At 120,000 cases in a population of 42m, the prevalence of HIV in Myanmar is not enormous by global standards. Yet with ART coverage among the lowest in the world, the death rate from HIV is estimated at 15,000-20,000 per year. Add to this an epidemic of multi-drug resistant (MDR) TB of three times the global average, considerably exacerbated by this HIV, and one can understand the sense of urgency with which a recent report by Médecins Sans Frontières (MSF) pleads the case for additional funding for HIV and TB programs in Myanmar.
For all these depressing figures, some considerable progress has been made thanks to the recommencement, following a five-year absence, of financial support (Round 9) from the Global Fund to Fight AIDS, Tuberculosis and Malaria. This has enabled levels of enrolment for ART to reach 29,000 as of 2012. Expected funding from Round 11 of Global Fund support was to have paid for 46,500 additional patients ART, helping to bring the coverage to 100,000 by 2018.
Sadly, Round 11 never arrived. In an unprecedented move by the Global Fund, it was cancelled when donor countries failed to contribute at the replenishment conference of 2010 even to the level of the lowest scenario.
The report describes the predicament of MSF workers who must refuse ART to patients whose CD4 count has yet to fall below 150. It also conveys a sharp sense of the opportunity that will be missed, if the resources are not made available for scale-up. With low-ish HIV prevalence and a related MDR TB epidemic, the arguments for a prompt intervention seem overwhelming. Furthermore, recognition of these needs is now reflected in the encouraging efforts of the Myanmar government to increase its health budget. There is ”acknowledgement, willingness and commitment for scale-up” in the country. Yet tragically the financial carpet is in the process of being drawn from under the feet of program providers.
In the light of this MSF pleads for increased funding by international donors for HIV and TB programs in Myanmar, and, above all, for adequate additional funding of the Global Fund in 2012.
Médecins Sans Frontières, Lives in the Balance: the Urgent Need for HIV and TB Treatment in Myanmar, 22nd Febrary, 2012
OF RELATED INTEREST from our journal:
M.J. Toole, N. Chanlivong et al., “Understanding male sexual behaviour in planning HIV prevention programmes: lessons from Laos, a low prevalence country”, Sex Transm Infect 2006;82:135-138 doi:10.1136/sti.2005.016923
http://sti.bmj.com/content/82/2/135.full?sid=ede79323-e743-4a05-907e-d4f33c483b98