wave have different social factors causing increased spread. hiv has not yet made a move into the general populations of some countries, such as russia. the single social factor (80–90% of new cases) for russian spread is ivda, coming from prostitutes and prison inmates—many of whom are ivdas—are contributing to the spread of the disease. drug use is so widespread that many users are integrated into society with jobs and families, suggesting the disease is moving into the mainstream. an estimated 20–25% of ivda in prison, where there is easy access to drugs, are seropositive. russian 2nd wave, general population by region hiv/aids also is increasing in the russian military services. up to 33% of prospective conscripts are deemed unfit for service owing to the effects of prior drug use (chronic hepatitis or hiv infection). enlisted men in the ground troops have the largest number of infections, while strategic military forces and airborne troops have the lowest. india hiv spread projection from multiple sources intelligence community assessment on severe acute respiratory syndrome the outbreak of severe acute respiratory syndrome (sars) has been overcome, but sars has not been eradicated. although who declared on 5 july 2003 that all transmission chains of sars had been broken, many health experts fear it could return again. we remain vulnerable. the major concerns include: the possible presence of animal reservoirs of the coronavirus that causes sars lack of a reliable diagnostic test lack of a vaccine for eradication. if a resurgence of sars this winter coincides with the annual outbreak of influenza, identifying and isolating suspected sars cases will be much more difficult. sars also could mutate, altering the symptoms, transmissibility, or lethality of the disease. as the first line of defense, healthcare systems and workers are particularly vulnerable. moreover, most wealthy countries have little recent experience implementing large-scale quarantine and isolation programs, and poor countries already have inadequate health surveillance and infection control procedures. the emergence of sars illustrates the challenge of battling infectious diseases in an increasingly globalized world. global links have sped the geographic spread of the disease and amplified the economic and political impact. the initial sars outbreak sars exemplifies the potential of an infection spread through air travel. the first case of sars was reportedly originated from a rural area in foshan, guangdong, in nov 2002, and the patient, a farmer, was treated in the first people's hospital of foshan. the patient died soon after, and no definite diagnosis was made on his cause of death. china delayed reporting this to international health organizations, and sars spread beyond china. outside china, the first clue of the outbreak appears to be november 27, 2002 when canada's global public health intelligence network (gphin), an electronic warning system that is part of the world health organization's (who) global outbreak and alert response network (goarn), picked up reports of a "flu outbreak" in china through internet media monitoring and analysis and sent them to the who. subsequently, the who requested information from chinese authorities on december 5 and 11. importantly, while gphin's capability had recently been upgraded to enable arabic, chinese, english, french, russian and spanish translation, the system was limited to english or french in presenting this information. thus, while the first reports of an unusual outbreak were in chinese, an english report was not generated until january 21, 2003. in late april, revelations occurred as the prc government admitted to underreporting the number of cases of sars due to the problems inherent in the healthcare system. dr. jiang yanyong exposed the coverup that was occurring in china, at great personal risk. a number of prc officials were fired from their posts, including the health minister and mayor of beijing, and systems were set up to improve reporting and control in the sars crisis. since then, the prc has taken a much more active and transparent role in combating the sars epidemic. potential of sars recurrence political leadership has been a key variable in managing the epidemic. china's efforts to hide the initial outbreak allowed sars to build up dangerous momentum before chinese officials became more open, while vietnam's willingness to promptly highlight the threat and seek international assistance helped offset the country's weak healthcare system. the more sars spread, the tougher countries became in implementing control measures, including quarantining and isolating people to stop its transmission. although sars has killed far fewer people than die each year from more common maladies such as pneumonia, influenza, malaria, tuberculosis, and hiv/aids, it generated significant attention and created a sense of urgency to respond because it was a mysterious new illness that seemed able to go anywhere and hit anyone. sars hit parts of asia and canada with extensive commercial links to the rest of the world. although the economic impact, particularly in china, was less severe than initially forecast, sars wreaked havoc on the tourism and travel industries, erasing revenues and jobs. the same forces of globalization that drove the spread of sars also have been key to managing it. modern advances in communication, science, and travel almost certainly helped alert people more quickly to the disease, facilitated a stronger national and international response, and sped research efforts to help contain the disease. the intense focus on sars has opened a window of opportunity for the united states and the who to pursue longer-term bilateral and multilateral cooperation on health issues. three scenarios for sars the future course of sars will depend on a host of complex variables, making forecasting difficult. complexity and uncertainty preclude assessing the relative likelihood of any one of the three. sars, even in a developed country, demands extremely careful nursing practices to avoid having the disease spread by medical personnel, according to who. countries that lack the necessary respirators and other barrier nursing equipment can risk spread. the first scenarion is "sars simmers": sars could resurface but be limited to random outbreaks in a few countries, rendering it more of a public health nuisance than a crisis. political and economic reverberations still would occur, with some companies and investors looking to reduce their exposure in east asia, particularly china. the next alternative is that "sars gains a foothold in poor countries, regions. sars could spread to poor countries in africa or asia, potentially generating more infections and deaths than before but with relatively little international economic impact. the risk of spread would continue, however, even if sars emerged in poor countries or isolated regions of russia and china with weak healthcare systems. who and cdc probably would come under intense pressure to provide money and technical assistance to compensate for weak healthcare systems. some isolated countries such as north korea probably would resist outside assistance, even at the risk of putting their own citizens at risk and requiring the u.s. to improve its medical intelligence collection to protect its own and allied forces. some repressive regimes hit by sars are likely to employ brutal tactics to quarantine and isolate people, possibly sowing division among outside countries and multilateral organizations over how to respond to apparent human rights violations. the worst case is a full resurgence of sars could come back in the places it hit before—such as china, taiwan, canada, and singapore—or hit harder in other well-connected places like the united states, japan, europe, india, or brazil. even if the number of infected persons were not significantly greater, the resurgence of the disease in globally linked countries probably would generate a significant impact again. the return of sars to asia is likely to cause somewhat less disruption the second time as citizens learn to live with the disease, but more multinational companies probably would reduce their exposure in the region if they concluded that sars posed a long-term health challenge. bigger outbreaks in europe or the united states would hit a whole new set of business and government players, potentially doing serious damage to trade and growth.