This article expresses the hope of many that the 3D Fund will “find a way”.
All three recommendations made are directed towards the SPDC. Are there any other stakeholders that can take action?
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Burma Issues Newsletter October 2006
The Silent Dismantling of a Nation The impacts of HIV/AIDS in Burma S. Schafer
Over the past decade Burma has experi enced a continuing rise in its HIV/AIDS infection rate and is now classified as having a generalized epidemic. Surveillance of the situation is very poor so exact numbers are not available, but is it estimated that 360,000 people live with the disease in the country today. UNAIDS believes that approximately 1.3 per cent of the adult population, aged between 15 and 49, have HIV/AIDS - one of the highest rates in Asia. In addition, UNICEF estimates that 7,600 children younger than 14 are presently infected.1 This may sound little, but having a HIV prevalence among pregnant women of a startling 2 per cent we can expect a drastic rise in the number of infected newborns. Transmission of HIV/AIDS in Burma primarily happens through heterosexual interaction followed by drug use and contaminated blood with 65 per cent, 26 per cent and 5 per cent respectively. Accordingly, prostitutes and drug users are the population groups with highest HIV/AIDS infection rates. The armed forces also show an above average infection rate of 3 per cent.2
The State Peace and Development Council (SPDC) has accepted these numbers, but has so far been reluctant to take serious actions needed to address the HIV/AIDS issue. National spending on health care is ridiculously low with merely 3 per cent of the annual budget allocated to it (compared to 40 per cent spent on the military). Only about 200 people receive treatment through the national HIV/AIDS program, while it is believed that about 50,000 are in urgent need of antiretroviral drugs. Additionally, Médecins Sans Frontieres Holland independently runs a treatment project covering approximately 1,000 to 2,000 people.3 However, this is merely a drop in the bucket of what is needed, since, in total, no more than 3 to 4 per cent of the people that need treatment receive it.
Although non-governmental organizations have been allowed to operate in Burma, within a limited scope, work has been rather frustrating under the regulations imposed by the junta. Over the past two years the SPDC has even further tightened its restrictions making achievements virtually impossible. As a result, Global Fund, the main financial contributor to fight HIV/AIDS, Tuberculosis and Malaria in the country, withdrew from Burma last year, leaving behind a big gap in health care provision for the general population. In the hope of preventing a health crisis the Three Diseases Fund to fight HIV/AIDS, Tuberculosis and Malaria was recently created. The main donors, the European Commission, Britain, Australia, Sweden, Norway, and the Netherlands, have pledged $99.5 million over the next five years. At present, work has not yet commenced and it is still unclear how the Three Diseases Fund will deal with the obstacles imposed by the SPDC. We can only hope they will find a way, as a further increase in HIV/AIDS infection will eventually ravage the entire country.
Consequences of a HIV/AIDS Epidemic
Peter Piot, executive director of UNAIDS argues that HIV/AIDS “is devastating the ranks of the most productive members of society.”4 Classified as a sexually transmitted disease, HIV/AIDS spreads primarily among the sexually active part of society, people between age 15 and 49. At the same time this age group constitutes a nation’s labour force. Thus, as HIV/AIDS devastates people in their strongest years, it undermines the basis of a country’s economy: productivity declines while labour costs rise. In rural areas a decreasing number of farmers may endanger a secure food supply for the entire population. Even the loss of only a few workers during planting and harvesting can reduce the size of the harvest significantly. For Burma, a decline of its rural labour force may have devastating consequences as a secure food supply is already absent. In 2003 it was estimated that about 5 per cent of the population suffered from malnutrition.5 Even worse it is believed that 32 per cent of children under 5 years of age are underweight.6 Hence, a further decrease in food supply may lead to a country-wide famine.
At the same time however, the government will not have sufficient funds to deal with the impact of the disease. As a result of reduced human resources public revenues decline as well, leaving the state with a budget too small to serve the needs of the citizens.
HIV/AIDS also disrupts communities and households, as families lose their income earners while their spending on medication increases. Countries like Burma do not have a social welfare system that could provide support in such situations. Hence, to deal with this insurmountable financial burden, children often have to drop out of school to find work and care for sick family members. Stable family relations break apart, forcing children onto the streets, to work and, in worst cases, to sleep there as well. Many such street children are assaulted, raped or drawn into prostitution. At the same time they often become involved in petty thefts, muggings and burglaries. The shame, fear and rejection that often surrounds people affected by HIV/AIDS may create additional stress and isolation for these children.
According to UNICEF 1.9 million orphans lived in Burma in 2003.7 Compared to the number of street children, which Friends International, an international network working with street children in Southeast Asia and beyond, estimates between 10,000 to 30,000 (it is unclear which year these numbers refer to)8 it shows that so far the majority of orphans has been taken care of, usually through relatives. However, as the number of HIV orphans will increase with rising HIV/AIDS infection rate, it will become more and more difficult for the extended families to provide support, especially as they are likely suffer from financial hardship due to HIV/AIDS as well. Consequently, more and more children will face a life in despair, pushing Burma further into this downward spiral.
HIV/AIDS has many more destructive impacts on society in highly affected countries. Yet, these two examples are enough to demonstrate the horrendous effect a rising infection rate may have in Burma. As Peter Piot explains: “(…) the long-term result – over another two generations or so – could literally be the unravelling of economic and social development. These countries are no longer ‘developing’ – they are ‘un-developing’.”9
What needs to be done?
Given the fact that the HIV/AIDS epidemic is still in its infancy in Burma and that a serious awareness campaign by the junta is lacking, the disease is not yet felt as an immediate threat by large parts of the population. However, by the time the impacts become apparent, it may be too late. It takes between five and ten years until symptoms of AIDS appear, giving the virus the chance to spread unabated in the meantime. While some people may not know about their infection for years and spread it unintentionally, they can also hide it from others. Just fifteen years ago South Africa had an estimated HIV prevalence of 1 to 2 per cent, comparable to Burma. However, due to carelessness and negligence the infection rate increased nearly tenfold and now South Africa finds itself trapped in the vicious circle of HIV traumas.
The only way for Burma to avoid such a disastrous outcome is to protect its existing human capacity by providing treatment for infected people and preventing a further spread of the disease. The acknowledgment of having a HIV/AIDS problem is not enough. The SPDC must immediately tackle the disease, and this has to be done on various levels.
First of all the SPDC has to increase its national budget for health care and specifically for its HIV/AIDS program. Campaigns have to be launched to educate the population about the disease and means of protection. ‘Simple’ actions such as distributing condoms and clean drug needles would certainly slow infection rates. The regime must also begin to openly discuss the sensitive issues that surround HIV/AIDS: sex, commercial sex, homosexuality and drug use. The prejudice and discomfort of addressing these taboos have posed major obstacles in the past.
Secondly, the SPDC has to improve conditions for independent organizations to work in the country as their funds and expertise are crucial in the fight against the disease. Only through their help a country-wide surveillance of HIV/AIDS may be established. Hence, the abolishment of restrictions and bureaucratic obstacles is a necessary step to attract foreign support. It has to be the population that benefits from their help and not a corrupt government.
Lastly, the SPDC has to stop the civil war as it undermines living conditions and dangerously facilitates the spread of HIV/AIDS. In the absence of an adequate health service surveillance and treatment of people living with HIV/AIDS becomes impossible. Political instability also makes people more vulnerable to exploitation and abuse. In Shan State, for instance, systematic rape has been a common military tactic used by the Burmese army. Once infected, soldiers highly contribute to the spread of the disease, first in the conflict area and later in their home communities.
Unfortunately, at the moment there is no sign that the SPDC is willing to change its policy on HIV/AIDS. Strong activism is therefore needed from every section of society: policy makers, civil society, economy, and media, because it may push the regime to overcome its reluctance to deal with the disease. We can only hope that the Three Diseases Fund will be able to commence its work unhindered, as the actions taken today will determine whether Burma will suffer a HIV/AIDS catastrophe in the future.
Endnotes:
1. http://www.unicef.org infobycountrymyanmar_statistics.html 2. For figures see http://www.unaids.org/en/Regions_Countries/Countries/myanmar.asp 3. Interview with Thai Network of People Living with HIV/AIDS in October 2006 4. Peter Piot in R. Pharaoh and M. Schonteich: AIDS, Security and Governance in Southern Africa, p. 1. 5. http://www.fao.org/faostat/foodsecurity/Countries/EN/Myanmar_e.pdf 6. http://devdata.worldbank.org/AAG/mmr_aag.pdf 7. http://www.unicef.org/infobycountrymyanmar_statistics.html 8. http://www.friends-international.org/cwww.html#e 9. Piot Peter (2005): Why AIDS is exceptional. p. 9.
With thanks to: http://health.groups.yahoo.com/group/burmaaids/message/448
