Here is yet another story about lack of HIV treatment for refugees, migrants, exiles, emigres, and expatriate Myanmar people. Why are there so few stories about lack of access to prevention services for them?

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Burmese migrants excluded from AIDS treatment
IRIN/Khao Lak, Thailand
Irrawaddy
23 March
 2007

Zaw, 30, from Rangoon, the former capital of Burma, came to Thailand eight
years ago in search of job opportunities unavailable in his impoverished
homeland.

He found work on construction sites and, more recently, in a sawmill in
Khao Lak, a beautiful coastal area where new hotels have been springing up
in response to Thailand's booming tourist industry.

While being treated for tuberculosis around a year ago, Zaw learned he was
HIV positive. After losing his appetite and becoming increasingly sick and
weak, he began taking life-prolonging antiretroviral drugs provided by the
charity Medicins Sans Frontiers in November 2006.

Although still frail and battling multi-drug resistant tuberculosis, Zaw's
strength is returning and he is now able to work two or three days a week.
Small bags of pills attached to a home-made calendar hanging on the wall
of his room in the workers' barracks at the sawmill remind him to take his
ARV medication every day.

"I feel so relieved that I am getting treated," he said. "I feel that I
will get better and I am confident about the future."

Zaw's story is far from common. Thailand has won accolades for its
commitment to providing ARV drugs to all Thai citizens who need them, but
the policy does not extend to the Burmese migrant workers who play a
crucial role in the economy.

An estimated two million people have fled poverty, lack of opportunity and
oppression in military-ruled Burma to work on Thai construction sites,
fishing boats, farms, factories and in kitchens, often taking dirty,
dangerous or dull jobs that Thais are unwilling to do. They are highly
vulnerable to exploitation, frequently paid less than the legal minimum
wage and live in constant fear of deportation or abuse by Thais harboring
deep-rooted prejudices against migrants from Burma.

The Thai government began registering the Burmese migrant workers several
years ago, granting them access to public health services in an effort to
improve their legal status.

So far only about half those believed to be working in Thailand have come
forward for registration; the rest are thought to be deterred by their
employers' refusal to formally sponsor them, the cost involved, or fears
that the authorities in Burma would learn of their flight to Thailand and
punish their families.

Although those who are registered have the right to access public
healthcare, ARV drugs are not part of the package: only pregnant women
receive the drugs necessary to prevent transmission of the virus to their
babies.

The Thai authorities argue that workers from Burma are simply too
transient to start a course of treatment that must be monitored and taken
regularly to avoid drug resistance; health activists counter that the
migrants are often no more mobile than many working-class Thais who do
seasonal work.

"They [Thai authorities] say that they cannot follow up, that they
[migrants] move often, change their names and the area where they live,"
said Suksri Saneha, coordinator of an MSF project in Khao Lak.

According to Saneha, local health workers frequently urged migrant workers
found to be infected with HIV, whether registered or not, to return to
Burma; advice that few heeded, given the lack of jobs or basic medical
care in their home communities.

It is impossible to say how many Burmese migrant workers are living with
HIV in Thailand, but Burma has one of South-East Asia's most serious AIDS
epidemics. UNAIDS estimates adult HIV prevalence at between 1.3 and 2
percent, with up to 570,000 people infected in a population of 47.3
million, and treatment largely unavailable.

Migrant workers are constantly fearful of arrest and deportation by Thai
police, who often pay little attention to whether they are registered, and
are unwilling or unable to organize themselves into social support groups
or press for access to ARV treatment.

Prejudice against people from Burma has also impeded prevention efforts.
In the coastal areas of southern Thailand, where tens of thousands of
migrants work on construction sites and in the fishing industry, MSF
wanted to use local community radio to broadcast Burmese-language programs
about how HIV is transmitted and how to protect against it. Local
authorities refused, saying broadcasting programs in a foreign language
constituted a "national security threat".

Saneha, a Thai national, said she sometimes encountered outright hostility
in her efforts to address the problem of HIV among the workers from Burma.
"They say, 'why do you care for migrants? Why not care for Thai people?'
They don't think it's a disease that can spread from Burmese to Thais that
has to be controlled."

Efforts by MSF and groups representing the Burmese workers to provide them
with ARV treatment have met resistance, not only from Thai authorities but
also from the migrants themselves, many of whom are poorly educated about
the disease.

"They have a very low knowledge about antiretroviral," said Saneha. "They
want to go for the traditional drugs or to see the magic doctor. They
don't believe in ARVs."

With the assistance of a Burmese translator, MSF has nevertheless begun
providing ARV drugs to a few willing migrant workers in the Khao Lak area.
Part of MSF's strategy is to encourage Thai health workers to view Burmese
migrant workers the same as other HIV patients, and treatment is being
delivered at the local hospital.

However, progress has been painfully slow. The MSF team is monitoring
around 70 HIV-positive Burmese, about half of whom would benefit from
starting treatment. Only two have begun taking ARVs so far, and two others
died after starting treatment too late.

According to Saneha, the perception of many patients "is that they will
die anyway - they have no example of somebody who takes ARVS and gets
stronger and lives", but she believed this attitude would eventually
change as treatment reached more Burmese workers, and gave others hope.

The Integrated Regional Information Networks (IRIN) is a news service that
forms part of the UN Office for the Coordination of Humanitarian Affairs
(OCHA). But this report does not necessarily reflect the views of the
United Nations.