Grant withdrawal hits Burmese Aids fight - FT

Grant withdrawal hits Burmese Aids fight
>Published: November 24 2005 02:01 | Last updated: November 24 2005 02:01 - Financial Times
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A young Burmese woman from the outskirts of Rangoon set out one day five years ago to find a job 800km away in the border town of Kawthoung, just across the border from the busy Thai fishing port of Ranong.

She soon found work singing in a bar for fishermen on shore leave. When she fell ill a few years later, doctors told her she was infected with HIV – something she had never heard of before.

“I didn’t know anything – that is why I got it,” the woman, now 27, said after a recent support meeting for HIV/Aids patients at a Médécins Sans Frontières clinic in the Rangoon suburb of Hlaingthayar.

Today, she is one of about 2,000 Burmese receiving life-saving, anti-retroviral drugs from MSF Holland, which runs Burma’s biggest Aids treatment programme. She recently married another HIV patient: a 31-year-old trishaw driver, who suspects he contracted the virus during a year spent working at a plastic factory in Thailand. He too now receives anti- retroviral drugs from MSF.

Yet in military-ruled Burma, the couple are among a relatively lucky few. About 46,000 people in the impoverished country are thought to be in immediate need of the life-saving Aids medications. But their prospects for obtaining it – and for an intensification of Burma’s wider battle against HIV/Aids – have greatly diminished since the Global Fund for HIV/Aids, Tuberculosis and Malaria terminated its $98m (€83m, £57m) health grant for the country.

Burma has one of Asia’s most serious HIV/Aids epidemics, according to the latest UNAIDS report this week, with HIV prevalence in pregnant woman estimated at 1.8 per cent. The Global Fund money was to have been used for much-needed expansion of availability of anti-retroviral drugs and voluntary HIV testing centres, enhanced condom promotion, and efforts to reduce HIV among injecting drug users.

Yet nearly as damaging as the loss of money has been the Global Fund’s reinforcement of Burma’s international image as a country where it is impossible to provide effective humanitarian aid – a picture that UN agencies and international charities working in the country say is simply wrong.

“The loss of resources is critical, but it is the contribution to the perception that you can’t work here that is really so bad,” said Brian Williams, UNAIDS country co-ordinator in Rangoon.

“We can deliver services to people in need even in difficult circumstances here. But we need more resources, or a lot of those services are going to dry up.”

In cancelling its Burma grants, the Global Fund publicly blamed travel restrictions imposed in July that it said would have hampered its ability to monitor how funds were used. But even before that, the Global Fund was under intense pressure from US-based critics of the Burmese junta, who vehemently opposed seeing such a large sum of money flow to the country – especially if it were used to strengthen the government’s provision of public health care services.

Burma’s response to its HIV/Aids epidemic was indeed agonisingly slow. Through the 1990s, the military junta – treated as a pariah by western governments – denied or played down the disease’s spread, declaring that the country’s traditional morals would prevent an epidemic. But in 2001, a senior general publicly acknowledged that Aids was a serious problem, and in 2003 the UK, Norway and Sweden committed a total of $24m for a three-year Burma Aids fund.

The US, Australia and Japan have also increased support for selected Aids charities working in the country.

Today, 18 international non-governmental organisations, including MSF, Care, World Vision, Population Services International, Marie Stopes International, the International HIV/Aids Alliance, are on the front lines of Burma’s campaign against Aids.

Foreign aid workers still confront many impediments, including requirements to obtain advance permission to travel outside Rangoon, excessive red tape for crucial imports, and some resistance from conservative local authorities to their activities – especially those targeting sex workers or drug users.

The health ministry’s national Aids programme faces its own bureaucratic constraints, including a tiny budget – just 22m kyat, or about $22,000 at current exchange rates.

Despite these difficulties, progress has been made. Aids awareness has risen as authorities have allowed explicit public information campaigns and condom adverts in state media, including television.

Condom use is up, while public access to voluntary Aids testing and treatment for sexually transmitted infections has grown.

But the combined efforts fall far short of what is needed to contain the spread of the disease, and the loss of the much anticipated Global Fund money has cast a pall over the future.

“Things feel like they have stalled,” said Mr Williams of UNAIDS. “The excitement about new plans, and scaling up, has dissipated.”

The worries about resource constraints now overshadow concerns about travel restrictions, which have eased, and other obstacles.

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