The [him] moderator asks your patience for his posting one more piece on ‘AIDS roads’. This report on Muse/Jegou was written eight years ago but little has changed. What sustainable programmes have been developed? Please write the [him] moderator with examples.
Viral Buffers and Truckers: Muse, Myanmar, and Je Gou, Yunnan, China
Muse is a border town with a reputation. In the recent past, it became identified with drug-trafficking and injecting drug abuse. In collaboration with Myanmar authorities, several large projects by UNDCP and ESCAP have brought significant resources to bear on this problem. This mission was in no position to evaluate these projects, but all reports suggest these projects as having essentially succeeded in greatly reducing both flow and use of illicit narcotics in this border town. In the recent rounds of the national sentinel surveillance for HIV, Muse has had difficulty in locating sufficient numbers of IVDUs for a valid sample size.
HIV/AIDS awareness is high in Muse and incidence is relatively low, presumably due to the extensive resources of the projects noted above.
Nevertheless, interviews with leaders of local NGOs, such as MMCWA, MRCS, and USDA, suggest that high-risk activities remain a concern, particularly among young people and traders. The USDA representatives were particularly insightful in their concerns over risk-seeking behavior among youth. With the rapid growth of border trade, the lure of easy money and the flash of nightlife across the border represent a real concern for many parents. The USDA representatives noted that youth activities were needed, but that the most at-risk or risk-seeking youth were unlikely to be attracted by any USDA youth programs. This prescient insight is pertinent to many of the existing programs for HIV/AIDS prevention in Myanmar: that programs too often attract or are designed to cater to the lower-risk and less-risk-seeking members of a given community. While often more acceptable to authorities, from the standpoint of intervening in a rapidly escalating epidemic, this is a strategic failure regarding focus and purpose of programs.
The border crossing between Muse, Myanmar, and Je Gou, Yunnan, China, is characterized primarily by trade and truck traffic. While the border has been closed from time to time, it is currently open to cross-border trade. Recent changes in customs and trade regulations has, reportedly, significantly increased the clearance time required for each truck and, important for considerations here, increased the time necessarily spent by drivers and their assistants (spares, as they are called), waiting for completion of these procedures. While formerly over 2,500 trucks per month were reported to cross the border, the current number being cleared is estimated to be about half that. Large numbers of trucks were observed to be awaiting inspection and clearance procedures.
The value of this trade is significant for both countries. For the Chinese counterparts, value of the trade at Je Gou and Ruili is 50% of the total Yunnan Province economy. An example from an earlier study by Save the Children-UK (1997), noted a battery company in Ruili that sells 6.1 billion units per year to Myanmar, but only 1 billion to the rest of Yunnan. Goods from Myanmar are primarily agricultural, forestry and food products, while Chinese export consumer goods ranging from toothpaste to satellite dishes.
Recent road improvements between Lashio and Muse have greatly reduced driving times to about 3-4 hours from the previous 10-12 hours for passenger vehicles. Trucks with trade goods may still take somewhat longer as several security checkpoints must be cleared along the route. The upgrade of the road also allows for truck traffic throughout the year, including the rainy season, which is also a major change from the past. Rainy season traffic will remain lower than other seasons, however, as the road south of Lashio to Mandalay remains rough and may be impassable during the peak rains. Whether this is increasing the number of trucks and drivers held pending at Lashio was not determined, but should be investigated for volume impacts on risk-associated behaviors there.
The road improvements suggest fewer trucks stop over-night along the route between Lashio and Muse, reducing but not eliminating the significance of indirect sex workers, such as restaurant girls, along this section of the highway as identified in earlier reports. It is reported that along the unimproved road south from Lashio to Mandalay, however, this concern remains very high. It does, however, increase the number of drivers (and spares) who find themselves at the back of long lines awaiting inspection and clearance procedures in Muse.
Je Gou, China, is divided from Muse, Myanmar, by a fence, yet the differences are profound. In Je Gou, there are open brothels, massage parlours, bright casinos, video game parlours, nightclubs, and drugs. Reportedly, there are 500 to 1000 Myanmar women working as sex workers in the immediate vicinity of Je Gou. Prices vary from 50 to 2000 Kyats. The young women come from all parts of Myanmar and are trafficked in by brokers. The women arrive in debt and must work off the debt before earning any money. Current data is unavailable, but some months of work is required to pay off debts and the share following this is reportedly 60%/40%, with the smaller share going to the sex worker.
According to the 1997 Save (UK) report, the sex workers average 10 clients per night, and less than 20% use condoms. Condom availability is low and costs are high (50 Kyats or more), and low-income clients such as truckers and spares are not interested to purchase them. The same document reported interviews with truckers suggesting 100% use alcohol, 90% smoke opium, and 80% have sex with sex workers. They also reported casual sex with girls working at restaurants along the highway. Few reported use of condoms.
Further in from the Je Gou border zone and into the town of Ruili are other venues and forms of prostitution. Here, nightclubs and massage parlours are tailored to Chinese customers. The sex workers are primarily Chinese and charge higher fees than the Myanmar women on the streets of Je Gou. Few truckers or spares are attracted to this area, due partly to language issues, but primarily due to the higher costs.
Consequently, a viral buffer zone is functionally established between China and Myanmar. There is no suggestion here of an overt policy establishing such a buffer zone, but merely the functional fact that the economics and logistics of these services has structurally produced this effect. The sex workers at the Je Gou truck terminal zone function both as a reservoir of HIV infection, being infected by and infecting truckers, spares and traders, and also as an effective viral buffer zone keeping contact between Myanmar nationals and Chinese sex workers serving the higher fee paying Chinese clientele to a minimum. Data from China suggests that, within Yunnan, sexual transmission of HIV/AIDS remains below 20%, with the majority of infections coming from IDU and blood transfusions. Thus, the Je Gou low-fee CSW zone effectively functions to restrict the sexual transmission of HIV primarily to Myanmar nationals. It also serves as one of the "hot zones" for redistribution of HIV infections to the rest of the Myanmar.
from: "HIV/AIDS Prevention & Care in Myanmar: A Situation Analysis and Needs Assessment", UN Theme Group on HIV/AIDS Myanmar, 1998. re-published by UNAIDS April 2001.
