AIDS AND HIV IN MYANMAR
Myanmar is facing a serious epidemic - an estimated 240,000 of the population is infected with HIV. Myanmar’s authoritarian military regime is widely condemned for its human rights abuses, and in 2005 these concerns led the Global Fund to fight AIDS, TB & Malaria, to withdraw its proposed $98.4 million grants for the country. Prevention services for injecting drug users are severely lacking with needle exchange programmes operating in just a few locations. Drug users are dealt with heavy-handedly and crackdowns on drug production have led to a scarcity of opium and heroin. This has resulted in drug inhalation being replaced by injecting, as a more cost-effective way of drug consumption, carrying with it a higher risk of HIV transmission. In 2006 methadone substitution therapy was introduced in a small number of government locations. Furthermore, in some cities the HIV prevalence among MSM (men who have sex with men) is extremely high with 23.5 percent of MSM infected with HIV in Yangon and 35 percent infected in Mandalay. However, in 2011 Myanmar implemented a four-year plan to use mass media as a tool for HIV education and reducing discrimination around HIV and AIDS. [Source: Avert, International AIDS-HIV charity website]
HIV/AIDS - adult prevalence rate: 0.6 percent (2009 est.), country comparison to the world: 62. HIV/AIDS - people living with HIV/AIDS: 240,000 (2009 est.), country comparison to the world: 24. HIV/AIDS - deaths: 18,000 (2009 est.), country comparison to the world: 17. [Source: CIA World Factbook]
The figures were higher in the past. It one time it was estimated the adult AIDS-HIV rate was 1.99 percent. This is one of highest rates in the world. HIV/AIDS - adult prevalence rate in 2003: 1.2 percent. AIDS cases in 2000: 530,000.
HIV-AIDS spread at an alarming rate in Myanmar in the 1990s for several reasons according to doctors: 1) a large number of intravenous drug users and a large supply of cheap and easy-to-get heroin; 2) a migration of prostitutes; 3) shortages of condoms and testing equipment; 4) a conservative socialist structure that makes AIDS education difficult; 5) economic sanctions from other countries which prevented medicine and equipment form entering the country. [Source: Philip Shenon, New York Times, March 11, 1994]
Myanmar has remained largely in denial about HIV-AIDS even though it has one of the highest infection rates in Asia (Cambodia also has a very high HIV-AIDS infection rate). This situation is closely linked to an abundance of heroin in Myanmar. The military regime has long denied the existence of AIDS in Myanmar. Government AIDS statistics are not reliable. One foreign aid worker told Newsweek, “The government says Burma is the most moral place on earth so how can it admit having an AIDS crisis?”
HIV-AIDS in Myanmar: Stigma, Neglect and Misery
Damir Sagolj of Reuters wrote: “The mother and child who touch hands in an overcrowded Yangon hospice are not family, but their tragic history begins in the blood. Jam, 42, a mother of six, and Kanama, aged 2, are both HIV positive. Abandoned by their families, they must now find comfort in each other, although Jam still yearns for her husband to return to the private HIV hospice in the suburbs of Myanmar's biggest city. "He promised to come back but I'm afraid he never will," said the woman as she burst into tears. She is known in the hospice by her nickname, Jam. [Source: Damir Sagolj, Reuters, May 31, 2012]
Because of the social stigma and medical neglect associated with HIV-AIDS hospices that bring to mind leper colonies. Jam once lived in Kadon, a fishing village in the impoverished Irrawaddy Delta, with her farmer husband and their six children. In 2008, feeling unwell, she was treated by a self-styled medic, who injected her with a drug. The needle was dirty and had been used repeatedly. It is assumed she contacted HIV from it.
Apart from her six-year-old, her children shun her. Her husband, who is not HIV positive, returned to the farm. Five or six people from her village were also treated by the same medic and exhibit the same symptoms and weakness, says Jam, but they refuse to be tested for HIV. Her neighbours would allow her to return to the village, she says. "But they will not talk to me, because they know my illness is dangerous." Not that Jam is going anywhere. Weak and skeletal, she can barely walk or talk. She doesn't eat and is responding poorly to the drugs the hospice gives her.
Her only solace is Kanama, who was brought to the hospice by her father in 2011. He and Kanama's mother have both since died of AIDS. While her siblings, who are not HIV positive, stay with their grandparents, Kanama is mostly looked after by Thein Htay, 73, who has been a volunteer at the shelter for three years. The children get better care and more sympathy here, he says, although not always from the shelter's neighbours. "They were scared at the beginning and were avoiding people from the center," says Thein Htay. "But we explained them what is HIV and how it works. Now, most are much more relaxed - but not all."
Jam's story of rejection is shockingly common, she says, recalling an HIV sufferer who was left to starve by villagers, then possibly cremated while in a coma. "HIV patients are often left alone and abandoned by the family," she says.
Drug Users, Sex Workers and the Spread of AIDS in Myanmar
Health workers have accused Myanmar's former military rulers of largely ignoring the disease when it began to spread in the 1990s, particularly among sex workers and drug users. In the 1990s, Myanmar had the highest rate of H.I.V.-positive intravenous drug users in the world. By one estimate 90 percent of the intravenous drug users and half the sex workers in Myanmar were infected with HIV at that time. In 1994, 81 percent of the addicts in Yangon, 74 percent of the addicts in Mandalay and 91 percent of the addicts in Myiykyana had the HIV virus.
In the 1990s, a single syringe was sometimes used by 25 to 40 different users. One drug addict told the New York Times, "I used heroin with my friends, and we always shared the needles. Even today my friends do not worry about AIDS. They are not sick yet." Myanmar has been blamed for spreading AIDS through the smuggling of opium and heroin, which are used by drug users in other countries that infect others.
AIDS is believed to be have arrived in Myanmar with drug-addicted prostitutes from China In a pattern similar to Thailand, transmission of the virus began through needle sharing by intravenous drug users and then spread by sexual contact among heterosexuals. Intravenous drug use formerly was a problem mainly in the northeast among ethnic minorities, but in the 1990s drug use spread to the lowlands and the urban areas inhabited by the Burmese majority. Many men in Myanmar have gotten HIV-AIDS from Burmese women who sold and made into prostitutes in Thailand, where they were infected with the H.I.V. virus, which the brought to Myanmar when they returned home. The HIV rate among prostitutes in Myanmar leapt from 4 percent in 1992 to 18 percent in 1995.
Mon Mon Myat of IPS wrote: “According to a 2008 report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), more than 18 percent of some 240,000 people living with HIV/AIDS in Burma are female sex workers. HIV-positive sex workers are a hidden reality in Burma. “Our society covers up the truth that prostitution exists because of shame and fear of sin, but it actually makes the situation worse,” pointed out Htay. “I think a network of commercial sex workers needs to be set up in this country,” said Nay Lin of Phoenix Association, a group that provides moral support and vocational training for people living with HIV/AIDS. “Through that they could stand for their rights and protect their communities.” Just like others, commercial sex workers who are mothers earn money in exchange for sex to support their children and their families, but they always work under fear of the police and of being abused by clients,” Lin said. “We should respect them as mothers instead of abusing them.” [Source: Mon Mon Myat, IPS, February 24, 2010 ]
On the HIV-AIDS situation in the Yangon suburb of Kawthaung, one doctor told the Irrawaddy, "We can’t know exactly what is going on in Kawthaung in terms of HIV/AIDS because of the lack of transparency; but we do know that antenatal care studies show that 12 percent of pregnant women in Kawthaung are HIV-positive, compared to 7 percent in Ranong. "It’s scary to think of the HIV rate among sex workers in Kawthaung." [Source: Neil Lawrence, The Irrawaddy, June 3, 2003 ^]
AIDS Treatment in Myanmar
The government does not provide even the most basic treatment for AIDS and HIV sufferers. It lacks the most basic drugs. A small budget for anti-viral drugs makes AIDS a “a relatively fatal condition.” As of 2002, the annual government expenditures for AIDS was $3.5 million (of this about $30,000 was provided by the Myanmar government, with the rest coming from foreign donors). It was estimated that at that time Myanmar needed at least $50 million to adequately fund basic treatment and prevention programs. One woman with AIDS who went to a hospital for help told the Washington Post, “They said, ‘There’s nothing we can do.’..They said I would have to take care of myself and that I should just go home and die.”
The military regime has pleaded with the international community for help treating AIDS patients Sanctions and restrictions on foreign aid agencies complicated the provision of drugs and treatments. Aid groups have been reluctant to comply completely with requests by the Myanmar government out of concern that money would siphoned off by the generals and the aid would be viewed as tacit support of the regime.
Thousands of people have died of AIDS because of the near-absence of retroviral drug treatment outside Rangoon and Mandalay. Lucile Andre of AFP wrote, “Starved of funds and medicine during decades of military rule, doctors at a clinic in Yangon offer their usual advice to one of Myanmar's newest HIV patients — come back when you're sicker. In a country with one of Southeast Asia's biggest armies but a healthcare system in tatters, scarce antiretroviral drugs are given only to those with the advanced form of the illness. "If I don't get the treatment, I'm worried the disease will get worse," a 47-year-old farmer told AFP at the clinic run by charity Medecins Sans Frontieres (Doctors Without Borders) after she was diagnosed with the virus. [Source: Lucile Andre, AFP, May 26, 2012 :::]
“Neighboring Thailand, with a slightly bigger population, has more than twice the number of people with HIV but access to drugs and greater public acceptance mean that many can lead normal lives. Doctors Without Borders, a medical aid group, says some 85,000 HIV-infected people in Myanmar are not getting treatment because of a lack of funding, despite an increase in international engagement with the government. :::
“Some groups predict the situation will only worsen despite more attention on AIDS and the country's nascent democracy. The Global Fund to Fight AIDS, Tuberculosis and Malaria, is cutting funding worldwide because of a lack of donations, jeopardising a plan to provide HIV drugs to 46,500 people in Myanmar. The new government has brought little hope, said Phyu Phyu Thin. "Actually, nothing has changed. The situation has even declined," she said, adding that the number of patients in the hospice doubled between 2010 and 2011. :::
AIDS Prevention and Education in Myanmar
There is little money for testing the blood supply (even though kits cost only about 70 cents a piece) and condoms (even at 10 cents a piece that is too expensive for many poor people). The United Nations sponsors some programs in which sex workers are instructed on how to use condoms. Mitchell Koss wrote in the Los Angeles Times: “In the Mong Pawk market we watched as U.N. workers demonstrated how to put a condom on a model penis (ignored by the passing karaoke girls).”
In the 1990s, a movie called "Poison Love" about a man who gets AIDS from prostitute and then passes into his wife and child was almost never shown on Burmese television because it showed condoms, which the government was worried might offend conservative Buddhists. The movie was shown after an appeal was made to by Gen. Khin Nyunt, a leader in the SLORC junta. "Khin Nyunt's wife is a physician, thank goodness," a Western health worker told the New York Times, "Otherwise it might have never gotten on the air."
Neil Lawrence wrote in The Irrawaddy, “While general awareness of the threat of HIV/AIDS has increased among most segments of the populations of Thailand and Burma, many inside Burma remain ignorant of the means of prevention. "A lot of people think that penicillin can be used as a prophylactic," remarked one health worker in Shan State. "Others simply apply toothpaste or chewed tobacco to the tip of their penis after sex." Even among better-informed Burmese, years of economic stagnation and limited educational opportunities have fostered a nothing-to-lose attitude in many young people. "I was shocked when a friend told me he didn’t use a condom when he slept with prostitutes," said a thirty-year-old shopkeeper in Rangoon. "He said he just didn’t care if he caught AIDS." [Source: Neil Lawrence, The Irrawaddy, June 3, 2003 ^]
AIDS Hospice in Myanmar
Describing a Yangon hospice that is home to 182 HIV patients, Damir Sagolj of Reuters wrote: “The hospice is basic, its bamboo walls decorated with pictures of pro-democracy leader Aung San Suu Kyi. Doctors pays visits, but patients cook and clean for themselves, helped by volunteers. Volunteer Thein Htay expects little help from the government, even that of a reforming President Thein Sein. "It does not matter what I expect, they will do nothing. So, I don't expect anything. Just to let us alone, not to disturb us. Things will change only when NLD becomes the government." [Source: Damir Sagolj, Reuters, May 31, 2012]
The government threatened to close the center in 2010 after Health Ministry officials warned of "the possible spread of infectious disease from the patients", reported the state-run New Light of Myanmar newspaper. But the center, which Suu Kyi visited after her release from house arrest in 2010, remains open. A sister hospice nearby is home to another 82 HIV patients. Phyu Phyu Thin called for the government to increase its health and education budgets to buy more HIV drugs and fight the stigma attached to the disease. "The two most important things are sufficient drugs and health education," she told Reuters.
The patients range in age from two to almost 50. They are at different stages of illness, and many live in rural areas where even basic health services are limited. Describing a patient there AFP reported, “Tin Ko found out he had HIV only after his daughter was born with the disease. “If we’d had a chance to prevent mother-to-child transmission, my daughter wouldn’t have gotten HIV,” he said. At two years old, his child is the youngest person receiving help from Phyu Phyu Thin’s group. But he’s one of the lucky ones receiving anti-retroviral treatment from Myanmar’s Wai Bar Gi infectious disease hospital. “I have no fear of death, but I want to work so that others can have access to drugs,” Tin Ko said. [Source: AFP, July 5, 2007 ///]
Myanmar AIDS Activist Phyu Phyu and Her “Patients”
Phyu Phyu Thin, an HIV activist, founded the above hospice in 2002. She is now a parliament member from and National League for Democracy (the political party of Aung San Suu Kyi). She was arrested in May 2007 along with more than 60 others for joining in vigils to pray for the release of Myanmar’s democracy leader Aung San Suu Kyi. She was released several weeks later along with dozens of others. “We feel stronger mentally when we see Phyu Phyu Thin,” said Boat Sone, the HIV-positive widow of a political prisoner who died last year of an AIDS-related illness. “We felt really depressed when she was arrested. She is a light for us while we are living in darkness.” [Source: AFP, July 5, 2007 ///]
AFP reported: “Phyu Phyu Thin has headed the NLD’s AIDS programme since 2002, tapping into the party’s youth league and recruiting students and Buddhist monks as volunteers to help about 1,000 people with HIV from around the country. When patients come to Yangon, she helps them find places to stay and tries to match them up with the few treatment services available, mainly at clinics run by international aid agencies. She also organises home-based care for patients who need it, and has found private donors to pay for life-prolonging drugs for about 30 people. Although she’s not a doctor herself, she talks about the people she helps as “her patients.” Eleven of them were so distraught by her arrest that they held a prayer vigil last month to call for her release, only to be detained themselves for four days. ///
“By the time many of them come to us, they already have AIDS-related illnesses,” Phyu Phyu Thin said. Getting treatment to people in remote parts of the country is one of her most difficult challenges, a struggle shared by international agencies that are forced to work within strict limits imposed by the military government. Emmanuel Goue, head of mission for Doctors Without Borders-Switzerland, said his group’s main problem was access to their patients in southern Myanmar, where they provide 700 people with anti-retroviral drugs. Goue said he had to ask the military for permission to travel to the region two months in advance. ///
Phyu Phyu Thin said she believed that expanding treatment programmes in Myanmar was the only way to save the country’s youth. “Treatment is needed urgently because people are dying everyday. Treatment not only can prevent death, it can also save the country’s workforce of young people,” she said. ///
AIDS Activism in Myanmar and Efforts to Keep an AIDS Hospice Open
Joshua Hammer wrote in Smithsonian magazine: “Shortly after Suu Kyi’s release from house arrest, I met the organizers of the 379 Gayha AIDS shelter at the NLD Party headquarters one weekday afternoon. Security agents with earpieces and cameras were watching from a tea shop across the street. ...The large, ground-floor space was bustling with volunteers in their 20s and 30s, journalists, human-rights activists and other international visitors, and people from Myanmar’s rural countryside who had come seeking food and other donations. Posters taped on the walls depicted Suu Kyi superimposed over a map of Myanmar and images of Che Guevara and her father. [Source: Joshua Hammer, Smithsonian magazine, March 2011 */]
Phyu Phyu Thin, 40, the founder of the HIV/AIDS shelter, told me about its origins. In 2002, concerned by the lack of treatment facilities and retroviral drugs outside Yangon and Mandalay, Suu Kyi recruited 20 NLD neighborhood youth leaders to raise awareness of HIV/AIDS. Even in Yangon, there is only one hospital with an HIV/AIDS treatment facility. Eventually, Phyu Phyu Thin established a center in the capital where rural patients could stay. She raised funds, gathered building materials and constructed a two-story wooden building next door to her house. Today, a large room, crammed wall to wall with pallets, provides shelter to 90 HIV-infected men, women and children from the countryside. Some patients receive a course of retroviral drugs provided by international aid organizations and, if they improve sufficiently, are sent home with medication and monitored by local volunteers. At 379 Gayha, says Phyu Phyu Thin, patients “get love, care and kindness.” */
‘In trying to close the shelter, the government has used a law that requires people staying as houseguests anywhere in Myanmar to obtain permits and report their presence to local authorities. The permits must be renewed every seven days. “Even if my parents come for a visit, I have to inform,” Yar Zar, the 30-year-old deputy director of the shelter, told me. In November, a day after Suu Kyi visited the shelter, officials refused to renew the permits of the 120 patients at the facility, including some close to death, and ordered them to vacate the premises. “The authorities were jealous of Aung San Suu Kyi,” says Phyu Phyu Thin. She and other NLD youth leaders sprang into action—reaching out to foreign journalists, rallying Burmese artists, writers and neighborhood leaders. “Everybody came out to encourage the patients,” Phyu Phyu Thin told me. After a week or so, the authorities backed down. “It was a small victory for us,” she says, smiling. */
Myanmar Bans AIDS-Related NGOs
Kenneth Denby wrote in The Times, “The authorities in Burma are risking lives and increasing the dangers of the HIV epidemic in the country by preventing foreign aid organisations from giving crucial help to patients suffering from AIDS, The Times has learnt. The ban is part of a growing hostility towards international organisations since the mass demonstrations by monks and political activists and the violent crackdown in September 2007. The Government has prevented aid workers and diplomats from visiting certain projects, made it difficult for them to secure visas and expelled the head of the United Nations in Burma for drawing attention to the humanitarian catastrophe facing the country. [Source: Kenneth Denby, The Times, March 29, 2008]
‘An HIV/Aids project run by the opposition National League for Democracy (NLD) on behalf of its detained leader, Aung San Suu Kyi, has been devastated by the arrest of its leaders and organisers. In October 2007, police arrested the monks of the Maggin monastery in Yangon, which acted as a hospice for AIDS patients. The patients were transferred under guard to a government hospital where they were treated with suspicion, according to AIDS activists. At least two of them died soon afterwards and their deaths were accelerated, their supporters claim, by the callous treatment that they received.
“In the latest move, projects being run by non-governmental organisations (NGOs) in Mandalay, including the British charities Save the Children and Marie Stopes International, have been suspended. Foreign NGOs in Mandalay have been banned from taking part in work that takes them outside their local offices, a ruling that hinders "outreach" programmes such as those that promote safe sex and the use of clean needles among drug users. Worse, they are also unable to deliver much-needed food to thousands of AIDS patients. Local authorities have offered to allow the deliveries to resume if the NGOs provide the names and addresses of patients, but aid workers refuse to comply. "If this continues, these people will not get food," Andrew Kirkwood, programme director for Save the Children in Burma, said. "We're talking about thousands of people, not hundreds."
French Countess Sets Up AIDS Facility in Myanmar
Mark Magnier wrote in the Los Angeles Times, “Thousands patients in Myanmar and beyond owe their health to a French countess, Albina du Boisrouvray, 70. Inspired by the memory of her late son and her inherited fortune, she created the charity Assn. Francois-Xavier Bagnoud, or FXB, and for two decades has been battling government restrictions, inefficiency and medical stigmas. "I imagine they felt it was an honor to have a European countess come to Myanmar," said Dr. Aye Aye Thein, project coordinator at the FXB clinic in Shwepyitha, outside Yangon. "She's very attractive, has a way of getting around problems. It's hard to say 'no.'" [Source: Mark Magnier, Los Angeles Times, April 07, 2013 =]
“In the early 1990s, a raid in Ranong province that du Boisrouvray pressured Thai police into conducting freed several dozen underage sex workers, including eight HIV-positive Burmese girls. Told they'd been repatriated, she later learned that they'd been killed, their bodies dumped in the Moei River dividing Thailand and Myanmar. She accused Myanmar's generals at an international conference of complicity in the girls' slaying. When a second Thai raid freed 95 more Burmese sex workers, half of them HIV-positive, she decided to visit Myanmar to ensure the young women's safety. The military government was furious about the public slight, however, and turned down her visa request. “For a year she fought back, eventually pulling French diplomatic strings to help secure a visa. "I can be pushy," Du Boisrouvray said,"If you put me out the door, I'd come through the window."Rather surprisingly, Myanmar finally welcomed her. She later concluded that Thai police probably killed the women and the Burmese wanted to prove their innocence. =
“She decided to establish an FXB presence in the politically isolated country, following on earlier FXB clinics and village projects in Thailand, Uganda, Burundi and Bolivia, among others. But the path was often rocky. Du Boisrouvray contacted Nobel laureate Aung San Suu Kyi's English husband, and got word back that the then-detained human rights champion sanctioned her contacts with the ruling generals, given the upside for the Burmese people. =
“Each time she worked with the government, Du Boisrouvray sought to reach out to pro-democracy activists. She named Suu Kyi to the board of a Harvard University health and human rights center she established, asking the government for permission to visit Suu Kyi and tell her about the selection. The health minister excoriated her in Burmese. "You give me headaches," he concluded. =
“She locked horns with the government again when James Leander Nichols, the Scandinavia consul, a friend and British passport holder, died in prison in 1996, jailed for having two fax machines and assisting Suu Kyi. Outraged, Du Boisrouvray wrote a New York Times column urging tourists to shun Burma. She didn't get another visa for six years. In 2003, Myanmar relented. She soon met with then-Prime Minister Khin Nyunt, who realized that soldiers and ruling families also could be infected with HIV, Du Boisrouvray said. "They were sizing me up, decided they might as well get some of the money inside," she said. In recent years, as Myanmar has opened its doors to the world , FXB's aims have increasingly dovetailed with those of a government struggling to reform healthcare after decades of neglect.” =
Story of French Countess Who Set Up AIDS Facility in Myanmar
Mark Magnier wrote in the Los Angeles Times, “Du Boisrouvray father hailed from French aristocracy and her maternal grandfather was known as the Bolivian "Tin King." Her decision to set up FXB followed a somewhat tortuous path. Born in Nazi-occupied France during World War II, she was smuggled out — her father was part of the Free French movement — as an infant. She and her mother moved to New York and lived at the Plaza Hotel, she said. [Source: Mark Magnier, Los Angeles Times, April 07, 2013 =]
“Her father later moved them to Argentina, Switzerland, Morocco, England and France."They treated me like a parcel," said Du Boisrouvray, who lives in Paris and Geneva. "I don't feel French. I feel Gypsy." She developed an independent, anti-authoritarian streak and searched for meaning, embracing Marxism, feminism, militant ecology, film production and politics. A marriage to a pilot when she was 20 produced a son, Francois. The marriage lasted four years, and she vowed to give her son the stability she'd never had. Francois loved flying, obtaining his pilot's license at 11, she said. The same year, he retrieved his first corpse on an alpine rescue mission. =
“On the death of her father in 1980, Du Boisrouvray inherited his fortune and planned to divide it with her son. But in 1986, at age 24, he was killed piloting a rescue helicopter during a desert road race in Mali. His death shattered her, but it was a catalyst. In 1989, she sold her film production company, jewelry, art, houses and real estate business, funneling $100 million into FXB, named after her son. “ =
AIDS Facility in Myanmar Run by French Countess
Describing a patient at FXB clinic in Shwepyitha, outside Yangon, Mark Magnier wrote in the Los Angeles Times, “After her heroin-addict husband died five years ago, Ei Ei Phyu discovered she was HIV-positive. She thought her life was over until friends directed her to the open-air clinic here where she receives antiretroviral medicine. "This place has been a blessing," she said. [Source: Mark Magnier, Los Angeles Times, April 07, 2013 =]
“The program includes medical treatment, women's support groups, job training, support for 48 HIV-positive orphans as well as administration of an AIDS education theater group and sale of crafts made by patients. In referring patients to state hospitals, FXB found that many Myanmar doctors knew little about HIV/AIDS, so it has helped to educate them. =
FXB, which has 450 employees and 100 programs worldwide, focuses on AIDS orphans, human rights, education, nutrition, health and children's rights. "It can seem disorganized, but it all has to do with Francois," she said of FXB, which promotes self-sufficiency over handouts. "Charity's a Band-Aid."
FXB's active approach has helped pull families out of poverty, Du Boisrouvray said, even as it focuses more on local decision-making. Although it's become easier to operate in Myanmar, huge challenges remain. The United Nations estimates that only a third of about 120,000 HIV-positive Burmese receive antiretroviral drugs. "People are poor and education is low, so you have to give instructions repeatedly," said Saw Lin Hutt, a community educator and counselor at FXB's Shwepyitha clinic. "They don't take their drugs. They don't come for follow-ups. "But it's gradually getting better."
Image Sources:
Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, The Irrawaddy, Myanmar Travel Information Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, burmalibrary.org, burmanet.org, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.
Last updated May 2014