraman, coordinator of the Madras-based AIDS Research Foundation of India, estimates that within five years, 30 percent of the truckers entering Madras will be infected.
Ignoring reality. Nonetheless, trucking companies will not even discuss the issue of AIDS, let alone do anything about it. They know that most HIV-infected truckers, like Bahadur, have yet to show any symptoms that keep them from their work. And with high unemployment, trucking companies are counting on a ready supply of replacements. One of the only groups to try to confront the HIV epidemic among truckers, Sundarraman's foundation will go directly to the drivers as it starts to distribute condoms this month at dhabbas situated at city border checkposts.
Even the medical profession in India has shown signs of being insensitive to the impending AIDS debacle. In early January, Bombay's first private AIDS clinic opened. Set up at the initiative of the secretary general of the Indian Health Organization, the clinic was supposed to provide scarce counseling for HIV and AIDS victims. But the clinic was adjacent to other medical facilities, and within two hours of its inauguration, 18 doctors, fearful that its presence would scare away their patients, forcibly shut it down. The clinic has not opened since.
BRAZIL Shooting up the future
In a decaying apartment near the docks of Santos, Claudio, Chupta and Cintia often sit on a couch that smells of rot and inject themselves with cocaine. Drug use is on the rise in this Brazilian port city near Sao Paulo, an increasingly popular shipping point for narcotics smuggled from the Andes. Needle sharing and prostitution, which often accompany drugs, have helped give Santos the highest reported AIDS incidence in South America. Chupta and Claudio have already tested HIV positive. For Cintia, it may only be a matter of time; she supports her addiction by selling her body.
Distracted by the economic disarray surrounding them, few Brazilians comprehend the impact of the fast-spreading AIDS epidemic. In a country where the official unemployment rate has hit a record high of 17 percent and hyperinflation roars along, 22,583 AIDS patients in Brazil have yet to set off an economic panic. "If we lose someone, we don't have any trouble finding a replacement," acknowledges Dr. Michel Patrick Polity, head of the health and safety program at Autolatina, the nation's largest auto maker. "It may seem cold to say this, but what we lose on health care we gain on the pension."
Those who have peered into Brazil's future, however, including Polity, know that the economic malaise is only temporarily concealing the impending AIDS disaster. With an estimated 700,000 Brazilians infected with HIV, the number of AIDS cases is expected to more than quadruple by 1995. "We may not have a problem now, but the future is another matter," worries Polity. "Assuming the numbers we have are correct, the price of AIDS will probably exceed our ability to finance it."
The bill for the growing number of sick AIDS patients will further hobble the government's already lame health sector. Most Brazilian companies do not offer comprehensive medical insurance, and private insurers routinely exclude AIDS from coverage. "Most companies don't want to do anything about this," says Larry Worner, a partner in de Montigny Warner Ltda., a Sao Paulo health-care and consulting company.
Heavy weight. The government cannot handle the burden that business is passing along. Already, the city of Sao Paulo needs to triple its number of available beds for AIDS patients to 1,000. AIDS doctors and nurses are so underpaid--with annual earnings of $7,800 and $2,400 respectively--that 60 percent of the health-care workers trained by the state of Sao Paulo for AIDS work have left their jobs. Nevertheless, hospital costs for AIDS patients average more than $20,000 per year, according to Hesio Cordeiro, dean of the University of the State of Rio de Janeiro. And a new program that offers the drug AZT free to all HIV carriers will cost $25 million in its first year alone. "The system as a whole is going to fall if they don't reform it," says Dr. David Salomao Lewi, director of Sao Paulo's main public AIDS clinic. "We've seen only the very beginning, and we're having trouble dealing with it already."
DOMINICAN REPUBLIC Cutting bitter lives short
Enara Jean-Baptiste's eyes glitter feverishly in the windowless, 10-by-8-foot barrack room on a Dominican sugar cane plantation that he shares with three other Haitian cane cutters. Chronic diarrhea has confined him to his bunk bed for the past five months. His arms and legs are as thin as sticks. These are the classic tropical symptoms of AIDS, but the once sturdy 28-year-old has no idea what disease is killing him and no public health official has shown any interest in testing his blood. As a companion cooks a thin soup of beans and dumplings over a smoking charcoal pile on the floor, he reviews the nine years since he left Haiti, unwittingly revealing the probable source of his inevitable demise: His girlfriend from several years back used to sleep with other cane cutters for money.
Haitian cane cutters like Jean-Baptiste are the backbone of the Dominican Republic's sugar industry, the nation's largest export earner. Local Dominicans refuse to endure the grueling, low-paid work, so the plantations must search out cutters in dirt-poor Haiti, on the western side of the Caribbean island they share. But the sugar plantations' worker communities, called "bateyes," are scorpions' nests of AIDS. HIV infection rates among the 250,000 people who live in the bateyes average about 9 percent, but the rate in one batey approaches 20 percent. Despite a chronic labor shortage that contributed to the decision to close three of 12 government-owned sugar mills in recent years, employers show no sign of concern over the epidemic that is sweeping through their work force. "AIDS has had no impact on the sugar industry," says the State Sugar Council's chief of social welfare programs, Argentina Taveras. "There may be isolated cases, but there is no epidemic."
Exporting disease. Such a willingness to ignore reality stems in part from the fact that AIDS is concentrated within the foreign Haitian community; the Dominican population has less than a 1 percent infection rate. Haitians, who are already more likely to carry HIV when they arrive, greatly increase their risk of the virus the longer they remain in the bateyes, where women forced into prostitution by the scarcity of jobs and itinerant single males create an infectious breeding ground. But the exceptionally high HIV rates among Haitians should give little comfort to Dominicans, who often havesexual relations with Haitians. As Dr. Ernesto Guerrero, head of a local AIDS institute, puts it, "The bateyes are a bridge for HIV spread." One Dominican, Domingo Fernandez, recently became the sixth man in a month to die of AIDS-related symptoms in the batey of Mata Mamon, a dozen miles outside Santo Domingo. As two candles lit his shrouded body, the silence was repeatedly pierced by the wailing of his pregnant wife, a Haitian.
AIDS education efforts out of Santo Domingo have largely passed the Haitians by. Speakers of a French-derived Creole, they are unlikely to hear or understand the Spanish-language public service advertisements on Dominican radio stations. Keti, an 18-year-old prostitute who recently fled political violence in Haiti, finds the men in her Dominican batey of San Luis more reluctant to use condoms than those in the Haitian capital of Port-au-Prince. "I try to make them, but I don't always succeed." So she tries to gauge whether the men have HIV by their appearance.
Even the efforts of international aid organizations in stopping the spread of AIDS in the bateyes have taken a turn for the worse. Millions of free condoms were once distributed through government agencies, financed first by the World Health Organization and then by the U.S. Agency for International Development. But supplies to the bateyes have fallen since USAID started requiring that the condoms be sold. None are available, for instance, in the batey of Mata Mamon, where Enara Jean-Baptiste lies dying.
UGANDA Harvesting a crop of sorrow
In the southwest Ugandan town of Kyotera, the AIDS virus is gradually destroying a coffee factory that is one of the area's largest employers. The owner succumbed to the disease in 1990, and the company's 36 employees know that his widow, too, will soon die. The proprietor's children cannot help; they are too young to take over. Moreover, AIDS killed two of the staff this year and, several months later, the company is still unable to find skilled workers to replace them. Those left behind frequently take time off from work to attend funerals. Laments 28-year-old accountant William Yiga, "We cannot complete a month without four or five members of staff losing a relative."
In what is probably the world's most AIDS-riddled nation, even day-to-day business has been affected by the endless deathblows of the disease. After 14 years of military regimes and civil war that by 1985 had claimed almost 1 million lives, Uganda is now waging a fierce struggle against AIDS. Up to 1.5 million people out of 18 million are infected with HIV, 8.3 percent of the total population. Among the sexually active, 19 percent carry the AIDS virus. By the year 2010, some 4 million people will be HIV positive and an estimated 870,000 will be dying of AIDS. Experts compare this scourge to the sleeping sickness epidemic that wiped out half of Uganda's population at the beginning of the century.
Weak coffee. The hollowing out of Uganda's work force will drag down the country's crucial agricultural sector, now employing 86 percent of the labor force. Coffee, which made up 88 percent of all exports in 1990, worth $184 million, is particularly at risk. Uganda's robusta coffee bean--considered one of the world's best--has been shrinking as decades of neglect from economic chaos are exacerbated by the epidemic. Many Ugandans now prefer to grow the staple matooke banana because it requires little care. In Uganda's southern district of Rakai, which grows much of the nation's coffee, entire families have been wiped out by the epidemic. Their mud-and-wattle houses sit crudely boarded up while the surrounding small farms fall prey to weeds, the coffee bushes left to grow wild. At a local coffee operation, Director John Bazoonona says production has not yet been affected by AIDS, but he knows that before long, the disease will catch up to his business. "It's skilled people who are dying," notes Bazoonona, "those who know how to run businesses."
Like many of the nation's business leaders and workers, Bazoonona is encumbered by a growing number of orphans. Three of his offspring have died of AIDS, leaving behind 10 children. Nationwide, Uganda will have an estimated 1 million to 2.8 million orphans in the next two decades. "Running an orphanage of 150 is a big deal," warns Jill Armstrong of the World Bank. "In Uganda, the sheer numbers will be overwhelming."
The Ugandan government in Kampala has not surrendered to the onslaught yet. Unlike many African leaders who have hidden their heads in the sand when confronted by AIDS, the government of President Yoweri Museveni is credited with one of the most enlightened AIDS policies in Africa. Funds from such international donors as USAID and the World Health Organization are channeled to many public and private organizations to provide AIDS education, home health care, HIV testing and counseling. But despite success in wiping away the stigma of AIDS and building up widespread awareness of its causes, aid workers worry that they have seen no significant behavioral changes--at least not for the better. Older men, fearful of catching HIV, have reportedly begun seeking out sex with more virginal teenagers. Some of these men are unwitting carriers of the virus, however, and instead of protecting themselves, they are merely passing the disease on to the next generation.
ZAMBIA Digging a very dangerous hole
The scores of beer guzzling mine workers that noisily crowd around the old wooden tables of the Lido Recreation Club, near the Nkana copper mine, look to the state-run mining company for virtually all of their needs. The bar itself is owned by Zambia Consolidated Copper Mines, and the beer is subsidized by the company. Many of the 19,000 Nkana workers live in company housing, send their children to school with fees paid by the employer and use the mine's medical services, considered among the best in the country. But for the workers' most urgent need, help is nowhere to be found. Perhaps 1 in 5 of the miners is already condemned to death by what the workers here call "slow puncture"--AIDS. Yet the company has no education or prevention programs, and it very rarely tests for HIV. Most senior Zambian copper executives refuse to even talk about how AIDS might be affecting their work force and the industry.
Zambia can scarcely afford to pretend AIDS does not exist. The country's per capita GDP fell almost 5 percent a year during the last decade, the victim of economic mismanagement and a crushing foreign debt. Now, the epidemic threatens future economic growth by stealing the country's best and brightest. Recently, one third ofall students attending teaching universities in the capital of Lusaka were found to be HIV positive--this, in a country where teachers are in short supply and less than a quarter of all students attend high school. At two Lusaka prenatal clinics frequented by the educated middle and upper classes, 23 percent of women patients carry the virus. And in the Copper Belt, source of 12 percent of the world's copper and 95 percent of Zambia's foreign earnings, the death toll among mine workers has only just begun. Overall, one analyst estimates that the south-central African nation of 7 million harbors several hundred thousand HIV carriers, most of whom will die by the year 2000.
Beneath the surface. It is impossible to measure how deeply the mining labor force has been wounded by AIDS. Underground mechanic Henry Siame says one of the workers in his shift has been off sick for the last six months, and though Siame suspects he has AIDS, no one really knows. Workers known to be HIV positive frequently become outcasts, so few ask to be tested. "It is very rare for people to know for sure who has AIDS and who doesn't," says Mavuto Gondwe, health and safety director of the Mineworkers Union of Zambia. Still, copper company medical adviser John Mesange notes that tuberculosis, one of the most commom symptoms of AIDS in Zambia, has increased dramatically among mine workers. And Gondwe, who receives a telex whenever a union member dies, has seen more and more telexes every month, a phenomenon he blames on the AIDS epidemic. Warns Dr. Mannaseh Phiri, vice chairman of the Copper Belt Health Education Project, "There are tremendous implications for the future performance of industry, and top management [is] only just beginning to realize it."
It is doubtful that Zambia can avert a human and economic tragedy. So far, official statistics acknowledge only some 6,000 cases of AIDS and about 20,000 "AIDS related" cases since 1986. But the true scale of the plague is hidden by underreporting and the relative newness of the virus in the country. The government has made efforts to educate the public. One roadside billboard admonishes: "Drive carefully, love carefully!--Don't let AIDS ruin your life." But Father Elias Afwenye, a priest who works in the Copper Belt, notes that on weekends, the same number of prostitutes continues to walk the streets. Dr. Phiri explains that in the climate of economic collapse, "people think they have nothing to lose and little reason to live." If such a tragic mindset leads to more AIDS, the abyss of poverty can only grow deeper.
DRAINING THE WORLD'S ECONOMY Global dollar loss from AIDS by the year 2000 Worst-case scenario Best-case scenario $514 billion $356 billion
SAPPING GROWTH IN THAILAND AIDS could mean $8.7 billion in lost income $2 billion a year in foreign funds is at risk AIDS health costs could jump by a factor of 65
THINNING LABOR'S RANKS IN INDIA Income lost from AIDS could hit $8.4 billion Nearly 6 percent of tested truckers have HIV Health costs could reach $1.6 billion by 2000
CRIPPLING FISCAL OPTIONS IN BRAZIL Ranks 4th in global AIDS cases Needs $600 million to help AIDS victims $116 billion in foreign debt hurts AIDS efforts
HURTING THE DOMINICANS 9 percent of sugar cane workers have HIV Sugar cane constitutes 40 percent of exports Heterosexual sex causes 70 percent of HIV
WASTING THE LAND IN UGANDA 8.3 percent of the population has HIV 86 percent of workers are in agriculture Coffee makes up 88 percent of all exports
RISKING EARNINGS IN ZAMBIA The Copper Belt has 45 percent of AIDS cases 12 percent of world copper is from this area 95 percent of foreign earnings is in copper
AIDS around the world: a costly epidemic
AIDS has spread tragedy to all corners of the earth. By the end of the decade, it could wreak havoc on the global economy.
The economic cost of AIDS Green bars show the best and worst-case losses resulting from AIDS, as well as percent of gross domestic product lost by the year 2000.
Worst-case scenario Best-case scenario
United States $107 billion $81 billion
1.1 pct. 0.9 pct. Canada $11 billion $8 billion
1.0 pct. .8 pct. Africa/Middle East $50 billion $26 billion
4.6 pct. 2.4 pct. Southeast Asia $52 billion $38 billion
2.3 pct. 1.7 pct. Japan $53 billion $42 billion
0.8 pct. 0.7 pct. Latin America $24 billion $13 billion
1.4 pct. 0.8 pct. Europe $108 billion $86 billion
1.0 pct. 0.8 pct. Rest of World $109 billion $62 billion
3.1 pct. 1.8 pct.
The human cost of AIDS Tables show the regional change in HIV/AIDS cases from 1992 to the year 2000, using best and worst-case scenarios.
Sub-Saharan Africa
HIV Infections AIDS Cases 1992 6.5-7.8 million 1.0-1.4 million 2000 15-34.1 million 6.5-15.9 million
Southeast Asia
HIV Infections AIDS Cases 1992 675,000-1.0 million 917-65,000 2000 9.0-46.2 million 1.0-1.4 million
Latin America/Caribbean
HIV Infections AIDS Cases 1992 1.0-1.3 million 150,000-216,000 2000 3.2-15.4 million 1.0-2.7 million
North America
HIV Infections AIDS Cases 1992 1.0-1.2 million 228,000-258,000 2000 1.3-8.3 million 1.0-2.4 million
Western Europe
HIV Infections AIDS Cases 1992 500,000-718,000 99,000-114,000 2000 700,000-5.1 million 500,000-1.5 million
Rest of World
HIV Infections AIDS Cases 1992 120,000-131,000 6,883-14,000 2000 480,000-900,000 120,000-300,000 Figures are in 2000 dollars and do not include some regions. GDP loss is the difference between estimated GDP levels in a world with AIDS and estimated GDP levels in a world without AIDS. Percentages reflect the loss from baseline 2000 GDP. Best-and worst-case scenarios of GDP loss are based on low and high estimates of AIDS cases. The grim future The number of HIV/AIDS cases will soar by the year 2000, and Southeast Asia's share of the epidemic will grow significantly.
HIV infections as percentage of world total
Global Total
HIV Infections AIDS Cases 1992 10-11.8 million 1.5-2.0 million 2000 30-110 million 10-24 million
HIV Infections as percentage of world total
1992 2000 Sub-Saharan Africa 64 pct - 66 pct 31 pct - 51 pct Southeast Asia 6 pct - 10 pct 30 pct - 42 pct The plague punishes the poor Developing countries will lose less GDP at the hands of AIDS than industrialized nations, but the Third World will forfeit more of its economy on a percentage basis.
Loss from AIDS by the year 2000, in dollars and as a percent
Worst-case scenario Industrialized nations 1.0 pct of total GDP $279 billion Less developed nations 2.7 pct of total GDP $235 billion
Best case scenario Industrialized nations 0.8 pct of total GDP $217 billion Less developed nations 1.6 pct of total GDP $139 billion
Note: Epidemiological estimates are based on projections by the World Health Organization and the Global AIDS Policy Coalition. "Rest of world" includes North Africa and the Middle East, Eastern Europe, the former Soviet Union, the Far East, Australia and New Zealand.
USN&WR--Basic data: Global AIDS Policy Coalition-Harvard University, World Health Organization, DRI/McGraw-Hill, USN&WR estimates
This story appears in the July 27, 1992 print edition of U.S. News & World Report.