Burma at the crossroads of HIV epidemic

Amy Kazmin and Amy Yee
Financial Times, UK
July 02, 2004

The small town of Aung Ban, a community of 22,000 people in mountainous central Burma, is a crossroads for migrant workers, small traders, truckers and travellers heading east to booming Thailand. While pedlars along the two main streets tout vegetables, clothing and household goods, Aung Ban's economy depends on providing meals, shelter, and other services - including sex - for travellers.

But Aung Ban's profits have come at a heavy price. The town has an emerging HIV/Aids epidemic that has orphaned at least 20 children. United Nations experts fear the virus will wreak havoc on the community and those passing through, most of whom still lack basic facts about the disease.

Since 1999, the Aung Ban Community Group has had a team of about 40 volunteer counsellors, some HIV positive themselves, working to inform residents of the town and surrounding villages how to prevent the spread of HIV/Aids.

Myo Kyaw, a 33-year-old betel nut seller who volunteers as a peer educator, says many people have misconceptions about the virus - some believe it is transmitted by mosquito bites, or haircuts. But while Myo Kyaw says he and fellow educators are working hard to dispel such myths, it is already too late for many.

Myo Kyaw, a thin, weathered man with a six-year-old son, is infected with HIV; his wife died from Aids. The boy is not infected but faces a bleak future as one of Burma's growing number of Aids orphans.

The Community Group, which operates with the financial support of the UN Development Programme, also runs a spartan clinic providing minimal medical care - mostly treatment for opportunistic infections and pain relief - to 80 adults, most aged 25-30, suffering from full-blown Aids.

Conditions in Aung Ban reflect the uphill struggle facing Burma as it belatedly tries, after years of inaction, to rein in what the UN describes as one of Asia's most serious epidemics.

Through most of the 1990s, Burma's military junta dismissed warnings of an impending HIV/Aids epidemic as politically motivated, arguing that Burmese society's "impeccable morals" would protect it. Western donors, frustrated by the generals' obstinacy on Aids and political reform, said there was little they could do to help a pariah regime.

But over the last several years the generals appear to have woken up to the dimensions of the epidemic and its potentially devastating impact. And while western countries remain aggrieved by the military's refusal to ease its oppressive rule, donors are pouring money into the battle.

The UK, Sweden, Norway, the European Union, the US, Australia, Japan and several private foundations have contributed a total of $48m (?40m, £26m) towards an $88m, three-year HIV prevention and treatment programme, developed by the UN and the military government and endorsed by Aung San Suu Kyi, the detained pro-democracy opposition leader. The funds have remained committed in spite of international dismay over Ms Suu Kyi's re-arrest in May 2003.

"Everyone recognises the seriousness of the HIV/Aids epidemic," says Eamonn Murphy, the country co-ordinator for UNAids. "I don't think donors would withdraw the funds. The only reason they would not replenish it is if we cannot prove to them that the funds have been used effectively."

Health workers now face the challenge of scaling up HIV prevention programmes across a large country with poor infrastructure and an array of ethnic and linguistic groups. Even recruiting capable local staff is a challenge, after Burma's four decades of isolation.

"We need to build capacity. both technical and managerial," Mr Murphy said. "This is a country that hasn't had international community support for a long time."

Burma has little time to lose. Of its 50m people, UNAids estimates that about 330,000 - and maybe as many as 620,000 - are infected with the virus. Adult HIV prevalence is estimated at 1.2 per cent, a generalised epidemic, and the virus is known to have spread widely.

Treatment options in Burma are almost non-existent for most and prevention remains the priority. Condoms, once confiscated as evidence of prostitution and subject to advertising bans, are now widely available thanks to organisations such as US-based Population Services International, which distributes heavily subsidised condoms. In 2003, sales of PSI condoms, retailing at about 1 cent, hit 18.5m; by 2008 it hopes they will reach 50m. PSI and Sail Marketing, its local partner, devised a subtle marketing campaign that finally won government approval. Condom advertisements featuring a chameleon in a jaunty pith helmet can now be seen from popular magazines to roadside billboards.

Burmese are increasingly aware of Aids, Mr Murphy says, as they watch friends sicken and die. But health workers aim to get the message to all Burmese so they can protect themselves from a similar fate.