BANGKOK (AlertNet) – Myanmar is on course to eliminate new HIV/AIDS infections among children by 2015 but sustained investment, attention to cross-border movements and a focus on those most at risk are needed to achieve this, the head of the United Nations agency for HIV/AIDS says.
Donors are also keen to support Myanmar, and the Global Fund to Fight AIDS, Tuberculosis and Malaria is “more confident now than before that investing in Myanmar could be a good thing,” said UNAIDS executive director Michel Sidibé, who was in the country last week.
This would help improve Myanmar’s low use of lifesaving anti-retroviral treatment (ART), which is reaching only one third of the 120,000 people who need it.
Many are pregnant mothers – in 2011, 84 percent of an estimated 37,000 pregnant women living with HIV received the treatment, which also reduces the risk of transmission to their babies to less than 5 percent.
In May, AlertNet reported that medical clinics in Myanmar were having to turn away HIV patients because of a lack of funding.
For Sidibé, 30 percent coverage is still an improvement from 2008, when only 12 percent of people who needed it were receiving ART.
He praised Myanmar, a former pariah country now lauded for its democratic reforms, for tackling the epidemic, and reducing the number of new HIV infections from 11,000 in 2008 to 8,500 in 2011, despite “the difficult circumstances (where) the resources have not always been made available.”
MYANMAR WILLING TO REFORM PUNITIVE LAWS
The key now is to target those groups most at risk of HIV– sex workers, men who have sex with men, and people who inject drugs – inside Myanmar as well as across borders.
“It's very difficult for Myanmar to control the epidemic if they don't pay serious attention to migration and cross-border movement and trying to see how that could be managed jointly with the different borders,” Sidibé said.
There’s also a need to increase testing for HIV. Less than a third of pregnant women are currently tested for HIV but the government is looking to decentralise testing services to reach more pregnant women, he said.
About 500 children a year are born with HIV in Myanmar.
Though socially conservative, Myanmar is also willing to reform laws that penalise the groups most at risk, and to consider sex education as a form of HIV prevention, said Sidibé.
He told AlertNet he was encouraged by his discussions with the vice-president and the attorney general. “They consider (reforming punitive laws) would be a strong message to the world that Myanmar is taking the issue of inclusiveness very seriously,” he said.
“ALARMING” SIGNS IN ASIA
Sidibé, who also visited Indonesia and Thailand, called for vigilance in the Asia Pacific region. “We’re seeing alarming signs. In countries like Indonesia, Pakistan, Philippines, we're seeing expanding epidemics” of HIV/AIDS, he said.
In the early days of the fight against HIV/AIDS, Southeast Asia stood out as a success story because of improved condom usage and awareness campaigns.
Sidibe suggested increasing the amount of HIV testing – testing of some of the most at-risk groups is as low as 29 percent in some countries – and improving the quality of prevention services.
“For years we've been working on men having sex with men in Bangkok but we still have 31 percent who are HIV positive. In Indonesia we still have 36 percent of the drug users who are still HIV positive… that means the quality of the prevention programme is still poor,” he said.
He also urged Asian countries to work together on HIV prevention, treatment and care and not just to rely on development aid, which is facing a squeeze as countries look to cut back in an era of financial austerity.
INCLUSIVENESS KEY IN TACKLING EPIDEMIC
Still, Sidibé said the trip had been encouraging, especially a visit to an Indonesian prison where inmates who are injecting drug users – a group most people believe does not deserve any services – have access to methadone treatment and peer education.
He also held a discussion with religious leaders in Indonesia, where using AIDS as an entry point allowed them to have “the difficult discussion of sex education”, he said.
“(And) the minister of justice telling me how (they plan) to reform the law on reproductive health – only married couples currently have access to reproductive health information and education – it was huge, huge, huge," said Sidibé, who is pushing for an end to punitive laws and discrimination against those most at risk and people living with HIV.
He was also keen to emphasise inclusiveness as a key dimension of the fight against HIV/AIDS.
“The whole debate of AIDS is showing us that if you don't deal with inclusiveness, even if resources are there, you will not reach people,” he said.
“If people are excluded, if they're not part of the social transformation, if people don't have a voice, if people are sick and not educated, then I think you will fail,” he added.
“My personal view is that that is key in Asia.”