Here an expatriate writes on HIV in Lashio for the Myanmar Times. The [him] moderator wishes a Myanmar journalist would do this.

[him] moderator

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NGOs fight to stem the tide of HIV in Lashio
By Becky Palmstrom

THE air in Lashio has a cold bite and despite spells of glaring sunlight, clouds often roll in from the surrounding hills and settle among its pagodas, mosques and markets.

It is the last major town along the road from Mandalay towards the Chinese border through northern Shan State, and it is also an area whose Shan, Chinese, Burman, Kachin and Lahu inhabitants face a high incidence of HIV/AIDS.

The United Nations estimates that 240,000 people are infected with HIV/AIDS in Myanmar. Many of them, like 20-year-old Myo Myo, are on the Médicins Sans Frontières Holland (AZG) waiting list for the antiretroviral treatment (ART) that could prolong and improve the quality of her life.

“To get ART is the most difficult thing [about living with HIV],”she said. “If you receive ART, you can work well and then you can earn money and so you can also eat well. But without it, I don’t know what will happen to me. I can’t afford ART, so the waiting list is my only hope.”

AZG is the primary INGO offering the treatment in Myanmar. Despite providing funding for most of the 11,000 ART patients in the country, the organisation has been forced to cut back on the number of new patients it treats.

Eighty percent of those requiring ART are unable to obtain it. A report released by Médicins Sans Frontières last week details how inadequate funding for ART could result in a death toll in 2008 similar to the 25,000 who died of HIV/AIDS in Myanmar last year.

Myo Myo knows she is going to have a long wait and that without ART her chances of long-term survival are slim. When I spoke to her last week, she was sitting in a cramped office space on the edge of Lashio with five other men and women living with HIV/AIDS.

As well as struggling with their own illnesses, they are providing support to others in the area living with the disease. They call themselves Oasis and are part of a network of three volunteer groups supported by the Three Diseases Fund and UN Office on Drugs and Crime (UNODC).

The 12 members of the group volunteer 10 days a month to make house calls to HIV/AIDS patients who need physical and psychological support. For many of the people they visit, Oasis is the only group providing external assistance.

“We are given K2500 a day to help out,” said Oasis volunteer Lwe San, “but it’s not for the money. We do it because of the solidarity, to encourage others. If someone gave us more money we would use it for the people we visit.”

Lwe San was 18 when she was diagnosed with HIV. The diagnosis came just after the birth of her son, now eight years old and thankfully clear of the disease.

“I thought at the time that it meant I had three months to live. At that time there was no counselling, no understanding and I had just had a baby. I was so scared,” Lwe San said.

“I have been on ART [through AZG] now for four years. In a way I was lucky to be diagnosed when I was – it meant I could get the treatment. Now it is so much more difficult.”

The stigma surrounding the disease is so great that nearly a decade after her diagnosis, she still has not told her mother that she is HIV-positive.

When I visited the Oasis office, the volunteers were comparing CD4 counts, a measure of immunity levels that indicate the strength of the HIV virus in a person’s body. An especially low CD4 count can be a mixed blessing, indicating that the disease has reached an advanced stage but giving the patient priority on the ART waiting list.

A healthy CD4 count is between 500 and 1500. One visibly worn young man who volunteers with Oasis registered a count of 80. He had contracted HIV by sharing needles with other heroin users.

Now on methadone to help overcome his heroin addiction, he is also waiting to make it onto the ART list. In the meantime, his strength is fading, making volunteer work more difficult.

UNODC research has shown that between 40 and 60 percent of injecting drug users (IDUs) in Myanmar test positive for HIV, while 2.3 to 2.6 percent of pregnant women are HIV-positive.

As elsewhere in Southeast Asia, the main causes of transmission are sharing needles and unprotected heterosexual sex. People in prison are also highly vulnerable, as are sex workers, migrants and truck drivers.

Other NGOs are also working in Lashio to fight the spread of AIDS. UNODC offers clean needle exchanges and raises awareness about the dangers of HIV to drug users at a local drop-in centre, while Marie Stopes International offers reproductive health facilities and testing for sexually transmitted diseases.

Since UNODC opened its Lashio drop-in centre in 2004, HIV rates among clients have fallen from 60 percent to 30pc – proof of the effectiveness of clean needle distribution and awareness-raising activities. So far UNODC has distributed 428,848 clean needles at the five centres it runs in Shan State.

“We know that you are most at risk of HIV infection the first time you inject because you’re not experienced with injecting yourself, so you end up having to try several times to find the vein,” said Doctor Htet Aung, who has worked for UNODC in Shan State for five years.

“It’s necessary to provide awareness training before people even become addicts,” he said.

Another danger is dry injecting: “This means taking crystals of heroin and drawing your own blood into the syringe to mix with those crystals,” explained Dr Htet Aung.

“Most people in this area are dry-injecting. We provide clean water and syringes so that people don’t pass on HIV or inject dirty water into themselves, which can kill.”

“You really can’t look at the two issues separately,” said Daw Moe Thu Zar, a professional counsellor who has worked with sex workers and drug addicts in Shan State for more than five years. “HIV and drugs are interrelated.”

In a region where smoking opium has been used as a traditional means of pain relief for centuries, it is only recently that drug use has skyrocketed, as factories in Thailand and China have started turning the opium into heroin.

One outreach worker estimated that in many of the villages outside of Lashio, there is at least one user in every family, with young men particularly likely to inject.

Under Myanmar law, an unregistered addict can be sent to prison for up to three years. Dr Frank Smithuis, the country director of AZG, highlighted the need to work with such vulnerable groups.

“We need to focus on people with high risk behaviour: [men sleeping with men], sex workers and their clients, intravenous drug users,” he said. “These people should not be criminalised, but we should contact them and work with them to decrease the risk of HIV transmission.

“Criminalisation drives high-risk behaviour underground, which makes it very difficult to change behaviour. It is an old-fashioned way of thinking, that if you don’t want certain behaviour you just forbid it. It doesn’t work. Look at intravenous drug use. It is forbidden but still widespread.”

Daw Moe Thu Zar told me the story of a sex worker in Lashio that illustrated the need to work with vulnerable people without criminalisation.

“There was a woman whose husband was addicted to heroin. To support his habit, the husband sold everything they had, even their furniture,” she said.

With a sense that she had no one to turn to and a husband whose mind was obsessed with getting his next drug fix, this woman felt she had no legal means to access help and beg
an selling her body to pay for her husband’s addiction, she said.

Sex workers are particularly vulnerable to HIV, and rates for infection among them rival those of injecting drug users. In turn, injecting drug users and men sleeping with sex workers often pass HIV to their partners.

“When this woman finally found a drop-in centre, both she and her husband were HIV-positive,” said Daw Moe Thu Zar.

When asked about what she can offer her patients, other than registration with AZG’s waiting list for ART and basic healthcare provided free of charge at the clinic, Daw Moe Thu Zar was practical but seemed aware of the inadequacy of her response.

“I advise people with HIV about positive living and how things like meditation can help,” she said.

http://mmtimes.com/no447/n004.htm