Vit uses the UNAIDS definition of driver. Piot: “It is patently clear that we need to make real headway against the fundamental drivers of this epidemic, especially gender inequality, stigma and discrimination, deprivation and the failure to protect and realize human rights."
The World Bank, on the other hand, uses both this definition and also calls sex work and injecting drug use 'drivers'. Sometimes in the same document!
And in India and South Africa the word drivers usually refers to long distance lorry drivers.
Whew! It is enough to confuse the general public ...
[him] moderator
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Junta's neglect hurts Burma's health
By Subhatra Bhumiprabhas
The Nation
Chiang Mai
Published on May 20, 2008
Crisis deepens in cyclone-hit state after ruling party focuses on refer- endum, not plight of survivors
When news broke about Cyclone Nargis striking Burma, Dr Voravit Suwanvanichkij was in Chiang Mai, discussing the health conditions of refugees and migrants from Burma with a group of Thai and Burmese journalists.
More than 100,000 people were reportedly killed in the natural disaster. Thousands more became displaced in their homeland.
And amid all this, the Burmese junta once again shocked the world; not only did it continue to hold a referendum, forcing people to vote, but it also closed its door to all assistance offered from countries around the world to help the survivors in the affected area. The health of the survivors is in a poor condition.
The junta's heartlessness, however, did not surprise Voravit, a researcher from the Centre for Public Health and Human Rights, Johns Hopkins University in the United States. He has been working with refugees on the Thai-Burma borders.
"The cyclone just underscored many realities that we have known about for years," he said.
Decades of neglect and abuse by the government have hurt the health of the Burmese people. The country's public health has long been in a state of crisis and now evidence is readily visible, Voravit said.
The junta government's expenditure on its people's health tells much about the situation, the doctor said. The World Health Organisation (WHO)'s report in 2005 stated that the Burmese government's expenditure on health per capita was only 40 US cents (Bt12.9). By comparison, Thailand provided US$61 (Bt1973.47) per capita.
More telling is the widespread prevalence of HIV in Burma. According to UNAIDS, in 2005, the country faced one of the most serious cases of HIV epidemic in Southeast Asia. The junta government's expenditure on HIV was US$ 0.005 (Bt0.16) per capita while Thailand provided US$1.43 (Bt46.32) per capita.
"If public health inside Burma is in a crisis, its frontiers are even worse - less visible, but increasingly evident," Voravit said. He has spent years with Dr Cynthia Maung's Backpack Health Worker Team (BPHWT), visiting refugee communities on the Thai-Burma borders. These people are not recognised as "refugees" as defined by the UN High Commissioner for Refugees. The doctor said the borders are permeable to everything except public health programmes.
In Thailand, for these refugees without a legal status, and thus at a risk for deportation, accessing health services is difficult. Sometimes it seems impossible when we consider the barriers the Burmese have to face, such as cultural and language differences, financial difficulties and a lack of adequate understanding about health, the doctor said.
"It is not a simple coincidence that this population bears a disproportionate burden of infectious diseases - conditions such as tuberculosis, malaria, HIV/Aids," Voravit said.
A chief concern for the doctor is lymphatic filariasis, which was found in two symptomatic patients in Chiang Mai in 2004. "The two patients came from Mongnai in Shan state, which the Burmese government claimed was a filariasis non-endemic area," Voravit said.
The two cases are signs of an epidemic, indicative of a system failure somewhere, said Voravit, adding that most of the infected have no symptoms, but could cause mosquitoes to turn infectious. That means Thailand, where millions of migrants flooded in and became undocumented workers, is also at risk.
But blame should be put on the junta, not the refugees and migrants, the doctor said firmly. The Burmese junta's expenditure to prevent the disease was negligible. In 2004, the governing body spent only US$6,000 (Bt 194,375.90). By comparison, Thailand, where the disease has been rarely seen for several decades, provided US$500,000 (Bt16,197,991.94) in 2002.
"The fundamental driver of these problems remains the flawed policies of the Burmese dictators; policies whose primary purpose is to entrench [the junta's] control rather than improve the well-being of the people of Burma," Voravit said.
The doctor said the Thai government's vocal support for the Burmese junta is not only morally bankrupt but is also highly incongruent with the assertions that it is serious about dealing with illegal migration and the problem of infectious diseases on the country's borders.
"Health problems do not simply happen. There are factors that often fail to control them or make them worse," Voravit said.
http://nationmultimedia.com/2008/05/20/national/national_30073433.php
