HEALTH-BURMA: HIV Rates Falling As Funds Dry Up – Experts

Johanna Son* – IPS/TerraViva

COLOMBO, Aug 21 2007 (IPS) – Burma is seen as a reclusive country whose real HIV and AIDS situation is a deep, dark secret. But top Burmese officials, independent experts and AIDS researchers here painted a picture of a country that is making some progress, despite what some called its unethical abandonment by international AIDS organisations.
At a discussion at the 8th International Congress on AIDS in Asia and the Pacific (ICAAP) here, participants heard information showing that HIV prevalence rates in Burma have been falling among some groups intravenous drug users, mothers who passed on the virus to their babies, military recruits.

Experts said that a lot of resources are needed if Burma is to continue with its efforts to address HIV and AIDS. But it is hard pressed because many donors and external agencies have restrictions on aid going to the military-ruled country, whose human rights record has been under fire by different governments and groups.

Myanmar is the lowest recipient of overseas aid in the world but it needs help, otherwise, tens of thousands of people will die , said Frank Smithius, Medecins Sans Frontieres (MSF)-Holland s country representative for Burma. More than 20,000 people die each year of AIDS in the country.

Challenging oft-cited concerns that aid to Burma cannot reach its beneficiaries, Smithius, who has worked in Burma since 1994, argued that HIV and AIDS are a humanitarian issue and stressed that foreign aid can reach the people of Myanmar effectively .

Projected resources are not sufficient to fund further scaling up, said Min Thwe, programme manager of Burma s National AIDS Programme.
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For 2007, Burma s government has 28 million US dollars for its work on HIV and AIDS, but needs 41.7 million dollars. In 2008, he said, the government needs 57.9 million dollars but can only identify sources for getting 26.5 million dollars.

Funding for HIV and AIDS programmes in Burma, comes from some foreign governments and development agencies, some international non-government and humanitarian groups. The World Bank and Asian Development Bank are not present in the country.

Burma s Deputy Health Minister Mya Oo, said the government was trying its best despite resource constraints, especially after the Global Fund to Fight Malaria, Tuberculosis and AIDS unilaterally and abruptly terminated its programme in August 2005. The Fund said it could not carry out its programmes because restrictions by the junta.

Asa Andersson, regional advisor for HIV and AIDS for the Swedish government, said Sweden decided to continue working in Burma even after the Global Fund left, like Britain, Norway, the Netherlands and Australia that are part of the Three-Disease Fund against AIDS, TB and malaria. It s important to show that resources are reaching beneficiaries. If you re able to show that, then maybe other donors would be there (in Burma) too.

Citing preliminary results, Wiwat Peerapatanapokin, an epidemiologist with the Policy Research and Development Institute in Thailand who has been part of estimation exercises of HIV and AIDS in Burma, put the HIV prevalence rate there at 0.67 percent as of 2007, after reaching a peak in 2000. This translates into 230,000 adults living with HIV and AIDS, 6,000 children and 13,000 new infections among adults, he added.

These new figures are in contrast to previous estimates of up to 2.2 percent HIV prevalence rates in the country of 50 million.

Mya Oo said that from 62.8 percent of intravenous drug users with HIV in 1992, the year Burma began sentinel surveillance, this figure fell to 34.4 percent in 2004.

This has now stabilised at about 40 percent, Wiwat said. He added that while HIV prevalence peaked among pregnant women at 2.5 percent in 2000, this now stands at 1.5 percent. HIV prevalence rates among new military recruits climbed to 2.5 percent in 1997-98, and fell to one percent in 2006.

The HIV epidemic in Myanmar is declining, but it has been happening slowly in the last two years, Wiwat pointed out, calling the epidemic a long-term one that has already impacted on the low-risk population.

Burmese officials, medical experts and workers all pointed to the severe lack of antiretroviral drugs in the country.

Only one out of 10 people get the antiretroviral therapy (ART) they need. We have a tremendous gap in ART, Min Thwe said, adding that 6,476 people get antiretroviral therapy now although the actual need is for 60,000 people .

ART is usually available only in big cities, and is far from affordable for many who need it, said Naw She Wah, who works with an HIV and AIDS programme in Rangoon. She tested positive for HIV 12 years ago but does not need to take antiretroviral medication yet.

Even those who get treatment need food and money, but many have no jobs, she told the seminar. It s said that not everybody has an equal chance in getting ART.

The need for ART is such that MSF-Holland, which runs clinics in Burma, is giving medication to some 18,000 people. But in July this year, due to resource constraints, Smithius said that it had stop taking on new people, except for staff and relatives of those already on ART.

He cautioned against relying too much on the figure of 60,000 people needing ART. Many people in Burma don t know they have AIDS, so the number of people who need ART should be higher, he added. Wiwat put at 73,000 the figure of people who need ART.

Min Thwe said that the National AIDS Programme reached more people in its intervention and education programmes in 2006. He said it reached up to 36,000 sex workers and 28,542 men who have sex with men, distributed 24 million free condoms, gave out more than 1.8 million needles to drug users, and treated more than 100,000 people with sexually transmitted infections.

But he said he was worried about having enough resources to keep this up, as the government tries to make its interventions in line with internationally accepted means and ways.

Explaining the declines in HIV prevalence in some groups, Wiwat and Smithius said these were also supported by the fact that reported sexually transmitted infections among males whose trend usually reflect the HIV trend have also been going down for syphilis, gonorrhea and others since around 2000.

Reported AIDS deaths, now exceeding 20,000 each year, have been rising because the people who had HIV a decade ago are now getting sick. Women are also making up a greater proportion of AIDS cases, rising to 37 percent in 2006, according to Wiwat.

Other worrisome trends in Burma s pandemic include the fact that HIV among children is still rising even if overall HIV prevalence has peaked, Wiwat explained.

Likewise, he said that while there is now higher use of condoms, it remains low for casual sex. He cited figures showing that an average of 54 percent of people use condoms during commercial sex, but only18 percent use them in casual sex.

Overall, Wiwat said, Burma s pandemic is shifting from being highly prevalent among the groups with high-risk behaviour, such as drug users, to those traditionally viewed as low-risk people, including women who get HIV from their husbands. (*Terra Viva is an IPS Publication)