Via The Irrawaddy: A Political Cure for What Ails Myanmar’s HIV Community. Excerpt:
For decades, Myanmar’s struggle against HIV/AIDS was held back by the former junta’s reluctance to acknowledge the scale of the crisis facing the country. As a leading expert on the disease since the 1990s, Dr. Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health, in the US city of Baltimore, has long been at the forefront of efforts raise the alarm in Myanmar, which he warned in 2005 faced an explosion of HIV comparable to that of the worst-hit parts of Africa.
Dr. Beyrer recently spoke with The Irrawaddy’s Marwaan Macan-Markar about the current state of Myanmar’s HIV crisis in the wake of recent political reforms. Although many things have improved, he says, the country still has vast unmet health-care needs, with 220,000 people living with HIV and only around half of the estimated 120,000 patients requiring anti-retroviral (ARV) therapy receiving it—and most of those in Yangon and Mandalay, the two largest cities.
Still, says Dr. Beyrer, the country’s newfound openness could have a dramatic impact on how well it can contain the spread of the deadly disease. But, he adds, much remains to be learned about how deeply rural regions have been affected by decades of neglect.
Question: It is now nearly three years since President U Thein Sein paved the way for political liberalization in Myanmar. Has this opening made a difference to the tens of thousands of people living with HIV and those vulnerable to being infected in the country?
Answer: There is much more freedom of information now. And I think the single biggest change has been the end of censorship and the opening the media for greater and more open discussions. That, of course, has very great implications for HIV and the people with HIV.
It has also marked the end of isolation for HIV professionals, and there has been a large increase in international donor engagement. And what we understand is there will be 50,000 new treatment slots in the pipeline [for people with HIV to gain access to ARVs].
Q: How are the country’s public health professionals coping with this shift?
A: What the people in the Health Ministry and in the national AIDS program say is that, earlier, they were waiting for resources to come, but now that they are coming, there is a big challenge to strengthen the absorptive capacity. They have to be able to handle that volume of increased funding and increased treatment. This is going to be a real challenge.
The backbone of the public health system in Myanmar is midwives and nurses, particularly in rural areas. There will have to be a lot of what is called “task shifting,” with many more healthcare workers being able to support people with HIV.
Q: What shift in policies is required to make the access to 50,000 new treatment slots for people with HIV meaningful?
A: Until now, the government’s treatment program had been accessible to people with HIV when it is very late. The levels of the CD4 [the white blood cell that targets the virus] count calculations had been so low that people have full-blown AIDS before they are started on therapy. And that is not good.
It is much better to start earlier, when their immune system could recover and they can benefit from the treatment. And that is what MSF [humanitarian aid organization Médecins Sans Frontières]was trying to do during all these years, since it has been a major treatment player. About half the people being treated were treated through MSF.
