Dr Picard has not mentioned that it is necessary for patients to have valid Mandalay citizenship cards in order to enroll in this ART programme so that migrants are excluded.

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Effective HIV/AIDS support in Myanmar (Burma)
and sustained development
Odile Picard
Hopital Saint-Antoine, 184 rue du Faubourg Saint-Antoine
75012, Paris
Retrovirology 2006, 3(Suppl 1):P75
Since few years the obligation to provide access to Antiretroviral
(ARV) drugs for HIV positive people living in resourcelimited
countries has become consensual. Numerous programs
implemented by the different United Nations Agencies
(UNAIDS), through inter-governmental collaborations, or
through non-governmental organizations (NGO) and private
foundations, have been funded in many Asian and African
countries. The benefit of the treatment of HIV/AIDS, which is
not restricted to the procurement of ARVs, is related to the
quality of the long-term patients monitoring (decline in AIDS
deaths) and to the efficacy of the prevention (decline in new
HIV+ patients). Most of the programs manage a limited number
of patients (restricted funds), and the benefits are limited
according the needs of the helped countries. However,
programs, which are focusing on a limited number of patients,
can be of prime importance if they are integrated to the
sustained development and able to improve the global level of
the public health of the country.
Although political sanctions preclude Burma from consistent
international financial contributions to HIV/AIDS, the first program
to access ARV drugs for the HIV+/AIDS patients in the public sector
has been funded by a private company: Yadana (Total and partners)
and implemented by an international NGO: the International Union
Against Tuberculosis and Lung Disease (IUTLD) also called ‘‘The
Union’’. The World Health Organization (WHO) and the Ministry
of Health of Myanmar support this program. It started April 1st,
2005 at the General Hospital (MGH) ofMandalay the second largest
city of the country where 7000 HIV+ patients are estimated to be in
need of ARVs. It aims at managing patients treated for Tuberculosis
(TB) and co-infected with HIV infection (tuberculosis occurs in 75%
of the HIV+ patients therefore providing the opportunity to detect
the HIV infection). At of the end of April 2006: 1372 TB patients
have been offered and have accepted to be tested for HIV, among
whom 427 (32%) patients were found to be TB-HIV co-infected.
Fifty-six spouses/children were offered HIV Voluntary Confidential
Counseling and Testing (VCCT). 28 were found to be HIV positive.
Of the 455 (427 + 28) patients diagnosed to be HIV-infected, over
300 are already managed and over 150 patients are being provided
ARVs. Although the program is limited, it has raised the level of HIV
+ patient management to the UNAIDS recommended level for the
following reasons:
• Implementation of the VCCT in the public sector: For the first
time, the test is performed on anonymous basis in a public
hospital and uses 2 rapid tests.
• Decrease in the discrimination: The implementation of the
program moved the HIV testing site from the department for
sexual transmitted infections (STI) to the tuberculosis center.
For the first time in the public sector HIV testing is not linked
anymore to STIs.
• Possibility to get HIV tested on voluntary basis without being a
patient at hospital and with obvious AIDS clinical signs. People
have now the opportunity to be tested and know their
serological status.
• Drug exchange program: For the first time, ARV drugs can be
exchanged between the different NGOs and organisms without
a request to the government. This will dramatically decrease the
risk of treatment disruptions.
• Promotion of a program coordinator: For the first time, the
technical decisions are decentralized and the coordinator can
deal directly with the members of the NGO without referring
to the government.
These conditions requested by the IntNGO and accepted by
the government during the implementation phase of the
program are now considered as regular practices at the national
level and are used in other AIDS and other disease related
programs.
In Myanmar, the IntNGO has assisted the government in
promoting international recommendations in the patient
management. This coordinated action provides a framework
for a successful fight against the HIV/AIDS epidemic in resources
limited countries, which take into account the sustained
development and the general benefit to the public health.

http://www.retrovirology.com/supplements/3/S1/?page=8