Laurie Garrett was a fine reporter for Long Island’s newspaper of
record. But she is out of her depth when she starts to analyse the Burma / Myanmar
epidemic. She appears to be unaware of the millions spent through the Fund for
HIV/AIDS in Myanmar. And she blames the epidemics in Mumbai and Jakarta on the Generals! …
21 December It has come to the attention of the [him] moderator that Mr Fullbrook might be treading on thin ice as well. See this anonymous comment:
Please note that the version of the article below is NOT the final
version. After communication with the author, the author informed
this reader that the reference for Chinese officials saying that rates
were 'four to five times higher' than officially admitted was from an
International Herald Tribune article. The IHT article, however, does
not even mention Myanmar. The author also informed this reader that
his article was subsequently revised, and indeed the version found on
the Asia Times website takes this reference to Chinese officials out.
Kindly post the final version, though evidently the author's original
version is still floating about.
The [him] moderator has noted the change in italics below.
***********************************
Myanmar's HIV/AIDS security threat
David Fullbrook
Asia Times
BANGKOK - Is Myanmar's HIV/AIDS situation heading for a pandemic on scale with the human
disasters seen in Africa?
Precise data about the AIDS and the human
immunodeficiency virus (HIV) that causes it are scant in the secretive
military-run country, which until recently banned all local reporting on HIV
and AIDS cases for reasons of national security. But many independent
public-health experts believe that Myanmar
is heading in a dangerous direction, a public-health risk large enough
potentially to have adverse effects on domestic and regional security.
"The current epidemic in Asia, with exception of the
blood-transfusion ones in China and
Japan, is really a [Myanmar]
epidemic," said Laurie Garrett, senior fellow for global health at the
Council on Foreign Relations in New
York. "It is in the
interests of Asian states to see Myanmar's
HIV epidemic as a national-security threat."
Myanmar's official headline
HIV-infection-rate data surprisingly suggest the epidemic is slowing, with 1.3%
of those aged between 15 and 49, or about 350,000 people, testing positive for
the disease in 2005, down from a 2.2% incidence rate five years earlier,
according to the National AIDS Program Myanmar as quoted in the latest report
by UNAIDS (the Joint United Nations Program on HIV/AIDS).
Another apparent cause for cautious
optimism comes from pregnant women, among whom infection has remained steady at
about 1.5% in urban areas throughout the decade. The situation in rural towns
and villages is hard to gauge because the public health-care system is in a
critical condition, struggling to function on meager funding. Among army
recruits, incidence eased to 1.6% in 2004 from 2.1% a year earlier, according
to Myanmar government data.
Yet there are concurrent reasons for grave
concern. Among people aged 15-24, or the country's future doctors, bureaucrats,
commanders, entrepreneurs and parents, the infection rate is a high 2.2%. One
in three sex workers tested positive for HIV in 2005, against one in four in
2004, according to the Department of Health and the National AIDS Program.
These high incidence rates could actually
be much worse, however, because of shoestring budgets for monitoring and the
ruling junta's obsession with secrecy, even over crucial public-health issues. Myanmar
has not held a reliable national census since the results of colonial-era
surveys were destroyed in 1942.
Some countries that in comparison take
their AIDS problems seriously and are deploying large budgets and able
officials to combat the disease doubt the veracity of Myanmar's
official data. Chinese Health Ministry officials said in November that Myanmar's
infections are probably four or five times what their data indicate. China
reported in October that its number of cases had jumped 30% to 183,733 from
144,089 at the end of last year.
[him] moderator This was later changed to : Chinese Health Ministry officials said in November that China's
infections are probably four or five times what their data indicate. China
reported in October that new cases had jumped 30% to 183,733 from 144,089 at
the end of last year. Total infections are about 650,000.
Likewise, Taiwanese public-health officials
told reporters in November that they believe Myanmar's
infections are three times as high as the military government admits, according
to a news report in the Taipei Times. Health officials and researchers usually
take stock of the HIV situation around this time of year in preparation for World
AIDS Day.
"I think what we can say for now is
that [Myanmar's] figures are likely a very significant underestimate, and the
true numbers of infected individuals is much, much higher," said Dr
Voravit Suwanvanichkij, an epidemiologist with the Johns Hopkins Bloomberg
School of Public Health in Chiang Mai. UNAIDS last year described the situation
in Myanmar as "one of the most serious AIDS epidemics in the
region".
Yet according to Myanmar's official
figures, new-incidence rates are rapidly declining without substantial spending
on the public-awareness campaigns that have successfully changed behaviors and
encourage condom use in other countries, including Thailand.
"The folks at John Hopkins recently
published an estimate that [the Myanmar
government] spent less than US$50,000 [on countering HIV and AIDS] in the last
year," said Garrett of the Council on Foreign Relations in New York.
"I've heard other folks say that through secondary mechanisms such as the
UN that it might be up to $2 million nationwide."
Meanwhile, international money, medics and
experts brought in to the reclusive country to track and combat its HIV/AIDS
problem have recently been called back, apparently because of the military government's
suspicions that foreign aid workers were too sympathetic toward the political
opposition.
In August 2005, the Global Fund for
HIV/AIDS, Tuberculosis and Malaria canceled its $37.5 million program in Myanmar,
blaming tight government restrictions on its movements that made working nearly
impossible. Medecins Sans Frontieres pulled out of the country's war-torn Karen
and Mon states last March for similar reasons.
In November, the International Committee of
the Red Cross was ordered to close all its offices outside of Yangon. Meanwhile local
non-governmental groups trying to prevent infections and care for sufferers are
often harassed by security forces, people aware of the situation say.
Look the other way
It took brash campaigns backed with huge
sums of government spending and foreign aid to break down taboos and change
behavior to help bring new infections down in impoverished Cambodia
and comparatively well-off Thailand.
And even there, with international assistance, those gains are tenuous as signs
of official complacency are putting a new generation of young people at risk.
In absence of the prevention and
public-awareness campaigns seen in Cambodia
and Thailand, condom use and availability rates in Myanmar -
although rising - remain dangerously low. Patchy education and awareness
campaigns, though better than official denial up until just a few years ago,
are not enough to keep pace with the evolving demographics of the virus's
spread.
The Myanmar
government estimates that condoms are used in only about half of all commercial
sex transactions. Combine that with what most observers characterize as an
expanding sex industry, and more doubts are cast on the government's overall
infection-rate data.
Anecdotal evidence suggests the clientele
includes a growing number of Chinese entering Myanmar, especially impoverished
border areas to trade in goods and natural resources, cut forests and mine for
jade and other minerals. Those human flows are creating conditions ideal for
the virus to spread further, faster, including into mainland China.
Improving measures in China to stem its still expanding HIV problem, health experts say, are
clearly being undermined by Myanmar's
uneven efforts.
Myanmar's infection rates are particularly acute in border areas where
intravenous drug use is endemic and poverty causes shared needle use. Australia's
Burnet Institute estimates 150,000-250,000 people in Myanmar
regularly inject drugs. Nationally 43% of people injecting drugs were infected
with HIV in 2005, reports the National AIDS Program Myanmar,
up from 34% reported by Myanmar's Department of Health in 2004.
In the remote Shan state, which borders China and
Thailand, rates for drug injectors are even higher, including, according to
the Department of Health, a startling overall 60% infection rate in Lashio, a
trading town along the main trade and trafficking route between the central Myanmar
city of Mandalay and southern China's Yunnan province.
Meanwhile, India reports that more than 3% of pregnant women tested positive in
districts along the Myanmar border in 2005.
"In some areas, the epidemic continues
to rage essentially out of control, particularly in Kachin state, and without
genuine attempts to systematically collect and analyze relevant information,
address the issue and the factors that drive HIV vulnerability, including
migration, poverty, and lack of education and health care, some regional
epidemics have the potential to reach prevalence rates more closely resembling
some countries in Africa," said Dr Voravit.
In many African countries, infection rates
of 5% opened the door to epidemics ripping through societies, leaving more than
25% HIV-positive. More worrying, new strains are beginning to emerge in Myanmar's
remote areas and China's Yunnan province, health experts say.
"We have molecular data to link China's
epidemic in IDUs [injecting drug users] in Yunnan to HIV
strains circulating in Burma," said Voravit. "And we have more molecular data showing
that HIV strains in IDUs from Burma and
Yunnan are not only similar but very diverse, strongly suggesting an
epidemic out of control, as individuals get infected again and again with
multiple HIV strains."
Health experts also note that comparatively
few Africans inject drugs, yet AIDS has ravaged that continent, significantly
rolling back life-expectancy rates and crippling the economies of many
countries. Similar to Myanmar, many of those countries were very poor with substandard
health-care systems, and rather than tackling their epidemics straight on, many
African governments looked away until it was too late. Only where governments,
often supported by foreign aid, have confronted the epidemic openly have
infection rates slowed.
"Unless Burma's epidemic is confronted
and there is a real aggressive campaign, then the whole region will continue to
receive new strains of HIV, part of the fluid movement of the black market
across southern Asia in drugs, sex and labor," said Garrett.
And unless the country's ruling generals are
soon persuaded to address the country's HIV/AIDS situation not only as a
public-health problem but as a potential domestic and regional security threat,
Myanmar could, a la Africa, be headed toward failed-state status.
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