TAUNGBYONE, Burma - Burma's AIDS epidemic mostly affects marginalized groups, such as the gay community. In a country where homosexuality remains illegal, finding and treating gay patients is a challenge for the few health workers devoted to their treatment. An annual religious event called a Nat festival, however, is one time when the gay community can network - and talk to health workers about treatment.
Burma's largest supernatural spirit festival [Nat festival] takes place annually in a small town outside of Mandalay called Taungbyone, attracting animists, including many members of the gay community, from all over the country for a week of celebrations and offerings.
About one percent of Burma's population is HIV positive. Among high-risk groups, such as men who have sex with men, health workers estimate as many as 11 percent have HIV. “Casper” is one health worker trying to curb infections.
"I want to give you a little test," said Casper, as he takes out a banana. "This is what we’ll use for the test."
Free testing helps awareness
Casper does counseling at a government clinic in Mandalay, and at the festival, where they offer free testing. He himself has AIDS, and he tells up to 200 people each year they are HIV positive.
“When I first see them, I ask them if they’re ready to hear the results of the test. If they’re ready, then I tell them," said Casper. "When I tell them, I observe their faces carefully, seeing whether there are any negative expressions on their faces. If I see a fallen face, then I disclose my own personal experiences.”
Most spirit mediums at the festival, known as nat kadaws, are gay, like Ko Chit Tae, who hails from Rangoon.
"HIV affects the gay community. It's highly likely among homosexuals having frequent unprotected sexual intercourse with each other," he said.
Moving toward improved treatment
While Burma's National AIDS Plan has helped stem new infections, it offers almost no help for marginalized groups already living with HIV. Dr. Kyaw Soe, the ministry of health's HIV officer for Mandalay Division, nevertheless recognizes the risks from not treating these groups.
"There may be laws against homosexuality, but if we look at it from a public health point of view, we have to help these people," Kyaw Soe.
The international medical humanitarian group Doctors Without Borders provides 70 percent of the lifesaving anti-retroviral therapy treatment in all of Burma, also known as Myanmar. Duncan Bell is the group's Burma country director.
“I think the tragedy in Myanmar currently is there is the possibility to save people's lives and it's not being fully taken by the international community. There is a treatment gap of 80,000 people, approximately, in need of lifesaving treatment," said Bell.
Because funding is low, no new patients in Burma will be able to receive the lifesaving drugs known as anti-retrovirals until 2014. In the meantime, they have Casper to console them.