Some readers are not going to like the [him] moderator's take on this issue.

Luke Arend responds to the posting on 'bizarre language' below. The [him] moderator has read the report cover to cover and recommends that all people interested in HIV treatment in Myanmar do so. He offers the following points in the spirit of discussion about constraints to HIV prevention and care activities in the country.

He continues to find the following phrase puzzling: "pushed to its limit by the lack of treatment provided by other actors". MSF was free to make its own decision to initiate an ART programme that stood little chance of being taken over by the government in 2003. As an autonomous and independent NGO it was not then and is not now 'pushed' by other actors.

And "unable to continue shouldering the primary responsibility for responding to one of Asia's worst HIV crises". MSF is not shouldering the primary responsibility for responding to the crisis. It is only bearing the primary responsibility for the ART part of the response.

Finally, MSF "insists that the government of Myanmar and international organizations urgently and rapidly scale-up the provision of antiretroviral therapy". No single international NGO should insist that any other NGO do anything. MSF should respect the autonomy of other NGOs just as they respect MSF's autonomy.

There is no clear reason given for MSF not doubling or tripling their ART programme. The MSF programme in South Africa, for instance, is massive. What are the true constraints that have led MSF to declare that they have reached their limit? Human resources? Material resources? Organisational resources? Financial resources? 'Lack-of-agency' resources? Why not increase resources? Get more money. Hire more people. Conduct more training. Treat thirty thousand people. Or forty thousand.

Comments?

[him] moderator

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Comment from Luke Arend http://www.hivinfo4mm.org/blog/_archives/2009/1/2/4043195.html#comments

In reference to the Him 841 I don’t agree that the language used in the MSF report on HIV/AIDS in Myanmar is bizarre, rather that the sentences quoted are out of context with the rest of the report. In this respect I’m glad that you put the link to the ‘Preventable Fate’ report in your email. I would like to urge the Him readership to please take a look at the report, and related slideshow on the MSF website:

http://doctorswithoutborders.org/publications/topten/article.cfm?id=3195

I would appreciate your feedback or better, as you propose, to stimulate a discussion on Him relating to this important issue.

The main aim of the report is to raise awareness of the ongoing lack of HIV/AIDS treatment and care in Myanmar, especially where the Millennium Development Goal to ‘’ Achieve universal access to treatment for HIVAIDS for all those that need it, by 2010” is woefully nowhere near being achieved for the people of Myanmar.

In response to your point about being pushed to the limits. MSF has been providing ART since 2003 and very quickly became the main provider in the country. In 2003, as today, there are tragically few providers of ART in Myanmar. MSF has continued to expand the program having today almost 12,000 PHAs on ART across the country. As you know this number is a drop in the ocean compared to the need, however MSF has done all in its means to tackle these unmet needs. With so few other’s providing treatment, MSF have been pushed to the limit operationally and financially to respond to the needs of PHAs in Myanmar. With finite resources the Myanmar mission was forced to set strict criteria for admission to the ART program, whereas prior to late 2007 all PHAs were admitted. This has meant denying several thousand patients treatment and sending them away knowing most have no other alternatives means of getting treatment. This predicament, which we face daily, has impassioned the organization further to call on others actors to urgently scale-up services. For too long the HIV situation has been known about in Myanmar without a comprehensive response. This is why there is insistence of change; highlighting the need is now enough, far too many people are dying each year with no concrete solution being tabled.

On your last point, MSF has continued commitment to HIV/AIDS treatment and care to PHAs in Myanmar, and these commitments, as in the nature of the virus, are not short-term. In fact we have ambitious plans in 2009 to admit several more thousand people of ART in Myanmar. However, as the report says, a single NGO, cannot meet the huge unmet needs that exist in the country, its needs to be a collective effort, led by the state, which as it stands today is still a distant reality.

If anything is bizarre, it is the sad lack of investment in HIV in Myanmar.

Let us all hope that this situation can change in 2009.

Please do read the report.

Luke Arend
Deputy Head of Mission and author of the report
MSF Holland, Myanmar