[procaare] Myanmar: Remembering HIV in cyclone response

["IRIN" <procaare@healthnet.org>]

MYANMAR: Remembering HIV in cyclone response
Source: IRIN - 27 May 2008
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JOHANNESBURG, 27 May 2008 (IRIN) - While most of the local and 
international aid workers in Myanmar are scrambling to meet the 
immediate needs of 2.4 million people left stranded by Cyclone 
Nargis, several organisations are working to ensure that survivors 
living with HIV are included in the response.

According to the latest estimate by UNAIDS, around 242,000 people - 
about 0.7 percent of Myanmar's population - are living with HIV, 
but only about 1,500 of them are receiving life-prolonging 
antiretroviral (ARV) treatment via a government programme. Another 
10,500 people are receiving ARV drugs from non-governmental 
organisations (NGOs), mainly the international medical charity, 
Médecins Sans Frontières (MSF) Holland.

Speaking on the phone from Yangon, the country's largest city and 
former capital, MSF country director Frank Smithuis said most of 
the people in their treatment programme were based in urban areas 
that had escaped the worst of the storm.

"We have a large programme in Rangoon [Yangon], where there are 
more displaced people than dead people," he said. "There were 
patients who lost their ARV treatment, or they came in with a 
plastic bag full of wet powder [from dissolved tablets], but it was 
easy to resupply them with medicine. Our clinics [in Yangon] were 
open again by the next day after the cyclone."

With 10,000 HIV-positive patients in Yangon alone, MSF decided to 
provide all of those who made it to one of their clinics with a 
one-off cash grant of about US$10 to buy food. Anti-AIDS treatment 
must be accompanied by an adequate diet.

"It would have been too difficult to make a private assessment for 
everyone, so we thought: 'let's keep it simple'," said Smithuis. 
"There's plenty of rice here [in Yangon], so there's not really a 
food shortage, but prices did go up."
With assistance from the handful of international AIDS 
organisations working in Myanmar - such as the International 
HIV/AIDS Alliance and the Association Francois-Xavier Bagnoud 
(FXB), a Switzerland-based NGO that fights poverty and AIDS - local 
networks of people living with HIV have tracked down their members 
and organised relief supplies for them.

"They're very aware and experienced in community solidarity in the 
face of adversity," said Brian Williams, the UNAIDS coordinator in 
Myanmar. "They were immediately out there, spreading the word about 
the cash grant and where to get more drugs." He noted that aid 
agencies were careful not to add to already high levels of stigma 
against people living with HIV by giving them more assistance than 
other cyclone survivors.

"We're not interested in creating stand alone, vertical 
programmes," he said. "But we do want to watch out for the reverse, 
that you're not getting help because you're HIV positive and you're 
being discriminated against."
Myanmar's health department reported that its methadone [a 
synthetic substitute for heroin] programme for injecting drug users 
in Yangon had not been interrupted by the cyclone. As many as 50 
percent of injecting drug users in Myanmar are HIV-positive, 
according to UNAIDS figures from 2003. The goal of the methadone 
programme is to reduce the spread of HIV through needle sharing.

Williams said it was only a pilot programme and needed to be 
significantly scaled up. "The government doesn't spend nearly 
enough on health care in general," he commented. "It should be 
providing more resources, but so should the international 
community."

In the Irrawaddy Delta, the area worst affected by the cyclone, aid 
organisations who have been allowed into the country are trying to 
respond to survivors' most basic needs for food, water and shelter, 
but most international NGOs are still navigating government 
restrictions that prevent foreign aid workers entering the country.
MSF, which already had about 1,000 employees in Myanmar, was well 
placed to respond rapidly to the disaster. "We didn't have staff in 
that part of the country, but we moved them there," said Smithuis. 
The medical charity has delivered 1,000 metric tonnes of food, 
60,000 shelters and several water treatment machines.

Despite Myanmar's relative isolation, levels of knowledge about HIV 
and AIDS are about average for the region, and the availability of 
condoms had improved dramatically in recent years. "There is a 
national plan here - the government considers AIDS to be a problem 
and lots of NGOs are working on it," Williams said.

However, the cyclone could set back Myanmar's HIV prevention 
efforts. "We're quite worried about women's protection issues," 
Williams told IRIN/PlusNews. "There are a large number of homeless 
people living in informal settlements, where access is quite 
limited and we don't know if measures are being taken to ensure 
that there are secure areas for women."

Mobile clinics equipped with reproductive health supplies, 
including post-exposure prophylaxis (PEP) kits, which can prevent 
HIV infection after a rape, have made it out to a few villages, but 
Williams said more reproductive health services were needed.

"Like in many emergency settings, we are also worried about women 
who might find themselves lacking alternatives and resorting to sex 
work."

ks/he

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