Myanmar's Hidden AIDS Epidemic

 
The AIDS virus thrives on ignorance and powerlessness. People who don't know how to protect themselves... or don't have the means to do so... often fall victim to HIV. What's true for individuals is also true for nations. And one nation in Southeast Asia provides a lesson in how silence and oppression can spread AIDS. That nation is Myanmar -- formerly called Burma.

Military dictators have ruled Myanmar for more than forty years. Dissidents are jailed, news is heavily censored, and now HIV is racing through the population. Foreign journalists are rarely allowed in the country.

But The World's Orlando de Guzman traveled there on several occasions during the past year. Today, in the first of two reports, he provides this glimpse inside the secretive nation and its hidden epidemic.

The story of AIDS in Myanmar is as much about human rights as it is about health. It's a connection that many experts are beginning to make. Among them is Chris Beyrer. He's an epidemiologist at Johns Hopkins University in Baltimore, and he's extremely worried about what's happening in Myanmar.

Beyrer: "You essentially have the perfect storm, the perfect set of conditions for explosive and sustained HIV epidemics."

Orlando:Beyrer says Myanmar's government has created fertile conditions for the spread of disease.

Beyrer: "The lack of freedom, the lack of scientific information, freedom of speech, freedom of assembly, these very fundamental rights that have been denied the Burmese people, have made HIV spread more likely and more grave."

Orlando:Myanmar is a beautiful country. It's lush and fertile. Crumbling colonial buildings line wide boulevards in the main towns. Golden Buddhist temples shine in the tropical sun. Myanmar looks like an exotic vacation spot. But dig a little deeper and a different picture emerges.

You soon realize that people are too afraid to speak openly about most anything.

If you want to meet people who can tell you about AIDS in Myanmar, it's best to arrange a secret meeting place away from the eyes of intelligence agents.

You'll have to drive around a bit to make sure you're not being followed.

And still your efforts may come to nothing.

Orlando (on location): "I came to this place. I'm not going to name the location, because its too sensitive. But I came here to have a meeting with some people who are living with HIV, and I'm here in this empty room. And nobody has showed up."

Orlando (in studio): A local contact organized the meeting. She asked that I not use her name -- the government imprisons anyone who meets with a journalist without prior approval.

She's an activist who formed a self-help group for AIDS widows. The group is secret and the members are known only to each other. She says she's not surprised that nobody showed up to talk to me.

Woman: "There's a spy in the group, and that spy has informed the authorities. So the rest of the members with HIV are afraid to meet you. The authorities can stop giving them assistance if they find out they have met with a foreigner."

Orlando:"But all we're talking about is a disease like HIV, we're not talking about politics."

Woman: "The authorities will think that we're discussing politics."

Orlando:In Myanmar, everything has to do with politics. Here, anything said or done that contradicts the official line is considered an offense to the state. And this makes talking about HIV dangerous -- because the epidemic has a lot to do with the state. Myanmar's AIDS epidemic has its roots in a crop that's enriched the country's corrupt military rulers: opium.
br>It's grown in the rugged mountains in northern Myanmar's Shan state. During the harvest season each winter, the hills here bloom with red and white poppies. Opium farmers cut each poppy bud with a sharp comb to extract a sticky white sap. The sap is refined into heroin in secret militia controlled labs. This opium farmer says the fields around here were planted under the orders of the local military commander.

Farmer: "We're forced by the military government to grow opium poppies. And when we harvest the opium from these fields, the government comes and taxes us for every pound of opium we make."

Orlando:Wherever there's an abundance of heroin in Myanmar, there are AIDS outbreaks.

The town of Lashio lies along one of Myanmar's notorious heroin trafficking routes. The town is poor. Clusters of rickety homes perch on barren hillsides. Drug use is rampant.

This young man is a small-time heroin dealer here. He says there's no shortage of drugs -- and sharing needles is common.

Sharing needles can, of course, transmit HIV. Three quarters of drug users here in Lashio are already HIV-positive, according to World Health Organization estimates.

The government's complicity in the drug trade is not the way only Myanmar's rulers are helping to spread HIV.

The country's leaders have also bankrupted the economy. Inflation has caused food and fuel prices to skyrocket, and unemployment is rampant. This has led to a mass migration of young people in search of temporary jobs. And AIDS moves where people move.

Nowhere is this more apparent than in northern Myanmar's Kachin state.

In the dry season, hundreds of thousands of men and women from all over the country come here seeking instant riches. For here you can find Myanmar's other famous export -- a translucent green semi-precious stone: jade.

Access to these government-run jade mines is tightly controlled, but this rare footage gathered by a European film crew last year shows large, open pits with tens of thousands of miners crudely digging for stones.

The workers live in ramshackle towns that sprout around the mines. Prostitution and drug use are common.

Dr Frank Smithuis

Doctors Without Borders.

Dr Frank Smithuis of the group Doctors Without Borders has been to the mines. He says the area is a hotspot for HIV transmission.

Smithuis: "When you have a migrating population, male migrating population, who are far way from home, they will look for girlfriends, or there will be some promiscuity. On top of that it is an area where access to heroin is not terribly difficult and people far away from home get into the heroin habit."

Orlando:And when the miners return home, many bring HIV back with them. The virus has now quickly spread to the general population. The doctor at this clinic outside Yangon says her AIDS patients include married women and children -- people who do not engage in risky behaviors.

Doctor: "The epidemic is getting worse. Because I have seen more and more cases in my clinics, there are new and fresh cases. And also, in the hospitals and other daily practice, there are more cases, new and fresh cases are seen."

Orlando:Many of her patients cannot afford life saving anti-retroviral drugs, and they quickly succumb to AIDS related illnesses.

This doctor says the government's response from the beginning has been ridiculously inadequate. She points to one early AIDS awareness campaign.

Doctor: "It was only done by giving pamphlets to the public saying STOP AIDS. Stop AIDS in English. Just imagine. How many of us can read in English? That is the earliest public awareness. It last for about 5 or 6 years."

Orlando:It's no surprise then that the public knows little about AIDS. In fact, the government has actively sought to keep the public in the dark. A former army doctor from Myanmar says his job was to silently dismiss enlisted soldiers who turned out to be HIV positive.

He agreed to this exclusive interview only if his name wasn't used and if his voice was digitally altered. He says the military's AIDS wards were always full -- even though those who tested positive were dismissed within 48 hours.

And what's continually shocked him, says the military doctor, is how little people knew about their disease.

Army Doctor: "Some patients seem to be very happy of contracting HIV because they are going to be dismissed from our military units. They don't know HIV has no cure. So they don't know what HIV mean, actually. They don't know."

Orlando:This doctor was also instructed not to tell his patients anything more about HIV.

Army Doctor: "If you are a military doctor, you must know your duty. You have to do whatever the superior command you. That's all you need to do. You don't need to do the unnecessary matter -- something that is not commanded to you. No need to do like this. It's very dangerous. Dangerous for your survival."

Orlando:This official silence has cost countless lives.

Down a busy street in one of Myanmar's larger towns is a nondescript building that's on the frontline in the battle against AIDS.

Hundreds of HIV patients come here for treatment. This hospital lacks the most basic supplies.

I was not permitted inside the hospital -- foreigners are not allowed to enter without official approval.

But doctors say patients and their families must bring their own soap, bandages, sheets and even drinking water.
A doctor who makes regular rounds at the hospital agreed to talk only if I didn't identify him or this town.

His voice has also been digitally altered. He says it's time to speak the truth about Myanmar's AIDS crisis.

Doctor: "I prefer to talk, rather than be in silence because of the words of Martin Luther King. The words really encourage me. 'The ultimate tragedy is not the oppression and brutality of the bad people, but by the silence of the good people.' So, I feel I am responsible to talk the truth."

Orlando:The truth, he says, is that he treats hundreds of AIDS patients, yet he's forbidden to speak about them.

Doctor: "We can't say there are HIV patients. They need help. They don't know where to die, you know."

Orlando:"The patients don't know where do die?"

Doctor: "Hmmm. Yes."

Orlando:"So where are they dying?"

Doctor: "They go to the -- they've been dropped somewhere else. By the roadside."

Orlando:"Who is dropping them by the roadside?"

Doctor: "Well, the hospitals need beds. So if they can walk, they hire trishaws or something else for transport. So, that's how they ended up."

Orlando:"So your hospitals, you need to empty the beds to allow other people to come in?"

Doctor: "Yes."

Orlando:"Other people infected with HIV?"

Doctor: "Uh-huh. Yes. These people should have a proper place to die. They didn't have anyone. I talk for them. On behalf of them. So that they have a proper treatment, proper care, a proper funeral. So that they have their rights."

Orlando: Talking about rights in Myanmar is dangerous. Many have gone to prison for it. But health experts say the recognition of fundamental human rights is critical to addressing the AIDS epidemic in Myanmar.

Chris Beyrer

Johns Hopkins University

School of Public Health.

Again, Chris Beyrer of Johns Hopkins University's School of Public Health.

Beyrer: "Human rights violations have aided and abetted the spread of this virus. And what one would hope for, and certainly, all the Burmese I know hope for, is that improvements in the human rights situation would have a big payoff in public health."

Orlando: But the human rights conditions in Myanmar have only worsened.

In this country, democracy -- and health -- remain elusive.

Yesterday we broadcast a story from one of the world's most secretive nations. It's Myanmar, formerly known as Burma. The Southeast Asian nation has been ruled by brutal military dictators for more than four decades. Now it's in the midst of an exploding AIDS epidemic. The result is a health crisis within the country's borders -- and that crisis threatens people outside those borders, too. Health experts agree that addressing Myanmar's AIDS epidemic should be a high priority for the international community, but they sharply disagree on what to do about it.

The World's Orlando de Guzman has the second and final part in our series on AIDS in Myanmar.

When it comes to a communicable disease, no country -- not even a reclusive one -- is truly isolated. And that means the AIDS crisis in Myanmar affects its neighbors.

Here in the southwestern Chinese town of Ruili, on the border with Myanmar, the open air jade market attracts gem dealers from across China, India, and Myanmar.

Prostitution is rampant here. So is drug use. And so is AIDS. China's first AIDS cases were diagnosed in this region, in 1989.

In one area of Ruili, men and women inject heroin in broad daylight along the sidewalks. They frequently share needles, which spreads HIV. Ruili is a gateway to a vast heroin trafficking network that begins in northern Myanmar. Epidemiologist Chris Beyrer of Johns Hopkins University has studied the genetics of HIV in this region. He's found a distinct pattern in the way HIV is spreading.

Beyrer: “You can look at the DNA fingerprints, and see, for example, where viruses are related to each other, where they're moving. And we did a collaborative effort looking at the genetic diversity of HIV in the areas around Burma, and we're able to identify rather clearly that HIV strains were traveling out of this region along heroin trafficking routes.”

de Guzman: The heroin routes radiate out of Myanmar like spokes on a wheel. And that means HIV is radiating out of Myanmar. Myanmar's neighboring countries have also seen a mass influx of Burmese refugees who are fleeing oppression and poverty. This movement of people also plays a big role in the spread of AIDS.

This prostitute in the Thai city of Chiang Mai is from Myanmar. She says she left her village and came here because she needed to support her family back home. She says she tries to protect herself from HIV, but she doesn't have the final say.

Female prostitute: Sometimes, the customers are drunk and don't want to use condoms. And if I ask them to use condoms, they tell the pimp, and the pimp comes and yells at me. Sometimes he beats me. So I often have to work without condoms.

de Guzman: Many Burmese migrants -- and not just those in the sex industry -- are at high risk of getting and giving HIV. A recent study found that many of them don't know how HIV is spread, and even those who do can't always protect themselves.

Dr. Worawit Suwanvanichkij is an AIDS doctor in Chiang Mai who works with Burmese migrants.

Worawit: “Because they don't have legal status, they are willing to put up with all kinds of abuses here, because deportation back home to the very conditions they fled from is much more threatening, in many cases, than the jobs they are currently stuck with. And on top of that, throw in other barriers, like language barriers, and fear, and poverty, and you have a very dangerous mix when you think about a disease like HIV."

de Guzman: Worawit says none of the countries neighboring Myanmar will be able to control HIV if Myanmar doesn't control its epidemic.

Worawit: “Until there is genuine change in Burma, Thailand will not be able to address the new HIV epidemics that are emerging.”

de Guzman: Yet Myanmar has shown little willingness to address its own health crisis. Foreign aid organizations have set up programs in Myanmar, but they face a gargantuan task. The country's health care system is in shambles, and there's little donor money available. So aid groups were ecstatic when, two years ago, one of the world's largest funding agencies for HIV stepped in to help.

The Global Fund to Fight AIDS, Tuberculosis and Malaria approved a series of grants totaling 100-million dollars for Myanmar.

Jon Liden is a spokesman for the Global Fund.

Liden: “The health situation in Myanmar is very dire. And the danger both for the population in Myanmar itself and for the neighboring countries is grave if we cannot scale up drastically activities to limit the spread of HIV AIDS in Myanmar.”

The Global Fund's grants were intended to do just that -- to dramatically boost HIV prevention and treatment in Myanmar. Aid groups thought they'd finally turned a corner. But then problems arose. The military government began to restrict the movements of the Global Fund's project monitors. They were barred from traveling to certain areas of the country. That's a common problem faced by aid agencies working in Myanmar.

The Global Fund's Jon Liden says it became clear that his organization could not operate effectively as the government's attitude became increasingly obstructionist.

Liden: "It has gone from an attitude that basically says, 'We don't mind if you help our people, although we are not very concerned about helping them,' to 'We don't want anyone around'."

de Guzman: So last August, the Global Fund announced it was backing out of Myanmar. It revoked its hundred million dollar commitment. The decision stunned many in the aid world, and it's triggered a bitter debate. Critics charge that the Global Fund is allowing AIDS patients to die because of politics.

Many suspect that the United States pressured the Global Fund to pull out of Myanmar -- to punish the military regime. The U.S. has imposed economic sanctions on Myanmar since 1997. The Global Fund denies that it succumbed to political pressure.

But Charles Petrie suggests otherwise. He heads the United Nations Development Program office in Yangon. The UNDP was the main recipient of the Global Fund grants. Petrie says his agency came under intense pressure from U.S. congressmen to forego the grant money.

Petrie: “Politics have to be kept out of the response. I mean, it's a response that is justified by reasons of humanity. The people who are suffering have a right to the assistance, and we need to find ways of providing that assistance.”

de Guzman: And he believes that by pulling out, the Global Fund has condemned Myanmar and its people to an ever worsening AIDS epidemic.

Petrie: “Right now, we still have time to try and contain it. To contain that spread. And if there is a delay in the response, we fear we will not be able to contain it in the future.”

de Guzman: Yet some human rights groups praise the Global Fund for pulling out. Kevin Hepner is an activist with a group that's been documenting military abuses in eastern Myanmar. He contends that when aid agencies cooperate with the military regime, even with the best intentions, they sustain the repressive system.

Hepner: “You really need to do some soul-searching on how much good are you doing for the people in the long run. The decision to leave can be a much more courageous decision, than a decision to stay and play ball.”

de Guzman: The controversy over how to address AIDS in Myanmar fits into a longstanding debate over how to help people suffering under brutal regimes.

Is it better to provide aid, even though that might help a corrupt government stay in power? Or is it better to withdraw aid, even though that could cause people to die?

Health workers and human rights activists agree on what they want in the long run. They all want Myanmar's brutal dictatorship to end. But for now, AIDS patients in Myanmar are left with no support from their government and little help from outside.

On my final trip to Myanmar, a woman living with HIV handed me a video disk and asked me to smuggle it out of the country and watch it on my return home.

It was a shaky amateur video, filmed about a year ago. In it, about sixty people sit on mats in a simple Buddhist temple. They listen to a monk, who's teaching them to meditate. There are a few teenagers, some mothers, a young girl. All sit with their eyes closed. All are HIV positive. The activist who gave me the disk told me these people have no access to life saving drugs, or even the most basic health care. Their only hope is to gain some peace of mind by meditating. I was also told that many people in this film are now dead. They couldn't wait for help to come.

For The World, I'm Orlando de Guzman, Yangon, Myanmar.