from 15 years ago -
September 25, 1999
Drug use and HIV/AIDS in Burma; Statistical Data Included
BYLINE: Chelala, Cesar; Beyrer, Chris
Since the military's takeover of Burma in 1962, with its persistent mismanagement and corruption, the country's economy has deteriorated and in 1987 the United Nations placed it among the group of least-developed countries. The United Nations High Commissioner for Human Rights, Amnesty
International, and several other human rights organisations have denounced widespread campaigns of forced relocation and population transfers of indigenous communities such as the Karen and other minority groups, religious persecution of Christians, Muslims, Hindus, and Animists, arbitrary arrests,
slave labour, and the use of civilians as human mine-sweepers.
This economic deterioration and such widespread human rights abuses has had a dramatic effect on the health status of the Burmese people, a situation that is compounded by limited access to health care, particularly in the ethnic-minority regions. According to statistics from WHO and UNICEF, the maternal
mortality rate in Burma is 230 deaths per 100 000 livebirths, compared with 44 deaths per 100 000 livebirths in neighbouring Thailand.1 UN statistics for 1999 show that the infant mortality rate in Burma is 81 per 1000 livebirths, whereas in Thailand it is 31 per 1000 livebirths.1 In addition, about one million children are malnourished. The health of the Burmese people is further jeopardised by another threat: the
increasing use of heroin and the alarming spread of HIV/AIDS.
Burma continues to be the largest source of illicit opium and heroin in the world; in the USA, for example, Burmese opium makes up about 60% of the heroin market. The cultivation of opium poppies in Burma has almost doubled since 1988 and takes place with the complicity of military officials. Indeed, many internationally wanted drug dealers have found shelter in Burma, without any interference from the Burmese authorities. The easy availability of heroin in Burma has led to its growing use inside
the country, especially intravenous use of the drug, and is contributing to a dramatic increase in HIV infection throughout the region.
According to Burmese official statistics, in some townships up to 25% of adults are injecting drug users. Government statistics estimate the drug-addicted population at 66 463. By contrast, the United Nations Drug Control Program and non- governmental organisations that work in the health sector estimate the number of addicts to be between 400000 and 500000. In 1994, WHO helped the National AIDS Program to investigate HIV infection among Burma's drug users and found that the rate was the highest among drug users worldwide.
According to Dr Peter Piot, UNAIDS's Executive Director, Burma currently has at least 440000 people with HIV/AIDS-the second worst AIDS epidemic in Asia after Cambodia. The Southeast Asian Information Network and other non-governmental organisations have confirmed Piot's estimate. The Burmese junta, however, claims that there are only 21503 confirmed cases of HIV infection and 2854 cases of AIDS in Burma.
The reason for the high rates of HIV infection among injecting drug users in Burma is needle sharing, a necessary measure among addicts because of the extremely short supply of syringes in the country. Furthermore, the "paraphernalia" laws in Burma make carrying needles without medical licence a crime. Habitual drug users work in "tea stall" shooting galleries, where they reuse needles and in this way transmit HIV.
Another factor that affects the high rates of heroin use and HIV infection in Burma is the young Burmese internal migrants who work in the jade and ruby mines in Shan or Kachin states. These
workers come from all over the country to work in the mines, in numbers that, in the dry season, may reach the hundreds of thousands. Because many of the young adults with HIV infection in central Burma have worked in the mines, they probably have had a key role in the transmission of HIV across the country.
The HIV epidemic among drug users in Burma has led to HIV epidemics in other border countries, such as China and India. The heroin route through western Burma, across the Indo-Burma border into the northeast state of Manipur, has led to an explosive parallel increase in intravenous use of heroin
and spread of HIV infection. Something similar has occurred along Burma's eastern border, particularly in China's Yunnan province.
The Chinese Ministry of Public Health states that 80[middle dot]4% of all cases of HIV infection and 60[middle dot]0% of all confirmed AIDS cases in China have been detected in Yunnan since 1995. There has been an increase in injecting drug users and HIV infection in the Chinese province of Guangxi, on the border with Yunnan and Vietnam, which is a third route from Burma and Laos, through northern Vietnam and into China. Drug users in the Indian state of Manipur have among the highest rates of HIV infection in India. In 1994, WHO estimated that the rate of HIV infection among drug users in Manipur state was 56%, and is spreading rapidly into the general population.
Burmese heroin export routes have a crucial role in the spread of intravenous drug use and HIV infection throughout south and southeast Asia. The failure of the Burmese junta to deal effectively with the production and widespread use of drugs bodes ill for their ability to cope with the HIV/AIDS problem. By all practical measures, the Burmese junta has become a threat to the health of not only to Burma's own citizens, but those of neighbouring countries as well.
Cesar Chelala, Chris Beyrer
390 West Broadway, New York, NY 10012, USA; and Johns Hopkins University School of Hygiene
and Public Health, 615 North Wolfe St, Suite 7132, Baltimore, MD 21205, USA
1. UNICEF. The state of the world's children 1999. Geneva: UNICEF, 1999.
Official publication of the manual by the United Nations is expected by the end of the year. In the
meantime electronic copies of the version submitted to the UN may be obtained from several websites
(
www.phrusa.org,
www.hrft.org.tr, and
www.tihv.org.tr). Those who access the manual are requested
to consider signing a letter of endorsement that may facilitate a UN General Assembly Resolution on the
Principles.
[I was puzzled by the note at the end, since it seemd to say that the UNICEF report was on the websites given, but I couldn't find it. However, I looked on UNICEF's own website,
http://www.unicef.org/ and the State of the World's Children 1999 is there, in a good clean Text 760K version, at
gopher://gopher.unicef.org:70/00/.cefdata/.sowc99/whole.txt which took a second or so to download.
The tables are in good shape.
There's also a glossy 1860K PDF version with pictures, colour and all at
http://www.unicef.org/sowc99/sowc99e.pdf which downloaded in 10 minutes plus downloading the Acrobat reader if you don't have it. DNA]
HERE'S A STATEMENT TO THE COMMISSION ON HUMAN RIGHTS THAT HAS ALREADY BEEN ON THE NET:
COMMISSION ON HUMAN RIGHTS (55th Session)
Item 14
19 April 1999
Statement read by David Arnott
HIV/AIDS AND DENIAL
Mme Chair,
We read in report E/CN.4/1999/76 that a grand total of 13 governments replied to the Secretary-General's request of September 1998 for opinions on the Draft Guidelines on HIV/AIDS and Human Rights. This is a meagre response indeed, given the severity of the problem, and indicates the level of denial involved.
The human rights dimensions of HIV/AIDS highlight the inseparability of civil and political, and economic, social and cultural rights. The ICASO statement, delivered last Friday, and which we would endorse, rightly stresses the civil and political rights dimensions of the epidemic, since hitherto it has been treated almost uniquely as a health issue. Here we address the question of denial, taking as an example the epicentre of HIV/AIDS in Asia, namely Burma, keeping a special focus on the right to freedom of opinion and expression.
Addressing a Bangkok press conference on the 2nd April this year, the Director of UNAIDS, Peter Piot, said that "Burma has the second worst AIDS epidemic in Asia" (after Cambodia), that UNAIDS estimated there were at least 440,000 cases of people infected by HIV in Burma, where intravenous drug use is widespread and there is an active cross-border sex trade with neighbouring Thailand and China, and that "The big challenge is the recognition of the problem by the government." The Burmese junta claims to have only 21,503 confirmed HIV cases and 2,854 AIDS cases.
To throw some light on the differences in these figures, I would like to read out a couple of paragraphs from a remarkable book, "War in the Blood: Sex, Politics and Aids in Southeast Asia"*, by epidemiologist Dr Chris Beyrer who spent some years in Southeast Asia doing research into HIV/AIDS in the region, and who is a leading authority in the field.
"In upper Burma I met a doctor working in a hospital. He is a lovely guy; bright, committed and brave. He is starved of medical news and information on HIV, and longs to share his work. We talked in the tacky VIP room above a local bar -- his choice -- a place supposed to be "okay", meaning secure. He told me that in 1994 his superiors became alarmed at how many AIDS cases and deaths he was reporting. He was told to stop being so "thorough". His own practice has become almost entirely AIDS care. He is one of only two physicians in this town who treat people with HIV infection.
Most of his patients have three things in common: they're young, they're addicts or ex-addicts, and they've worked in the jade and ruby mines in Shan or Kachin States. This doctor thinks the mines have been crucial in the spread of HIV. He explained that in the rainy season the mines have about 5,000 people. When the ground dries out, the numbers swell into the hundreds of thousands. People come from all over the country to work in the mines. It is dangerous and most don't do very well, but a handful do, and that's the draw. Heroin dealers are everywhere, as are cheap brothels; women migrate seasonally to earn some money as well. SLORC runs the best concessions; the poorest people sift through their waste water looking for shards. When the rains come again, the miners go home, taking HIV to every nook and cranny".
.........
Beyrer continues: "Health reform, like reform of virtually every other sector, will not move forward as long as the political process remains deadlocked. ...The Generals still do not come to the negotiating table. Burma's anguish continues; the triple epidemics of heroin use, HIV, and tuberculosis rage on.
"In November 1996, a Dutch journalist visiting the Shan states discovers that people with HIV infection are being isolated in leper colonies. The leprosy patients are terrified of the people with AIDS, as are those with HIV infection of those with leprosy. This is reported to be a temporary measure" (as, we remind the Commission, was the Burmese martial law administration established in 1988, which is still in power.)
"War in the Blood" draws a much more optimistic picture of the HIV situation in Thailand, where the authorities have acknowledged the problem, provided free condoms, confidential testing and counseling, have engaged in extensive research and consultation, and conducted wide-scale educational campaigns. By contrast, as Beyrer points out, in Burma, in addition to intimidating doctors from reporting, fear of the regime has also seriously inhibited people at risk from seeking testing and counseling, thus further lowering reporting.
In Thailand, the epidemic is no longer out of control, due to an open, rights-oriented strategy backed by substantial political will. In Burma and other parts of the world where politically weak, unstable governments deny freedom of expression and other rights, the HIV/AIDS epidemic is likely to spiral ever more out of control. With its cross-border vectors of shared needles along drug trafficking routes, and sex and long-distance transport workers, the HIV/AIDS epidemic and its management cannot be considered the internal affair of a single country.
Mme Chair,
We encourage all countries to disseminate and implement the International Guidelines, and we ask the Commission to request its country and thematic rapporteurs to address HIV/AIDS-related issues in their reports.
Thank-you, Mr/Mme Chair.
* "War in the Blood: Sex, Politics and AIDS in Southeast Asia" by Chris Beyrer, White Lotus (Bangkok) and Zed Books Ltd (London) 1998.
