Myanmar: The HIV/AIDS Crisis
HIV prevalence is rising rapidly in Burma/Myanmar, fuelled by population mobility, poverty and frustration that breeds risky sexual activity and drug-taking. Already, one in 50 adults are estimated to be infected, and infection rates in sub-populations with especially risky behaviour (such as drug users and sex workers) are among the highest in Asia. Because of the long lag time between HIV infection and death, the true impact of the epidemic is just beginning to be felt. Households are losing breadwinners, children are losing parents, and some of the hardest-hit communities, particularly some fishing villages with very high losses from HIV/AIDS, are losing hope. Worse is to come, but how much worse depends on the decisions that Myanmar and the international community take in the coming months and years.
The widespread incidence of HIV is a security issue in itself – it can undermine economic, personal and national security. It can also undermine the already weak capacity of the state to govern, threaten security and military structures and have a devastating impact on the economy. The government in Yangon has been quick to establish a surveillance system and nominal AIDS control structures but very slow to take any action that would slow the spread of the virus. The National AIDS Program, while professionally competent, is woefully under staffed and under funded and struggles beneath the weight of its tasks. It gets a little help from international NGOs and more from the United Nations system but the major donors are largely absent.
Recently, there have been signs that the government is crawling out of its deep denial about the true magnitude of the HIV epidemic in Myanmar and is preparing to take real measures to stem its spread. It will not be able to do so, however, without a vast infusion of technical and financial help. HIV is an unforgiving epidemic: once the initial opportunity for effective prevention is lost and a critical mass of infection builds up, the epidemic assumes a life of its own. Prevention becomes more and more difficult, and care needs begin to swamp health and community services, diverting resources that could otherwise be used for other development priorities. Myanmar stands perilously close to an unstoppable epidemic. However large scale action targeted at helping those most at risk protect themselves could still make a real difference.
Action on the scale necessary will inevitably involve working through government institutions, possibly in partnership with NGOs. The international community, and bilateral donors in particular, should look for ways to channel resources to Myanmar in ways that encourage political commitment and capitalise on the emerging willingness to confront the HIV epidemic.