According to an analysis by the National Intelligence Council (NIC), an arm of the Central Intelligence Agency, the AIDS pandemic will rapidly worsen, with the number of cases possibly doubling in sub-Saharan Africa in five years.

The AIDS pandemic, according to a senior US intelligence official speaking on condition of anonymity, is entering a "stage of substantial increase in size and scope." Another official described the crisis as entering "a larger breakout phase." The analysts are particularly concerned about possible sharp increases in HIV/AIDS in India, the second most populous nation in the world.

India has a large percentage of uneducated people and political leadership that has not 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.

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

David F. Gordon, a National Intelligence Council officer, presented the analyses at a two-day Institute of Medicine seminar. "Nigeria and Ethiopia may be at the takeoff point, where the epidemic becomes much, much, much more serious in the next five years," he said. He indicated that many believe the current infection rate in Nigeria is close to 10 percent and may be much higher. Ethiopia's infection rate, he said, also was roughly 10 percent or higher. Ethiopia acknowledges those figures.

"His talk blew me away," said Jim Yong Kim, a Harvard infectious disease specialist who attended the meeting. "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."

Gordon also addressed a second wave of the pandemic, particularly in India, China and Russia. China has an estimated 1 million cases, which UNAIDS said could grow to 20 million by 2030. Russia's Health Ministry estimated that 5 million to 10 million boys and men, ages 15-20, would have HIV in five years. China, Gordon said, has taken important steps in accepting the problem. "The focus on AIDS, far from suggesting bad news, suggests positive news," he said.

Peter Piot, director of UNAIDS, said last week the NIC's estimates are closer to his thinking. "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. Piot called for "massive programs" in Nigeria and Ethiopia.

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