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Burma/Myanmar
and Aids: The Silent Crisis
By Dr. Thaung Htun, Director, Burma UN Service Office
New York, June 25, 2001
HIV/AIDS
infection has reached epidemic proportions in Burma today and reports
by UN agencies as well as independent health professionals unanimously
confirm this fact. Estimates suggest at least five percent of the population
is infected. The alarming situation has become a national emergency that
affects all groups, including non-Burman ethnic nationalities and the
military.
Even if the problem is tackled now and under the best of circumstances,
the country will continue to face the negative effects for a long time.
In 1998, Daw Aung San Suu Kyi reaffirmed this view when she said, "Burma
needs effective education programs and services now. Unless, we act urgently,
HIV infection could reach epidemic proportions in our country and become
a major threat to our social stability and economic potential."
Burma is a country of various ethnic nationalities with diverse languages
and cultural backgrounds. It is vital to properly assess the situation,
needs, and community participation in decision-making processes and in
the planning stages from the very beginning before undertaking any HIV/AIDS
control and/or prevention program. With this in mind, Daw Suu agreed to
the proposal by the World Health Organization to send a fact-finding mission
to Burma in March 2001. The European Union extended US $ 12 million financial
support for the mission, which, I understand, will be coming up with a
report at the end of this month.
We of the Burmese democracy movement believe that HIV/AIDS crisis in Burma
can never be resolved effectively as long as the root cause remains ignored.
In other words, if the crisis is to be tackled effectively, the terms
of the debate addressing the issue must be shifted and the problem must
be viewed with a political context in mind. This is because the military
authorities in Burma today are placing political considerations above
any humanitarian crisis, regardless of its magnitude. A credible and practical
solution to HIV/AIDS crisis therefore needs to be sought through consultations
among all political stakeholders in Burma. Affected local communities
must also be incorporated into the process of consultations to determine
how assistance from the international community can be channeled to the
most needy areas. Given the fact that HIV endemic area is mainly in armed
conflict zones with 2 million internally displaced persons (IDPs) in non-Burman
ethnic areas being the most vulnerable to the disease, a nationwide humanitarian
cease-fire should be declared and a peace corridor created so that UN
agencies and international NGOs can initiate an effective operation.
We believe that a nationwide mobilization involving people of all walks
of life--religious leaders, students, workers, farmers, civil servants,
armed forces personnel, ethnic hill peoples, lowlanders, and business
circles--must be initiated so that people can work together to resolve
the current humanitarian crisis and end the political deadlock that has
become an obstacle to all positive national efforts.
In order to make international humanitarian assistance reach the right
people in the right way, aid delivery should be coordinated by UN agencies
and international NGOs experienced in the field and channelled through
independent religious and local community based organizations right down
to the village level.
We would also like to suggest the establishment of a national mechanism
comprising representatives of UN agencies, the Burmese military, the democracy
movement, and affected local communities to monitor and evaluate the national
HIV/AIDS program. A joint endeavour to address the humanitarian issue
would build trust and instil confidence among key political players and
the people; a precedent that would help prepare them to tackle long-term
problems of the nation.
To ensure success and sustainability, HIV/AIDS prevention and control
strategies should be based on two fronts.
(1) Prevention and control strategy specific to HIV/AIDS
(2) Strategies that tackle underlying socioeconomic conditions that contribute
to the spread of HIV/AIDS
Specific prevention and control strategies for HIV/AIDS should address
all risk factors for HIV, explain in clear and understandable ways how
to prevent them, the principles and availability of HIV testing and counseling,
confidentiality and rights of HIV infected persons, available treatment
and referral services for HIV-infected persons and their families/partners.
Preventive measures should be carried out embracing all modes of transmission
of HIV--sexual, blood and blood products, and mother-to-child transmission
during pregnancy, during delivery and post-natal period especially through
breast-feeding.
Key limitations to the effectiveness of public health interventions have
not been at molecular levels but at social and political ones. Implementing
prevention will require policies and national priorities. Sustainability
cannot be assured if status of women, the economics of narcotics trade,
and the levels of social tolerance or political repression in society
are not taken into consideration. Access to education; freedom of information,
expression and thought; the empowerment of women are key factors that
need to be addressed.
There are several underlying conditions, especially the social, economic
and political situation in Burma, that have exacerbated the spread of
HIV. There has never been such a period in Burmese history when the whole
society is so mobile at the backdrop of rapidly deteriorating economy
and political instability. Since the economic opportunities in urban areas
have been dried up, thousands of young people, men and women alike, are
migrating to the border areas and getting involved in border trades or
seeking their fortune in gold and jade mines infested with malaria and
drugs. Some of them crossed the border and become illegal migrant workers
in neighboring countries. The number of drugs addicts increased up to
50, 000 at a conservative estimate and sharing of needles has become the
common mode of HIV transmission. One survey in Phar-Kant jade mine in
Kachin State, in 1996, revealed that 99.5% of Intravenous Users of Drugs
(IUDs) in that area were HIV positive.
Women suffered the most in the midst of economic impoverishment. Equality
of men and women in Burmese society proclaimed by the State Peace and
Development Council (SPDC) at the 22nd session of CEDAW is indeed, a myth.
Women were left behind in terms of access to education, health care, economic
opportunity and participation at the decision making level in political
process. Discrimination and violence against women, in particular rape,
especially by the military personnel are common in non-Burman ethnic areas.
Without going into the incidence of prostitution of the Burmese girls
across the border, I would like to draw your attention to another aspect
of this which has escaped most people's attention: The economic problems
of our country are leading more and more girls to a life of prostitution
even in Burma itself. The number of girls, who are provided by hotels
for foreign tourists, is growing by the day. This is a problem right in
the heart of our country, in the capital itself, but the authorities are
ignoring it. Surveillance data showed 29.5% of commercial sex workers
(CSW) were infected with HIV in 1998. In the concluding observations and
comments to the report submitted by Myanmar (A/55/38, 28/01/2000), the
expert committee on CEDAW expressed their concern at the increasing number
of HIV positive women and also urged the government to prosecute and punish
those who violate the human rights of women, including military personnel,
and to carry out human rights education and gender sensitization trainings,
for all law enforcement and military personnel.
The ongoing civil war coupled with human rights violations such as forced
labor, forced relocation, torture, extrajudicial killings, and extortion
of money and properties including food have caused massive internal displacement
and the exodus of ethnic groups into neighboring countries where some
of them are exposed to risks of HIV infection. Obviously, the agenda on
protection of women rights and advancement of women, economic reconstruction
and reconciliation among all ethnic nationalities, need to be incorporated
in the dialogue process.
Another point that I would like to emphasize here is that regardless of
the outcome from temporary measures to prevent and control HIV/AIDS, success
cannot be sustained without an actual policy and structural reform in
the health care system of Burma. The structure and function of the health
care system has remained unchanged since the military seized power in
1988. Health care in Burma is primarily public but an urban biased and
elitist system. Public sector can no longer provide efficient medical
care because of the downward movement in health financing by the State--0.2%
of GDP in 1998-99. Published budgetary figures show that military spending
per capita exceeds that spent on health by nine times. (Reference:
Figure 7.1, 7.4 and 7.5, World Bank Report on Burma, 2000.) General
fiscal constraint in public sector led to shortage of qualified medical
staff and health facilities, shortage of medicines and corruption in health
professionals. In the face of poor quality public service, people are
impelled to rely more on expanding private sector. Table
7.3 and Figure 7.6 indicate this fact. Parallel to SPDC's introduction
to open market economy, private polyclinics equipped with imported medical
facilities and run by specialists have sprung up in major cities. However,
only wealthy people can afford to take advantage of these private medical
services. There is also no horizontal and vertical integration or coordination
in the present health system of Burma with respect to policy formulation
and the implementation of health programs between the private sector and
the public sector and within the public sector itself. The result is the
decline of national health standard. In the report of the World Health
Organization for the year 2000, Burma was relegated to a ranking of 190
out of a total of 191 member states.
In order to improve the health standard of the Burmese people, including
efforts to prevent and control of HIV/AIDS, Burma needs support from international
community. However, as recommended by the UNDP in its Human Development
Report in 1991, the government of Burma is obliged to express "mutual
commitment to human development and request for aid should include plan
to cut back military budgets and to increase the human expenditure ratios."
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