Today's blast from the past is an interview with Myat Htoo Razak almost fourteen years ago.
Jamie
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Facing the Challenge
Myat Htoo Razak
The Irrawaddy
Thursday, May 1, 2003
The Irrawaddy spoke to Dr Myat Htoo Razak about the severity of the HIV/AIDS situation in Burma. He is a medical doctor and PhD from Burma who specializes in Epidemiology of Infectious Diseases with an emphasis on HIV/AIDS and Health Policy and Planning. He currently works in HIV/AIDS research, prevention, care, and support programs in Asia through various international agencies and institutions.
Question: How serious is the HIV/AIDS situation in Burma?
Answer: As a health worker and a person from Burma, I would say the HIV/AIDS situation is one of the country’s most serious health and social challenges since the late 1980s. The focus has mainly been on how many are infected, as estimated numbers of people with HIV/AIDS in Burma vary. The UNAIDS 2002 report estimated from 180,000 to 420,000 cases, while another group of researchers estimated 687,000 cases. It doesn’t matter whether the number is one hundred or one million if little is being done to prevent more infections and to provide care and support to those who are already infected. We need to have good estimates for better planning but Burma needs to move forward with action now. I deeply hope that people in Burma will soon be able to respond effectively to this serious health, social and development challenge.
Q: What sort of challenges and difficulties are there when gathering data in Burma?
A: Information on behavior and practices related to sex and drug use is always challenging to collect. People do not usually provide correct information about sexual history and drug use if they don’t know how information will be used and how confidential it will be. Without the availability of reliable HIV testing facilities and confidential pre- and post-test counseling services, information from the community is not easy to collect. Information on HIV/AIDS in Burma comes mainly from the national sentinel surveillance system, which has been conducted by the Ministry of Health since 1992. Currently, there are 27 sites in 14 states and divisions that gather information from selected populations for a one-month period twice per year. The number of tests is limited. One hundred to 600 people are tested at each site during the surveillance period. Whenever such a system is used there is a concern whether the information is a good representation of the situation in the country.
Q: What have you discovered about the prevalence of HIV in the armed forces? Do you have a reliable class breakdown of HIV infections?
A: According to the reports from the national surveillance system of the Ministry of Health, HIV prevalence among new military recruits was 0.4 percent in 1993 and gradually increased every year, rising to 2.5 percent in 1999. A drop was reported between 1999 and 2000, when the percentage decreased from 1.7 percent to 1.4 percent, but it was 2.5 percent again in 2001. The Ministry of Health visited two sites on two occasions (March and September every year), but only tested 600 military recruits on each visit. So, we don’t know the actual HIV prevalence among all new recruits or the HIV prevalence among the armed forces personnel as a whole. It would be detrimental for the country not to provide HIV/AIDS prevention, care and support programs for the armed forces personnel because they are a part of the country. For the sake of the country, ethnic groups, students, artists, entertainers, businesspeople, politicians, military personnel, civil servants, religious groups and all other communities must work collaboratively. The goal must be effective prevention and control of the HIV/AIDS epidemic.
Q: The UK government recently pledged ten million pounds to help deal with the HIV/AIDS crisis in Burma. How seriously does Burma need international assistance?
A: Every country needs assistance responding to the HIV/AIDS epidemic. HIV/AIDS prevention, care and support programs require a substantial amount of money, more than national governments can allocate from their budgets. Ideally, international assistance is intended to allow countries to help themselves after the initial money is given. So, there should not be any "misplaced pride" (ta lwal mah nah) related to receiving assistance as long as the government is serious about using it to benefit the people. It is important to spend a large proportion of the international assistance on programs that benefit the communities on the ground directly, rather than spending it on international organizations and experts. The UK government and a few other governments have pledged to provide millions of pounds to Burma through the UN’s "Joint Funding Mechanism". Although it is good to assist the country through the UN system when other alternatives do not seem possible, the donor agencies and people of Burma will have to make sure that the UN’s bureaucratic system is judicious and efficient in this critical task. It is crucial that the Expanded Theme Group of the UN and "community advisory groups" make working together a priority when planning and implementing intervention programs. It is also essential that those groups include different segments of the community and should not exclude members of certain political or ethnic groups. Without active participation of such groups in the decision making process, the international assistance will benefit those who work with international agencies rather than the people of Burma. In addition, support for ethnic groups and people living in the border areas should be a high priority for donor agencies because of the serious impact of HIV/AIDS in some of these communities. Donor agencies and the international community should also focus on the cross-border aspects of HIV/AIDS prevention and care. There is a desperate need for better mutual understanding between the host countries and migrant communities from Burma to reduce the risks of HIV transmission and to improve access to health care for those who need it.
Q: Can you explain some of the practical concerns for international NGOs and donor agencies in regards to distributing resources and funds?
A: International NGOs play an important role in terms of providing resources and funds to the people. However, their usefulness depends on their objectives, experience, knowledge and commitment to the people. Donor agencies should monitor and evaluate the performance of international NGOs in Burma based on their actions and impact on the ground. I think there are a few good international NGOs working in Burma who can deliver both the financial and technical support provided by the international agencies. However, Burma will have to rely on those international NGOs for a long time if donor agencies insist on working exclusively through them. There are many good civil servants, local community organizations and ordinary citizens, who are dying to do—and dying while doing—something good for the country under challenging circumstances. The donor agencies should search for creative ways to support their efforts and enhance their capacity.
Q: Critics say that the government is in denial. Do you believe this is still the case?
A: We have to define the government first to answer that question. I would like to differentiate between the top SPDC decision makers and the civil servants. Civil servants working in the "government system" have been reporting on the HIV/AIDS situation in Burma at international forums for many years. If I remember correctly, in the year 2000, a former Minister of Health released a statement mentioning that the HIV/AIDS epidemic was very serious in Burma. And, Gen Khin Nyunt opened the World AIDS Day ceremony in Burma in Dec 2001. So, I think there has been some recognition of the HIV/AIDS situation in Burma by civil servants and the top SPDC decision makers lately. However, recognition does not necessarily translate to an effective response. Burma has lagged way behind neighbors such as Thailand, China and Cambodia in terms of prevention and control of the HIV/AIDS epidemic. There is a saying "better late than never" but being late has already hurt the country. The people of Burma have the will and the wits to overcome a lot of serious adversity. So, let’s hope that people will be able to respond to the HIV/AIDS epidemic effectively in the very near future.
Q: How are patients and their families inside Burma coping with the disease?
A: Only they can tell you how they are coping with the situation. They might be coping with the harsh reality, and hoping for miracles due to the limited availability of health services and social support. Without dramatic improvements in the health care and social support systems, it will be quite difficult for people living with HIV/AIDS in Burma to cope with the situation well. However, like in many countries, people with money and connections might be able to do a bit better than those without. People living in towns and villages far away from major cities will have more severe situations due to less access to health care and financial difficulties. I hope that in all states and divisions there will be a more systematic approach to providing sufficient care and support to people living with HIV/AIDS and their families.
Q: If Burma is really facing an AIDS crisis, as the media outside the country claim, what effect do you think this will have on Burma’s political stability and the democratization process.
A: The HIV/AIDS epidemic is one of the most serious crises the world is currently facing, and Burma is no exception. The impact of this global epidemic is felt beyond the health care sector. HIV/AIDS has caused changes in the social, economic and security situations in many countries because the most productive age groups are seriously affected. If the people of Burma have an opportunity to unite and rally together in response to the HIV/AIDS epidemic, it will be a very positive example of the country’s political stability and will help the democratization process. Every country that has responded to the HIV/AIDS epidemic effectively demonstrated that active voluntary participation from every sector of the country, and political will and action from the leaders of the government, are crucial ingredients for a successful and sustained response. Everyone in Burma has to ask what he or she has done for HIV/AIDS prevention, support and care lately. If we have not done much, we have to find the reason and work harder to overcome it. This is easier said than done. I hope all of us will be able to do more for the country.
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