The [him] moderator thinks it is yet too early to announce a decrease in prevalence as a result of increased prevention activities. Or to announce a decrease in prevalence at all. More evidence is needed.
The putative decrease in incidence is only of academic interest.
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Burma Says It’s Winning HIV/AIDS Fight
Clive Parker
Irrawaddy
30 November 2006
Minister of Health Dr Kyaw Myint on Wednesday told a press conference in Naypyidaw that Burma is winning the fight against HIV/AIDS, citing a drop in the number of cases over the past five years.
Referring to statistics that show infections dropped from 1.5 percent in 2000 to 1.3 percent last year, Kyaw Myint denied that Burma’s HIV/AIDS epidemic constituted a threat to international peace and security, one of the arguments used as part of the US-led effort to address Burma at the UN Security Council.
“HIV prevalence in Myanmar [Burma] has reduced,” he told gathered members of the government, press and the humanitarian community.
Despite claims of progress by the regime, privately it still appears to be highly concerned by the epidemic. Burmese Prime Minister Soe Win told his Thai counterpart Surayud Chulanont in a meeting in Naypyidaw this month that HIV in Burma is widespread and that there was a lack of experts in the country to solve the problem.
In response, Surayud said his government was ready to help and provide its own expertise, a Thai Government House press statement said.
While the UN’s recently released HIV/AIDS survey for 2006 says “there are early indications that the epidemic [in Burma] might be diminishing,” it adds that the country is still “experiencing a serious epidemic.”
The report says the 1.3 percent infection rate as cited by the Burmese health minister applies only to adults, or those aged over 24 years old, compared to a rate of 1.4 percent in 2003. For young people aged 15 to 24 years old, the UN estimates an HIV prevalence rate of 2.2 percent, which it describes as “a cause for serious concern.”
In addition, some 43 percent of injecting drug users and 32 percent of sex workers were found to be HIV positive in 2005, “proportions that have changed little since 2000,” the report says. Dr Kyaw Myint made no mention of this data during his speech on Wednesday.
The UN does, however, point to some notable successes in tackling the disease in Burma. HIV infection levels among pregnant women have declined from 2.2 percent in 2000 to 1.3 in 2005, studies show. Similarly, among men seeking treatment for other sexually transmitted diseases, eight percent were HIV positive in a 2001 study, compared to just four percent last year.
Burma has also recently introduced programs that the UN believes will help aid the fight against HIV/AIDS, as referred to by the health minister. A methadone program as a replacement for heroine users was piloted in February this year in Rangoon, Mandalay, Lashio and Myitkina.
Similarly, an education program on safety was offered to injecting drug users for the first time with the support of international non-governmental organizations working in Burma, along with 1.1 million disposable syringes, in 2005.
Nevertheless, it was not until the same year that public sector antiretroviral treatment was offered to HIV-positive people in Burma, and only in 2004 that safety was achieved nationwide on blood stocks, the health minister said. Just over 95 percent of supplies transfused were tested the same year.
An external UN review of Burma’s HIV/AIDS program conducted in March and April this year—the first for more than a decade—also shows mixed results. A copy of the findings circulated at a conference on HIV/AIDS in Toronto, Canada in August, as posted on the HIV Information for Myanmar website, shows that “significant progress has been achieved in the health sector in Myanmar [Burma] by the national response to HIV/AIDS.”
“These accomplishments deserve recognition. But much work is still needed for the NAP [National AIDS Program] to achieve the greatest possible impact,” it adds.
Describing Burma as “one of the countries hardest hit by the HIV epidemic in Asia,” the appraisal says that the national program to fight the virus is under funded and severely short-staffed, particularly at the township level. Similarly, health centers were found to be lacking adequate equipment and a reliable electricity supply.
Excerpt from 2 0 0 6 A I D S E P I D E M I C U P D A T E by WHO and UNAIDS
In neighbouring Myanmar there are early indications that the epidemic might be diminishing (Wiwat, Brown, Calleja-Garua, 2005). HIV infection levels have declined among pregnant women (1.3% in 2005, down from 2.2% in 2000) (National AIDS Programme Myanmar, 2005) and among men seeking treatment for other sexually transmitted infections (from 8% in 2001 to 4% in 2005) (National AIDS Programme Myanmar, 2005). Nevertheless, the country is experiencing a serious epidemic, with an estimated 360 000 [200 000¨C570 000] people living with HIV at the end of 2005, and national adult HIV prevalence of approximately 1.3%. HIV prevalence of 2.2% among young people (15¨C24 years of age) in 2005 is a cause for serious concern (National AIDS Programme Myanmar, 2005). So, too, are the high HIV infection levels found in most-at-risk groups, such as sex workers and injecting drug users. Some 43% of injecting drug users and nearly one in three (32%) sex workers countrywide were living with HIV in 2005¡ªproportions that have changed little since 2000 (National AIDS Programme Myanmar, 2005). In a study in urban and rural communities in seven townships, only 16% of youth (15-24) reported being sexually active and of the men, only 3% of youth reported having sex with sex workers in the past year. The proportion of men who reported using condoms consistently with sex workers was 60% among young men and 50% among older men (Thwe et al., 2005). Meanwhile, nongovernmental organizations working with the informal support of the authorities have established pilot programmes to bring HIV prevention services to injecting drug users. More than 11 000 injecting drug users are believed to have benefited from such efforts in 2005 (National AIDS Programme Myanmar, 2005).
Myanmar makes efforts in fighting against AIDS, TB, malaria
Myanmar has been making efforts in fighting against three diseases of national concern -- HIV/AIDS, tuberculosis (TB) and malaria, scoring many achievements in the aspect over the past two decades, according to the country's Health Ministry.
Myanmar treats the three diseases as priority with the main objectives of reducing the morbidity and mortality to make them no longer a public problem and meet the Millennium Development Goals of the United Nations.
According to a latest remarks of Minister of Health Dr. Kyaw Myint, a workshop involving Myanmar, the World Health Organization (WHO) and UNAIDS stated that 338,911 people were estimated to have lived with HIV/AIDS in 2004 and the HIV prevalence in Myanmar has reduced from 1.5 percent in 2000 to 1.3 percent in 2005.
In the course of its endeavors to contain the HIV/AIDS, Myanmar initiated study on prevention and control activities on the disease in early 1985, establishing the National AIDS Committee and laying down control programs in 1989.
HIV sentinel surveillance was started in 1992, followed by prevention of mother-to-child transmission program in 2000, 100- percent condom use program in 2001 and public sector antiretroviral therapy for HIV-infected persons in 2005.
In its anti-AIDS program, Myanmar launched health education and awareness raising activities against the disease covering a total of 550,000 people with 40 million condoms distributed in 2005, up from 11 million distributed in 1999.
In its harm reduction activities for intravenous drug users, Myanmar educated 10,000 such users and distributed 1.1 million disposable syringes and needles in 2005.
In prevention of mother-to-child transmission, 130,000 pregnant women were tested for HIV during 2005. Statistics show that HIV levels of pregnant women have declined from 2.2 percent in 2000 to 1.3 percent in 2005, while that among men seeking treatment for other sexually transmitted infections from 8 percent in 2001 to 4 percent in 2005.
The country also conducted blood safety program, access for all on HIV/AIDS education, information, prevention and care activities, introducing counseling confidential testing.
According to the ministry, during 2006, a total of 2,500 AIDS patients were provided with antiretroviral treatment and 10,000 patients with home-based care, targeting to offer such treatment to 4,000 more patients over the next two years.
In its regional and international cooperation in dealing HIV/ AIDS, Myanmar stands as an active member in the ASEAN Task Force and Mekong Region Collaborative Activities with a total of 17 local, 19 international non-governmental organizations and 7 UN organizations participating in the national response against HIV/ AIDS in the country.
With regard to TB, the minister said it is estimated that about 100,000 new TB patients develop annually and about half of them are infectious cases.
The minister disclosed that Myanmar achieved 95 percent case detection rate and 84 percent treatment success rate in 2005.
With the introduction of Directly Observed Treatment Short Course (DOTS) strategy of the WHO in 1997, the DOTS treatment covered 330 townships in 2002 and extended to the whole country's 324 townships in 2003 after DOTS expansion.
As for malaria, the trend of malaria morbidity and mortality has been decreasing at present with malaria morbidity per 1,000 population reducing from 24.5 in 1988-89 to 9.3 in 2005-06, while its mortality down from 10.4 to 3.1 correspondingly.
In its prevention efforts against malaria, the government has distributed 50,000 long lasting insecticidal nets annually since 2000 to hardly accessible areas of national races with up to 400, 000 existing bed nets also impregnated with insecticide annually since 2000.
Meanwhile, as part of the special project collaborative activities dealing with the three diseases, Myanmar-China and Myanmar-Thailand cross-border activities were also conducted bilaterally since 2000.
According to the minister, after the Global Fund to Fight HIV/ AIDS, TB and Malaria terminated its grant to Myanmar in August 2005 out of political reasons, it has been replaced as a compensation by another Three Diseases (3D) Fund which involves six donor countries -- the United Kingdom, Australia, the Netherlands, Norway and Sweden as well as the European Commission (EC). The six donors have pledged a grant aid of 99.5 million US dollars for five years to fight the three deadly diseases under a memorandum of understanding between Myanmar Health Ministry and the UN Office for Project Services signed in October 2006.
Myanmar is now in the process of its five-year short-term national health plan (2006-2011) which comprises 12 major programs and 66 projects.
Besides, the country, being a member state of the Association of Southeast Asian Nations (ASEAN), is also implementing a 30-year long-term plan (Myanmar Vision 2030), under the guidelines of the ASEAN Vision 2020.
Source: Xinhua
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