Why are we there?
- Endemic/Epidemic disease
- Healthcare exclusion
- Natural disaster
- Myanmar: the humanitarian emergency continues
- Myanmar: Humanitarian emergency in Rakhine state
- Myanmar: prevented from reaching victims of violence
More than two-thirds of the 120,000 people living with HIV in Myanmar do not have access to the lifesaving antiretroviral (ARV) medication they need.
While there have been encouraging efforts to increase the health budget, the state health system remains underfunded. Furthermore, although Myanmar is one of the least developed countries in Southeast Asia, with a high incidence of HIV and tuberculosis (TB), it receives very low levels of aid.
Médecins Sans Frontières/Doctors Without Borders (MSF) is working in close collaboration with the Ministry of Health and other agencies to build up the technical capacities and resources of the various HIV care programmes in the country.
Overwhelming numbers of people are in need of treatment, but there are only a few sources supplying medicines. MSF has had to make tough choices about whom to treat, and in some areas staff have been forced to restrict ARV treatment to the sickest patients.
At the end of 2011, MSF was the largest ARV treatment provider in the country, with just over 23,000 HIV patients enrolled at its clinics in Kachin, Rakhine and Shan states, and Tanintharyi and Yangon regions.
Staff also offered health education to high-risk groups such as intravenous drug users, sex workers and men who have sex with men, and provided testing and counselling, and prevention of mother-to-child transmission services.
In Insein prison, Yangon, MSF started 150 prisoners on ARV medication and treated 66 patients for TB.
TB and MDR-TB
TB can remain in an inactive state for decades without causing symptoms or spreading to other people.
The body’s immune system can fight off the infection and stop the bacteria from spreading by forming scar tissue around the bacteria and isolating it from the rest of the body. However, when the immune system of a patient with dormant TB is weakened, the TB can become active, and without treatment, be fatal.
Because HIV attacks the immune system, the body becomes more susceptible to infections, including TB. In many developing countries, TB is one of the first opportunistic infections to take hold in people with HIV, and is the main cause of death.
TB prevalence in Myanmar is nearly three times the global average. MSF provides TB treatment, diagnosis and counselling as part of its HIV programmes. Staff also conduct outreach activities in the districts surrounding the clinics, offering testing and following up on patients.
In 2011, MSF enrolled approximately 3,000 TB patients across its programmes in Myanmar.
The World Health Organisation estimates that 9,300 people develop multidrug-resistant TB (MDR-TB) in Myanmar each year. MDR-TB can be transmitted in the same way as drug-sensitive TB, through sneezing or coughing, but can also develop when a patient, either through mismanagement or misuse of medication, develops resistance to two or more of the standard TB drugs.
Treatment for MDR-TB takes up to two years and has numerous side effects.
In a pilot project set up by MSF with the Ministry of Health in Yangon, 72 patients have begun MDR-TB treatment, and there are plans to add MDR-TB treatment to HIV and TB services already being offered in Dawei, in the southern region of Tanintharyi.
MSF will continue to scale up treatment for HIV/AIDS and MDR-TB while urging donors to keep their pledges.
MSF continued to provide medical care to a stateless Muslim minority in Rakhine, who are marginalised in many ways and often excluded from accessing the most basic medical services. Activities focus on basic healthcare, with a specific emphasis on reproductive health and malaria.
Malaria is one of the leading causes of death in Myanmar. MSF clinics provide diagnosis, treatment and prevention measures in areas where the disease is particularly common. Staff treated some 93,900 people in total.
At the end of 2011, MSF had 1,290 staff in Myanmar. MSF has worked in the country since 1992.
33 years old
“I came to the MSF clinic for the first time four years ago and was put on ARVs around three years ago.
"It was my mother who recommended that I come here; personally, I had never suspected my status. After discussing with the counsellor, I decided to take a test. When it turned out positive it was a huge shock for me. I thought ‘that’s it; it’s the end of my life’.
"I talked a lot to my mother and to the counsellor and they really helped. This clinic offers good care and is the only place where I can find free treatment. Because I can’t afford my treatment, it’s really important that it’s free.”
* The patient’s name has been changed.