Only a third of people in need of antiretroviral treatment in Myanmar receive it, contributing to 18,000 deaths each year
YANGON (AlertNet) - Sales clerk Soe Hlaing was returning to work after buying some betel nut to chew when he suddenly collapsed under a blazing sun on Yangon’s waterfront.
The 45-year-old had been suffering from diarrhoea for a month but dismissed it as food poisoning. He had carried on with his job at a business buying and selling coconuts, which earned him 5,000 kyats a day ($6), often working round the clock to feed his wife and young daughter.
After a short stint in a private hospital - he couldn’t afford to stay longer - his health got worse. His weight plummeted and he could barely walk or eat.
A friend took him on a trishaw to a clinic run by international medical charity Medecins Sans Frontieres (MSF) in Hlaing Thar Yar, a poor satellite town on the outskirts of Yangon, Myanmar’s main city.
A blood test came back positive for HIV. He was also diagnosed with tuberculosis. His CD4 count - a measure of the white blood cells that play a key role in the body’s immune system - had dropped to a very low level of 20.
“When people see me now they say, ‘Oh you haven’t died,’” Soe Hlaing told AlertNet at the MSF clinic after a routine visit, recalling the events from over a year ago.
“Every night, when I say prayers, I think of all my benefactors, including MSF doctors and people in foreign countries and organisations whose donations made it possible for me to get ART and vitamins,” he added.
“It's only because of them that I'm alive today,” he said, hugging his two-and-a-half year-old daughter, who chattered excitedly as he talked.
18,000 DEATHS A YEAR
Despite his harrowing experience, Soe Hlaing is considered lucky in Myanmar. Tens of thousands of others who are HIV-positive go without treatment.
Some 215,000 people were living with HIV/AIDS in Myanmar in 2011, of whom around 120,000 need lifesaving antiretroviral treatment (ART), which can also prevent the spread of HIV, according to the U.N. agency UNAIDS. But only 40,000 are receiving ART.
The World Health Organization (WHO) says anyone with a CD4 count lower than 350 should get ART. Yet a severe lack of resources means MSF only treats those with a CD4 count below 150 in Myanmar.
The aid group has close to 20 clinics around the country, and provides the lion’s share of ART in the southeast Asian nation.
Nafis Sadik, the U.N. special envoy on HIV/AIDS for Asia Pacific, underlined the fact that only a third of people who need ART in Myanmar are getting it at a time when there is a new global push to treat all HIV-positive patients regardless of their CD4 count.
“The evidence is that the earlier you start, the more protected they are, the less infectious they are,” Dr Sadik told AlertNet during her recent visit to Myanmar. “And like other diseases, if you give treatment early, the survival rates are much higher.”
“There are still 18,000 people who die every year of AIDS-related diseases in Myanmar,” she added.
THWARTED HOPES
Yet a shortage of drugs – due partly to a lack of donor funds, as well as low spending on health by previous governments – forces doctors like Mya Thida to turn away patients every day.
“As a doctor, when a patient comes through the door, you'd like to treat them. You want them to get the treatment and medication they need and deserve,” said the doctor at the MSF clinic attended by Soe Hlaing.
“Many of them also come with the hope and expectation that they will get ART here, so when we have to turn patients away, both doctors and patients suffer,” she said.
The clinic has about 2,000 patients on ART, and another 2,000 who need ART but cannot get it.
In 2011-12, the Myanmar government allocated 1.3 percent of its budget (92 billion kyats, or less than $2 per person) to health. This is low compared to neighbouring countries, but is still an increase from 2007 when it spent only $0.70 per person.
The government has announced it will increase health spending fourfold in the 2012-13 fiscal year.
FUNDING SHORTFALL
MSF is worried that a freeze in new grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria up to 2014, announced last year, will worsen an already dire situation.
In a turnaround, the fund said in May it has additional funding of $1.6 billion for the next three years, and there are hopes that this could help bridge the gap. But it is not yet clear how this money will be allocated.
MSF released a report in February warning international donors of a health crisis in Myanmar among HIV-positive people with TB - the leading cause of death among people infected with HIV worldwide.
Money anticipated from the Global Fund would have paid for ART for a further 46,500 people until the end of 2018, increasing coverage to 80 percent or close to 100,000 patients, said Dr Maria Guevara, MSF’s medical coordinator in Myanmar.
“The cancellation (of the funding round)… condemns Myanmar to the status quo,” she told AlertNet.
A funding shortfall for the treatment of multidrug-resistant TB (MDR-TB) - which is harder to diagnose and needs longer and more complex treatment than other forms of TB - is another concern.
“The WHO estimates there are 9,300 new cases of MDR-TB per year in Myanmar, yet currently only around 350 people have access to treatment,” said Guevara. The cancelled round of Global Fund financing would have put 10,000 people on treatment by 2018, she said.
“These two diseases (HIV and MDR-TB) drive the AIDS epidemic together, and they are highly fatal as a combination,” she added.
UNABLE TO WORK
Getting ART has been crucial for Soe Hlaing, but it is just one of the many challenges facing patients like him, who have had to stop working.
His family has lost its income and lives hand-to-mouth with help from friends who do not know he is HIV-positive and are struggling financially themselves.
They live in a small rented house for 35,000 kyats ($42) a month, with no money to pay a deposit to the landlord, Soe Hlaing said.
“I cannot work so it is very difficult for my family to have a decent life,” he said.
“With help from two friends, my wife opened a little shop selling fried rice a while ago. It only lasted a month and 10 days. We lost money. Now all the pots and pans are at the pawn shop.”
His wife of 16 years, who carried him when he couldn’t walk and fed him using a large syringe when he couldn’t swallow food or medicine, vows she will stand by him.
“I was really sad when I first heard (he had HIV),” Tin Tin Hlaing said.
“But I told him I won't let him die and won’t give up hope. I starved myself and fed him. We still have a young daughter to look after and we need to make sure she grows up fine.”
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