By Kevin Anderson
BBC News Online in Washington
The World Bank is warning that unless steps are taken to aggressively prevent and treat HIV/Aids in Russia and South Asia, the epidemic there could soon rival that of the worst hit countries in Africa.
Cheap heroin is driving higher HIV infection rates
The warning comes ahead of an International Aids conference to be held this month in Bangkok, Thailand, a country that has had great success in slowing the spread of the disease.
For the first time, presidents, prime ministers and other political leaders will attend the conference.
And bank officials want to make sure that the leaders go home with a sense of urgency about the threat posed by the epidemic.
For several years Praful Patel, an Indian born in Uganda, worked as a senior official for the World Bank in Africa.
As the HIV/Aids epidemic was beginning in Africa several years ago, he often travelled to Botswana.
People there saw the disease as if "it were something around the corner that that doctors would take care of, like they had taken care of everything else," he said.
But over the course of the next 18 months, when he returned to Botswana, each time he visited the country he would note the absence of someone else he knew, someone else who had contracted HIV.
"No one would talk about it. They were in a state of denial," he said.
Now, as World Bank vice-president for South Asia, Mr Patel fears that history is repeating itself in that, as he says, "the locus of the epidemic is shifting from Africa to Asia.
Just as in the early days of the epidemic in Africa, there is silence and denial amongst some Asian leaders, he says.
Leaders quibble about infection rates instead of debating policies to deal with growing problem, he added.
Infections are still small as a part of the total population in India, Mr Patel says, only about 0.8%.
But in raw numbers, the world's most populous democracy will soon have the world's largest population of people with HIV/Aids.
And in Nepal, infection rates amongst intravenous drug users stands at 68% and at 18% for sex workers.
The bottom line
Bank officials will go to Bangkok bent on convincing the world's leaders that the impact of HIV/Aids is real and that it will eventually impact them economically.
Previous estimates, which predicted GDP declines of between 0.3 and 1.5%, were too low, bank officials said.
In Russia, long range projections by the bank show that if the epidemic is left unchecked, then by 2010 the country could see a decrease of 2 to 4% of GDP due to the disease, said Dr Armin Fidler, health sector manager for the bank in the Europe and Central Asia region.
That region is now seeing the fastest growing rates of infection in the world.
A flood of cheap heroin - in some places cheaper than vodka - is driving an epidemic of intravenous drug use, which is also driving rising rates of HIV infection.
And prisons are an "epidemiological pump", Dr Fidler said.
This is often how AIDS gets a foothold, bank officials says, by infecting populations on the margins of society.
Public officials often have difficulty justifying the expenditure necessary to stem the spread of the disease when it impacts populations scorned by the rest of society, Dr Fidler sad.
Bank officials hope to shock leaders into action, but also to highlight successful programmes.
The AIDS conference is being held in Thailand, a country that saw the generalised HIV/AIDS epidemic in the Asia Pacific region.
Thailand has tackled AIDS aggressively
In 1992, 31% of sex workers in the country were HIV-positive.
The prime minister took a lead in confronting the disease, and the government launched a high-profile public education campaign.
The country launched an HIV prevention programme amongst sex workers with regular testing of commercial sex workers and information and education for both the sex workers and their clients.
Condom use increased and rates of sexually transmitted infections, including HIV, dropped.
And repressive policies such as the mandatory reporting of names and addresses of people with HIV were repealed.
Officials estimate the inexpensive and simple programmes prevented some 6.7m infections by 2000.