A new weapon in Myanmar’s fight against HIV

Yangon, Myanmar – In a tumble-down hut housing nearly 100 people on the outskirts of the country’s commercial capital, Khin Zaw points to scar tissue on his forehead marking a near miss – a glancing blow from a bullet received during his two decades of military service.

It is one of four bullet wounds that 42-year-old Khin Zaw received, before a motorcycle accident sent him to a military hospital. He needed a blood transfusion – and contracted HIV from the blood he was given.

“I was in the Burmese military for 23 years,” he said. The army ruled the country until recent reforms, and continues to exert considerable influence. That the army provided the blood that brought Khin Zaw here, to a shelter on a dirt track in a township named North Dagon, is a stark example of where the country was left by years of military-contrived isolation.

The government’s own figures put the number of adult HIV sufferers at nearly 189,000, in a country of about 60 million people. Fewer than half of those affected are receiving treatment, according to the national AIDS authority.

But last month, Myanmar began receiving $160m from the Global Fund to fight HIV/AIDS, allowing the country to extend coverage to all its citizens who suffer from the illness.

Khin Zaw said he gets no army pension, and that he received just 150,000 kyat (about $150) in compensation from the military. “It was only a one-off payment. Now I just stay here,” he said.

He’s on anti-retroviral therapy (ART) – and feeling much better for it. Dressed in a bright orange Barcelona football shirt, Khin Zaw is modest about his misfortune, and is in good health compared with some of his emaciated, exhausted cohabitants.

Given the lack of government support, and with NGOs often blocked from working in the country, local activist Phyu Phyu Thin – now a lawmaker for the opposition National League for Democracy (NLD) – stepped in. She funds the North Dagon dormitory and the nearby NLD HIV/AIDS Prevention and Care Centre, which has been running since 2002.

Dr Myint Shwe, manager of the country’s national AIDS programme, said it was estimated that 7,000 people would contract HIV in 2013 – mainly intravenous drug users, men who have sex with men and sex workers. About 15,000 die each year of AIDS-related causes.

Since 2010, when the Global Fund resumed work after pulling out of the country in 2005 due to government restrictions on its staff, Myanmar has seen improvements, said Shwe. “Access to anti-retroviral drugs has improved, but due to limited funding, availability of anti-retroviral drugs has remained an issue and has curtailed access to treatment and care.”

At the end of 2012, just 43 percent of those needing treatment were receiving it, said Myanmar’s national AIDS authority. To put that in perspective, in nearby Cambodia, more than 94 percent of people eligible for ART are receiving it, according to a 2012 country report by UNAIDS.

Shwe Zim, 36, has only been diagnosed with HIV for a month, and is trying to get on ART. A rice farmer from the Ayeyarwady region, she says she doesn’t know how she contracted HIV, but said her husband, a construction worker, is also HIV-positive.

From the archives: Myanmar’s HIV crisis [2010]

The centre was helping Shwe Zim to get access to therapy, she said, and had also helped to calm her fears about an illness that is stigmatised among poorly educated villagers.

“I was afraid to get treated,” she said. “People in my village told me they would give me injections that would harm me. But the counsellors told me this was wrong. When I came here I was unhappy and confused. They helped to make me feel good again.”

According to one long-term expatriate with a public health background, some in Myanmar consider the prevalence of HIV/AIDS to be a reflection of the society’s morality. Combined with already flawed data gathering methods, this means the scale of the problem could be larger than figures suggest.

“People don’t want to be identified as HIV-positive due to the stigma, but there is also a perception that it stigmatises the nation to have a high HIV prevalence, so people’s subconscious motivation is to find fewer cases,” said the expatriate, requesting anonymity.

Thein Htay, who is a healthy-looking 74, has four years of ART behind him. He now mainly volunteers, energetically helping others at the South Dagon centre. “For HIV patients, it’s a very changeable disease: One day you run around and you feel good, then suddenly I’m aching and I can’t move,” he said. Those having good days help those who are not, he says, a system that fosters a supportive community.

Among the ten children living in this centre, eight are HIV-positive, including Thein Htay’s own daughter. Although they will be on therapy for life, the newfound Global Fund support and the country’s recent opening up to the outside world are hopeful signs.

The centre arranges blood tests and checkups for patients, and ferries them to collect drugs from a nearby clinic run by Doctors Without Borders, known by its French acronym – MSF, which treats more than 30,000 HIV patients across Myanmar.

In July, new guidelines from the World Health Organisation recommended people with HIV begin receiving ART at an earlier stage of the illness. This would reduce the risk of HIV-positive mothers passing the virus to their offspring, and lower the chances of other forms of transmission.

But in July, the Irrawaddy Magazine reported that Myanmar’s healthcare system would likely struggle to provide treatment in line with the new threshold.

MSF’s head of mission in Myanmar, Peter Paul de Groote, said that, while the new Global Fund money would have an impact, national practice would also need to change to put the new guidelines into effect. “Additional resources will also be required as the total number of people eligible for treatment in the country will increase,” he said by email.

“However, achieving this is not only a matter of financial resources for drugs, but also the overall availability and capacity for enrolment needs to improve – by looking into better treatment models and implementing increased, decentralised care and treatment.”

For the time being, de Groote said, the priority will remain treating the people who are most sick, since thousands of people eligible for treatment under the old rules are still not receiving it.

Follow Simon Lewis on Twitter: @Simondlewis