Myanmar already facing "a devastating gap" between people's needs and access to treatment
BANGKOK (AlertNet) – Tens of thousands of lives are at risk in Myanmar due to an anticipated funding shortfall to treat people living with HIV and tuberculosis, medical charity Medecins Sans Frontieres (MSF) warned Wednesday, urging international donors to provide immediate support to the impoverished country.
Myanmar is already facing “a devastating gap” between people’s needs and access to treatment, and the situation could worsen since the Global Fund to fight AIDS, Tuberculosis and Malaria cancelled its funding globally for 2013 because of a lack of donor money, MSF report Lives in the balance: the urgent need for HIV and TB treatment in Myanmar said.
“HIV and TB will continue to spread – unchecked – in many areas,” the report said.
“... If urgent financial assistance is not made available for Myanmar, the consequences will be devastating.”
With Myanmar’s recent political reforms leading to greater engagement with the international community, donors should either increase funding to the country or provide additional funding for the Global Fund, the report added.
It also asked donors to support Myanmar’s government, which has pledged to increase health and education spending, in its plan to scale up treatment for HIV and TB.
LACK OF ACCESS
Myanmar currently has some of the lowest coverage rates for the lifesaving antiretroviral therapy (ART) that also prevents the spread of HIV, said MSF, which has been working in the country since 1992.
The United Nations estimate that of the 240,000 people living with the virus in Myanmar in 2009, half need ART. MSF, which has been providing the lion’s share of ART there and says its capacity is limited, says preliminary unpublished figures from 2011 showed only about 40,000 (around one out of every three people with HIV) were receiving it.
The U.N. also said 15,000 to 20,000 people have died annually in the past few years due to a lack of treatment.
Myanmar has a lower HIV prevalence compared to many other nations. But it is lack of access to treatment that makes it “one of the most serious epidemics in Asia,” the report said.
The prevalence of TB, the leading cause of death among people infected with HIV worldwide, is also nearly three times the global average. There are also high levels of the multidrug-resistant TB (MDR-TB) which is harder to diagnose and requires longer and more complex treatment, MSF said.
There could be as many as 300,000 people with TB in Myanmar, of which 20 percent are also living with HIV, the report said
The World Health Organization (WHO) estimates there are 9,300 new cases of MDR-TB each year in Myanmar, yet only about 300 people are on treatment, MSF said.
AGONISING DECISIONS
One of Asia's richest countries in the early 20th century, Myanmar is now one of the world's poorest. A third of the resource-rich country’s estimated 60 million people live on less than a dollar a day.
The country has been praised for its recent democratic reforms but it is still struggling with armed conflict, human rights abuse allegations, displacement and the aftermath of natural disasters like the devastating 2008 cyclone.
As one of the world’s lowest recipients of official development assistance, the Global Fund’s cancelled round of funding “would have been crucial”, MSF said.
It would have paid for 46,500 additional patients on ART, put 10,000 MDR-TB patients on treatment and supported the introduction for new technologies to detect TB, the report said.
Already providing ART to more than 23,000 patients, and with over 6,000 new patients expected to be enrolled in 2012, MSF said it is reaching the limits of its capacity.
“As a result, our doctors are forced, on a daily basis, into the agonising decision not to provide ART to patients who, according to WHO standards, should receive it, but who are not as sick as the person next to them in the queue,” the report said.
This includes people like 21-year-old Kyaw Kyaw who has a CD4 count of 168 – WHO says anyone with a CD4 count lower than 350 should receive ART – but is unable to access treatment. CD4 cells are white blood cells that play an important role in the body's immune system.
“I understand very well (the MSF criteria). I saw a lot of people who are very sick and MSF cannot provide help to everyone. So I will get my ART when my CD4 is below 150,” he said in the report.
“Honestly, Myanmar is very poor and we can’t afford everything.”
The only other alternative would be to enroll less sick patients for treatment as they have a greater chance of survival, MSF said.
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