Integrated Regional Information Networks - February 24, 2012
BANGKOK/YANGON, 24 February 2012 (PlusNews) - Lack of access to
anti-retroviral therapy (ARV) to treat HIV has left thousands of
patients in Myanmar with deteriorating immunity and increased
vulnerability to tuberculosis (TB), say health workers.
"The situation is dire," said Peter Paul de Groote, head of
Medecins Sans Frontieres (MSF) in Myanmar. "The gap between the
treatment that is needed and what is received is unacceptably
ARV providers in Myanmar - of whom MSF is the largest - are
concentrated in Yangon and Mandalay divisions, and Shan and
Kachin states, which account for more than 60 percent of the
country's 133 ART distribution sites, according to UNAIDS
"The unfortunate case is that many people have to travel far to
access treatment. This country has the potential to treat more
people, save more lives and prevent transmission by expanding
service provision," Sung Gang, the UNAIDS Myanmar country
coordinator, told IRIN from Yangon.
But according to MSF, funding is the biggest problem.
When donors did not deliver on pledges, the Global Fund to Fight
HIV, Tuberculosis and Malaria cancelled its Round 11 funding in
While a Transitional Funding Mechanism has been established to
provide emergency relief to current recipients, which will run
out of money before 2014, it only covers essential services such
as HIV treatment, care and prevention, leaving ARV providers
unable to expand to other needed areas, notes MSF.
Funds from Round 11 were expected to treat 46,500 more patients
in Myanmar, according to a recent MSF study.
Of the estimated 240,000 HIV-positive people, only 24 percent
receive ARV therapy. Roughly 85,000 people need treatment but
cannot access it, causing up to 20,000 preventable AIDS-related
deaths annually, according to MSF.
"The Ministry of Health, MSF, and the hospitals all have the
willingness and capacity to scale up. There are a lot of new
donor pledges [going into Myanmar] but not for HIV," MSF's De
Doctors are forced to prioritize treatment for patients in the
most advanced stages of HIV/AIDS, despite proof that earlier
treatment decreases transmission rates and improves health
outcomes, according to the Inter-Agency Standing Committee's
(IASC) 2010 Guidelines for addressing HIV in humanitarian
"Turning back patients is a difficult and impossible choice. We
have to tell them, come back when you get sicker," said Khin
Nyein Chan, MSF's deputy medical coordinator in Myanmar and a
doctor at the NGO's clinic in Yangon, one of four nationwide.
While the World Health Organization (WHO) recommends starting ARV
medications when an HIV patient's CD4 count, a specialized immune
system cell measure, has dropped below 350 cells/mm3, doctors in
Myanmar administer ARVs only to those with CD4 levels below 150
"They have to wait until severe life-threatening and
opportunistic infections are in their bodies before we can treat
them," said Khin Nyein Chan.
TB is one such opportunistic infection. An HIV-positive status
can increase the chance of contracting TB by up to 37-fold,
according to WHO.
In Myanmar, 300,000 people are infected with TB - 60,000 of whom
are also HIV-positive - according to MSF.
The increased incidence of airborne TB among HIV patients not
taking ARVs raises the likelihood that it will spread among the
general population, said Maria Guavara, MSF's medical
"HIV/AIDS and TB are a lethal combination. Treatment of HIV drops
the instance rate of TB."
At Phoenix Association, a Yangon-based social support centre for
HIV-positive people, patients seek solace from debt and disease.
One patient from Phyuu Township of Bago Division in the country's
south, Sai Hlaw Aung, 33, told IRIN in 2011 that battling HIV and
TB had made him too weak to continue working as a bamboo cutter.
"Now I am not as strong as before. I have no idea how I could
earn household income when I go back home," said Sai Hlaw Aung.
The association allows out-of-town patients to sleep in the
office while undergoing treatment in Yangon. Space is tight.
"Currently we need shelter to accommodate the people," said Thiha
Kyaing, head of the association told IRIN. Little has changed
"We don't just want to bridge the treatment gap and walk away. We
need sustainable programmes, and the sooner the better," De
Groote said. "If we don't treat people now we will lose them," he