NEW YORK -- According to the latest statistics, the number of HIV/AIDS cases in Myanmar continues to rise, fueled by drug abuse, population mobility, poverty and a lack of effective government policies. Thai medical experts report that the epidemic, if not controlled, may soon eclipse the worst situation in Africa. The National AIDS Program, professionally competent but understaffed and underfunded, has been unable to contribute to controlling the spread of the infection. Myanmar urgently needs a change in policies primarily directed at high-risk groups. What happens from now will depend on the decisions taken both by the government and by the international community to control the spread of the epidemic.
Drug abuse and risky sexual practices, both heterosexual and homosexual, are the main reasons for the fast spread of the infection. Some experts estimate that Myanmar has the highest drug-associated HIV/AIDS rate in the world. The spread of the epidemic has become rapid in Myanmar's border areas, particularly on the eastern border with Thailand and the northern border with China, where there is intensive drug abuse and a large population of migrant workers. Drugs produced in Myanmar (both heroin and methamphetamines) are trafficked through China and Thailand to other countries. In 2000, 600 million methamphetamine tablets were sent to Thailand, mainly from areas controlled by the Wa minority in Myanmar's northern Shan state. Their value was estimated at $1.8 billion at Bangkok street rates. It is estimated that 60 percent of methamphetamines end up in the hands of young people ages 15 to 18.
Although the Myanmar government has banned studies of drug addiction, experts estimate that 4 percent of men and 2 percent of women are heroin users. Prevalence rates of HIV infection of up to 60 percent have been found among users of injected drugs. Needle sharing among heroin addicts is found not only in Yangon's tea stalls but throughout the rest of the country as well. It is also frequent in prisons where, according to a former prisoner, up to 200 people share the same needle since the price of new needles is unaffordable for the majority of addicts.
The United Nations Program on HIV-AIDS recently estimated that 530,000 of Myanmar's 48 million people are HIV-infected. Frank Smithuis of Medecins Sans Frontieres, who has spent six years working on HIV-AIDS prevention in Myanmar, believes that the real number could be as high as 1 million.
According to Johns Hopkins AIDS Training Program director Dr. Chris Beyrer, who has conducted studies in Myanmar, 3.46 percent of Myanmar adults are infected with HIV. Among those aged 20 to 44, the infection rate is 5.3 percent. Overall, one of every 29 adults in Myanmar is HIV-infected. The situation is even worse in some areas, as in Shan state, where it is estimated that 10 percent of the adult population is HIV-infected.
Dr. Cynthia Maung, who works with refugee and displaced populations and was the first recipient of the Jonathan Mann Award for Health and Human Rights, indicated that special conditions within Myanmar facilitate the rapid spread of HIV. Only 25 percent of children finish primary school, and there is very little health education in the general population, particularly on HIV/AIDS and its prevention. As a result, awareness of HIV/AIDS among the general population is very low. In addition, there is irregular HIV testing, improper care of sexually transmitted infections that facilitate HIV infection and relatively low condom use in the general population and among sex workers.
Condoms, which had been banned by the military until 1993, are too expensive for most people. Studies in sentinel male clinics for treatment of sexually transmitted diseases have found up to 20 percent infected with HIV. In 2000, the infection rate among prostitutes in Myanmar's two largest cities averaged 47 percent, three times the rate found in Thailand.
Experiences in other countries in the region, particularly Thailand and Cambodia, have shown how large-scale interventions can control the AIDS epidemic. Beyrer indicated that available information shows a "clear and urgent need" for Myanmar and neighboring countries like China, India and Vietnam to focus more on HIV prevention. At the same time, it is critical to intensify efforts to control the drug trade, to spread the positive results of locally generated initiatives, to increase AIDS care and counseling, to intensify educational activities in the workplace and among the general population, and to limit the spread of sexually transmitted diseases.
The spread of HIV/AIDS can be controlled, but political leaders must show the will, the compassion and the intelligence to initiate and systematically build such an effort.
Cesar Chelala is an international public health consultant. He is the author of "AIDS: A Modern Epidemic," a publication of the Pan American Health Organization. This publication was chosen as a "Literary Hit" by the Village Voice, a magazine in New York.