Myanmar: AIDS and the state's policies

Myanmar: AIDS and the state's policies

In Myanmar, the campaign to control the spread of AIDS is hampered by the military regime's archaic policies, writes Satya Sivaraman of Inter Press Service.

YANGON: Seven years after launching a national AIDS program, military-ruled Myanmar's efforts at controlling the pandemic remain seriously hampered due to woefully inadequate health infrastructure, poor international assistance and archaic domestic policies.

Now, NGOs and experts combating the spread of HIV/AIDS inside Myanmar warn that without drastic changes in its health care system and more resources, the country could end up becoming the worst hit by the deadly disease in all of Southeast Asia.

Since Myanmar recorded its first HIV-positive case in 1988, the number of affected persons detected through official surveys has increased to more than 14,500 by the end of 1996. By that time, the number of cases with full-blown AIDS had reached 1,783.

Extrapolating from sentinel surveillance data collected by health officials at 20 sites around the country, the total number of HIV-positive cases in Myanmar is estimated to have reached 460,000 last year in this nation of 46.8 million people.

Myanmar's National AIDS Program was created in 1990, with the development of its first medium-term plan for AIDS prevention and control by the health ministry. In order of priority under the national health plan (1993-96), AIDS is ranked third among 39 listed diseases after malaria and tuberculosis, which are the major national scourges.

Initially, the bulk of HIV cases in Myanmar was found among ethnic minority groups along the Myanmar-China and Myanmar-India borders, where intravenous drug use is prevalent due to the easy availability of heroin.

In the northern Myanmar's Kachin state for example, prevalence rates among drug users have commonly been near or more than 90 percent -- the highest for this category in the world.

But what worries experts the most is the rising incidence of HIV cases among sections of the population like housewives and blood donors. While rates of HIV transmission through intravenous drug use has actually dropped in recent years, heterosexual intercourse and blood transfusion have become major modes for the spread of the epidemic.

Out of 690 AIDS cases reported in 1996, nearly 53 percent contracted the ailment through heterosexual intercourse, a number expected to jump to 66.7 percent during 1997.

"Sex has emerged as the major transmission route for HIV in Myanmar, like in other countries in the region," says San San Myint, program officer of the United Nations Development Program (UNDP) here.

The UNDP is among the very few international organisations assisting the Myanmar health ministry implement programs for curbing HIV/AIDS. Since 1994, it has allocated nearly US$78.5 million for projects in parts of Myanmar with a high degree of HIV/AIDS prevalence.

Unlike neighboring countries like Thailand, China and India where thanks to numerous awareness campaigns the use of condoms is much more prevalent, in Myanmar cultural and even backward government policies are a hindrance to the practice of safe sex.

While the bulk of 39.4 percent of men with HIV are intravenous drug users, the profile of HIV infections among women is vastly different. Among the female population, an alarming 90 percent of cases are those of pregnant women, detected at maternity clinics around the country.

Myanmar housewives have a strong aversion to using condoms as they associate it with prostitution, says San San Myint. Condom quality and availability are also extremely poor throughout Myanmar. Worse still are laws under which women carrying condoms can be harassed or even arrested by police who assume that they are commercial sex workers.

Official surveys show that condom use among the country's sexually active population is less than 50 percent. In some remote areas, it is under 10 percent.

With the opening up of the Myanmar economy since 1991, prostitution, though illegal, has also grown into a major means of income generation for usually destitute and economically underprivileged women.

Thus, the incidence of HIV and AIDS cases is particularly high near Myanmar's borders with Thailand and China, where commercial sex outlets thrive. Rates of HIV incidence among commercial sex workers have soared from 4.3 percent in March 1992 to 21.5 percent by March 1996.

Displacement and growing internal migration are now the major reason for the rapid spread of HIV from one part of the country to the other, says Dr Myo Paing, national program officer for the World Health Organisation.

He says many migrants from all over Myanmar who go to border towns or gold and jade mining areas in the northern part of the country, come back infected to their villages. Then, they spread HIV through unsafe sex with their wives or girlfriends.

The social and cultural hurdles to fighting the HIV/AIDS pandemic are aggravated by the abysmal state of the country's health infrastructure, especially in the countryside.

The health ministry reports that nationwide, there are only 6.4 hospital beds per 10,000 citizens. The number of doctors and nurses is even lower at 3 and 4.2 respectively per 10,000 people. Less than six percent of Myanmar's national budget is allocated to health, while more than 45 percent is spent on the military.

There is an obvious reluctance among people to take HIV/AIDS issues seriously when they can as easily die of other diseases or simply due to poverty, says a NGO worker working on prevention of HIV/AIDS transmission along the Thai-Myanmar border areas.

HIV/AIDS is not simply a disease but also a political, social and economic problem, he says. And the situation is likely to get worse with the downturn in the Myanmar economy, due to a fall in exports and the devaluation of its currency, the kyat, by nearly 50 percent in recent months.

Meantime, many health workers and even some state officials say the greatest obstacles to tackling the HIV/AIDS epidemic in Myanmar lie on the political front. The ruling military junta, known as the State Law and Order Restoration Council, has paranoid attitudes toward issues relating to sex or drugs, analysts say.

Two years ago, the regime shot down the idea, suggested by some NGOs, of distributing clean needles to reduce needle- sharing among intravenous drug users in northern Myanmar. The military claimed it was `western plot' to increase the number of drug addicts in the country.

The regime has also refused to acknowledge the increase in prostitution in Myanmar, for fear that doing so would give it a bad image among ordinary citizens. The junta came to power in 1988, and have held onto it despite being defeated in general elections held in 1990.

Ultimately, the only effective weapon against the epidemic is a holistic approach. Piecemeal approaches cannot stop it from spreading, says Karl Dorning, program coordinator with World Vision International, a Christian humanitarian group working among people with HIV/AIDS in Myanmar.

-- IPS