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Both countries, with a combined population of nearly 200 million, have surpassed 5 percent infection rates among adults, a tipping point in several other African countries after which the rate of prevalence soared into double digits.

The analysts are particularly concerned about possible sharp increases in HIV and AIDS in India, the second most populous nation in the world. India has a large percentage of uneducated people and political leadership that hasn't adequately begun to destigmatize the disease, the analysts said.
That same mix of factors was deadly in the first wave of the crisis in Africa. India already has an estimated 3 million people infected with HIV or AIDS.

The AIDS pandemic is entering a "stage of substantial increases in size and scope," said a senior US intelligence official last week in an interview at CIA headquarters in Langley, Va., speaking on condition of anonymity. Another senior intelligence official described the crisis as entering "a larger breakout phase."

About 40 million people are infected with HIV or AIDS, which already is the deadliest disease in human history. About 23 million people have died from the disease - far more than even Europe's Black Death in the 14th century, according to medieval scholars.

In Africa, roughly 23 million people were infected with the disease in 1997, according to UNAIDS, the joint United Nations program for HIV/AIDS. The figure is 30 million now, a 30 percent increase over the previous five-year period. A doubling of cases in Africa in the next five years would push the number of people infected there to 60 million by 2007, analysts from the National Intelligence Council said.

Those dying are mostly people in the prime of their lives, a fact that has disastrous impact on economic growth, education and health systems, and the security infrastructure of the world's most vulnerable continent.

The new projections almost surely will be given considerable weight among leading global health officials because the National Intelligence Council has a strong track record in forecasting trends about HIV and AIDS. The council was the lone voice in the US government a decade ago that called attention to the disease. In 1991, it predicted 45 million infections by the year 2000.

Senior policymakers at the World Health Organization, World Bank, and UNAIDS said last week that while they had not heard about US
intelligence's new projections, they believed the forecast could be on target.

The Bush administration will focus on global development and combating the African crisis at the G-8 summit in Alberta, Canada, on June 26. The biannual international AIDS conference follows early next month in Barcelona.

The information about a spike in HIV prevalence in Africa was first revealed April 16 in a wood-paneled room at The National Academies in downtown Washington. In the first day of a two-day Institute of Medicine seminar on the impact and globalization of the disease, David F.Gordon, a National Intelligence Council officer on economics and health issues, delivered the news in a 20-minute talk. Addressing the nation's leading health experts, he said "Nigeria and Ethiopia may be at the takeoff point, where the epidemic becomes much, much, much more serious in the next five years," according to a tape recording of the meeting. "If, indeed, that is the case, if we are in a situation in Nigeria and Ethiopia parallel to that in 1992, '93, '94 [to that in southern Africa], and we do have a big run-up in prevalence rate, it's not inconceivable that the number of HIV infections could double in the next five years" in Africa, he said.

Though Nigeria claims an official 6 percent HIV infection rate, Gordon said, "A lot of people believe the numbers are closer to 10 percent already and might be on a much higher trajectory." Ethiopia's infection rate, he said, also was roughly 10 percent, or higher. Ethiopia acknowledges those figures.

Jim Yong Kim, a Harvard infectious disease specialist, attended the meeting. "His talk blew me away," said Kim, a founder of Partners in Health, a
Cambridge-based group running several international projects serving the health needs of the poor. "The NIC is the best at looking at HIV prevalence rates and projecting into the future," he said, "and if these guys are right about Nigeria and Ethiopia, it's more shocking news about the pandemic. I think it puts much more urgency to moving quickly on the
Global Fund."

The Global Fund to Fight AIDS, Tuberculosis and Malaria, initiated 14 months ago by Kofi Annan, UN secretary general, has received pledges of $1.9 billion, including $500 million from the United States. (The United States also is the world's largest bilateral AIDS donor, earmarking $790 million this year, or 44 percent of direct giving to developing countries.

In April, the fund's board approved $378 million over two years for projects, and plans to finance another $238 million if certain conditions are met. A WHO estimate has found that about $2.8 billion will be spent this year to fight AIDS. Annan estimated that $7 billion to $10 billion needs to be spent annually.

In the April talk, Gordon also addressed a second wave of the AIDS pandemic, particularly in India, China, and Russia. China has an estimated 1 million cases, which UNAIDS said could grow to 20 million by 2020. Russia also has more than 1 million people with HIV or AIDS, and its Health Ministry estimates that 5 million to 10 million boys and men between the ages of 15 and 20 will have contracted HIV or AIDS in five years.

China, Gordon said, has taken the important step of accepting that it has a problem. "The focus on AIDS, far from suggesting bad news, suggests positive news," he said. But he added, "China has a long ways to go in acknowledging the scope of the problem and getting on top of it. "He said there was "relative cause of optimism" for Russia, despite
its fast-growing rates of infection. He cited Russia's "high rates of literacy, extensive media links, active education program," and older population as factors that could blunt the impact of HIV or AIDS.

In Nigeria, however, few analysts believe the very low reported rates of HIV and AIDS, which range from 1 percent to 16 percent. The US intelligence official scoffed at the reported 2 percent infection rate for Lagos, Nigeria's largest city.

Peter Piot, the Belgian-born director of UNAIDS, said last week that the National Intelligence Council estimates were close to his thinking about the progression of the disease, especially in Africa.

"When I look at the epidemic, I see that even southern Africa has not reached a natural limit," he said of the six southern African countries where more than 20 percent of sexually active adults are infected with AIDS, including Botswana's 42 percent rate. "In Nigeria and Ethiopia, there should be the start of massive programs."

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BAMAKO, 28 Jun 2002 (IRIN) - From painkillers to antibiotics, just about any medicinal drug can be had on the streets of Mali’s towns and villages. The process is easy. You simply go up to the vendor and describe your pains. In a flash, he or she dives into a plastic bag, whips out a bottle of pills, reels off its healing properties, hands it over and pockets your money.

Chances are the vendors knows absolutely nothing about the chemicals from which the pills are made, or about potential side effects since none are pharmacists not do they have any licenses to sell drugs. Yet, they and their counterparts elsewhere in West Africa administer a large percentage (estimates range from 30 to 60 percent) of the drugs sold in the subregion.

Pharmacists in Mali are spearheading a campaign against unlicensed drugs. “Street drugs kill,” is the slogan they have been using to make people aware that such medicines are a major public health risk.

"These drugs are a great danger which is tolerated by the people and the government," says Dr. Deidia Diallo, president of the Order of Malian Pharmacists.

Why the proliferation of unlicensed medicine vendors? One major argument people put forward is poverty, says Diallo. They say they have to do something to earn a livelihood.

"Before, people would raise the argument of proximity and accessibility," she adds. "This is no longer true today. At every corner you have a drugstore where you can find all kinds of medicines. Even the price argument is no longer valid because of generic drugs."

The drug vendors’ clients think differently.

Street drugs "are very efficient, cheap and can be bought even singly", a secondary school teacher told IRIN. "I use them (street drugs) whenever someone in my family is sick. Let me give you an example. My daughter was sick so I took her to the health centre. The doctor gave me a prescription that amounted to more than CFA 7,000."

"Do you know how much I used to cure her? Less than CFA 1.500 with these people (the vendors)."

A housewife told IRIN she always bought her drugs from the same woman. "I don't know where they get their drugs," she said, "but you find them with extraordinarily efficient drugs."

The informal trade in medicinal drugs is anything but disorganized. Wholesalers smuggle in the drugs from countries such as Nigeria or Guinea, while retailers sell them on the street.

"Sometimes when you go to the pharmacy you don't find some drugs, but you never have that problem in the street," says Sadio Samake, a student at the University of Mali. "You can even buy a single tablet if you want, which is not possible in pharmacies," he adds.

For Dr Abdrahamane Tounkara, secretary-general of the Ministry of Health, "the regular provision of drugs is an essential component of a health care system that works satisfactorily, and their accessibility is one of the tangible symbols of the quality of health care”.

He stresses that it is necessary to make sure people have easy access to quality drugs at affordable prices.

This has been a cornerstone of Mali's public health policy in recent years, according to the health authorities. One measure to improve access has been to allow pharmacists to replace costlier medicines with cheaper, generic ones as long as they are also effective.

Twelve wholesale distributors import generic medicines into Mali. All such imports are authorised and controlled by the national drug administration.

Despite such measures, however, the illicit sale of drugs has become, within a decade, a major danger for people's health, according to Diallo.

Drugs, she says, should be prescribed solely by pharmacists and only to people with prescriptions. All drugs sold in Mali, she adds, should be authorised and checked regularly by the relevant health authority, as per state regulations.

Diallo says she is worried by the negative spinoffs of informal drug vending such as the development of resistance to antibiotics due to the misuse of medicines. "I am very serious when I say that resistance to antibiotics is posing a lot of public health problems," she says.

Pharmacists themselves have been accused of encouraging the illicit market by selling expired medicines to the street vendors. However, Diallo does not believe such claims.

"I don't think someone who has taken an oath would do that," she says. "Every professional knows that he or she can be prosecuted by a disciplinary commission and his/her license can be withdrawn if found guilty."

A national commission has been created in Mali to fight the illicit sale of medicines, but it is yet to develop its plan of action.