Health and Human Rights:

Why is the HIV/AIDS problem in Burma worsening?

How many cases of HIV/AIDS are there in Burma?

At a recent AIDS conference held in Durban, South Africa, it was stated that 34.3 million people around the world are carrying HIV or AIDS, including over 1 million children, and that there are about 500,000 new cases every year.

From these statistics, it appears that the incidence of HIV/AIDS is increasing alarmingly. But the picture is not the same everywhere in the world. In some parts of the world, the rate at which new HIV infections are growing and the pace at which HIV infection progresses to AIDS have begun to slow down. However, in other parts of the world, the rates remain the same or are increasing and the impact of HIV/AIDS is particularly severe. This is especially true for countries like Thailand, Cambodia, and our country Burma.

The United Nations estimates, that in Burma, 530,000 people have become HIV carriers. Dr. Chris Beyrer of John Hopkins Hospital says that the number of persons living in Burma with HIV is unknown, but that it has to be "over 700,000 at this point". However, the ruling junta refuses to acknowledge these estimates and puts the total number at only about 25,000.

Why is HIV/AIDS such a big problem in Burma?

Why there is such a difference for the HIV/AIDS rates in Burma? It is time to look at the underlying reasons.

Most of you know that people infected by the human immunodeficiency virus (HIV) eventually develop a serious medical condition, called acquired immune deficiency syndrome (AIDS), which affects the ability of the body's immune system to cope with a wide variety of diseases. HIV is passed from person to person during unprotected sex, through a transfusion of blood infected with HIV, and by using a contaminated needle. [That dirty needle might be one used in a hospital and clinic, where they recycle the needles instead of throwing them away, or it might be a needle shared during drug use.] From this brief explanation of how HIV is spread, it should be clear that, if people take a few simple precautions, they shouldn't be infected by HIV and the spread of HIV can be limited.

The simple precautions:

• Only have sex in a monogamous relationship with an uninfected partner.
• Always use a latex condom if you are not in such a relationship and engage in sex.
• Do not share needles and do not recycle disposable needles.
• Always screen blood donors for HIV.

But the spread of HIV infection is not being limited in Burma. Why are these simple precautions not working?

Health education on the control of disease has traditionally relied on pamphlets, posters, radio talks, and television shows. The success of prevention depends in part on strengthening the capacities of communities, and of the economic, social welfare, and political systems to meet the needs of the people. When simple health education is used as the only measure to control the spread of HIV/AIDS, it has been found to fail mainly in countries where human rights are violated.

Most of the people are quite aware that condoms must be used for protection. They know that from the health education programs. But in poor countries, condoms are usually not freely available and often they are costly to buy. So, people are willing to take the risk to save money or because they don't have the money.

Well if the people are poor because of the country has poor economic development, why don't we just get more foreign investment, get more foreign aid, quickly develop an economic system without infrastructure and forget about making long term plans. The outcome of this approach is short-sighted window dressing and the gap becomes wider between rich and poor — the rich are richer and the poor are poorer. As a result, some of those poor girls who are ambitious and want to enjoy luxury are willing to exchange their bodies for material goods. Poverty has plunged them into a life of prostitution. That is the initiating factor for the spread of HIV/AIDS.

In Burma, the problem is not only the gap between rich and poor, not only poverty, but the lack of security. Lots of our people have migrated to neighbouring countries because of arbitrary executions, unlawful imprisonments, forced labour and all sorts of violations of human rights happening inside Burma. There are also economic refugees — people who leave their homes in search of a better place for living. Most of these people ended up being put in refugee camps or hanging around in the jungles. Their lives are unstable and they live in crowds. As long as these kind of problems exist, there is no way that the spread of HIV/AIDS can be controlled.

Worst of all is the illegal drug trade. In Burma, there is evidence that the illegal drug trade is indirectly well supported by the government. Drug users may choose to share needles as it is an expression of solidarity. As long as the drug problem is there, it is hard to control the HIV/AIDS problem.

Public health deals with populations and prevention of infectious diseases. The public health people should realize the linkages between health and human rights. They should not concentrate on health education alone, but also must identify human rights burdens on the spread of the diseases. An approach to realizing health objectives that simultaneously promote or at least respect rights and dignity is clearly desirable. Health experts who are concerned about human rights have to make their expertise available to help document such abuses. HIV/AIDS can unequally affect certain individuals and communities as a result of human rights and societal constraints, which we called "vulnerability". To contain the HIV/AIDS epidemic and mitigate its impact, we need to identify this vulnerability condition.

The problem now is not only with the health education about the spread of the disease and its prevention, it is the vulnerability which results from the factors that affect adversely on one's ability to control over one's own health. It is important to recognize the factors that influence vulnerability. First of all, the government has to be honest and admit the truth with regard to the incidence and the scale of the epidemic.

Why does the junta deny the truth about how serious the HIV/AIDS problem is? This is something we should think about. HIV/AIDS problem is linked with socioeconomic, political and human rights situation. There is evidence that the increase in the incidence of HIV/AIDS is directly proportionate to the increased violations of human rights. The military junta would not want to let the world know that they are cruel evils. Thus they would not declare the true figure of HIV/AIDS incidence in Burma.

Unless Burma has a government that is accountable, transparent and willing to create conditions under which its citizens can live in political and economic security, the HIV/AIDS problem will continue to grow.

Dr Khin Saw Win (Alice)

This commentary is based on a posting Dr. Khin Saw Win made in the soc.culture.burma newsgroup and the FreeBurma Yahoo! Group on 2000-10-18. The posting has been edited for inclusion on the Burma Watch International Web site.