February 22, 2012

Joe Belliveau is an operations manager at Doctors Without Borders/Médecins Sans Frontières (MSF).

This article originally appeared in Thailand's The Nation newspaper.

While international attention focuses on Myanmar, a health crisis in the country looms large. An estimated 85,000 people infected with HIV in Myanmar are not receiving lifesaving treatment.

This is an improvement on previous years with new momentum in the country to tackle the crisis. However, the recent retreat of the Global Fund to fight AIDS, TB and Malaria threatens to undo improvements, leaving tens of thousands of people living with HIV and TB without treatment and a large scale crisis unchecked. 

In 2008 just over 15,000 people infected with HIV in Myanmar, less than 20%, received Antiretroviral therapy (ART) - the miracle treatment for HIV providing hope to millions around the world. An estimated 25,000 died. At the end of 2010, with the re-starting of the Global Fund in Round 9, in Myanmar as well as the combined efforts of the Myanmar Ministry of Health and non-governmental organisations working in country, this figure had increased to around 30,000.

Despite the improvement, an estimated 18,000 HIV sufferers died at the end of 2011, because of a lack of access to ART.

As the largest provider of HIV treatment in Myanmar, Médecins Sans Frontières (MSF) sees people, men, women and children, on a daily basis coming to our clinics in search of the life saving drugs they urgently need. Often they arrive in a state of extreme weakness, co-infected with diseases such as TB. Because of limited resources and supply in the country, many only reach us at an advance stage of the disease. MSF has more than doubled its capacity to treat HIV patients, from 11,000 to 23,000 in the years 2008 – 2012. We are reaching our limits. 

This is a defining moment for Myanmar. Commendable efforts to rapidly scale up treatment and significantly close the large treatment gap have begun. A momentum to increase access has developed. 

By 2018 with funds committed from Global Fund Round 11, a scale up to 80% ART coverage of people in need, and a substantially diminished treatment gap was envisioned.

With the cancellation of the Round planning for the scale up of additional treatment for 46,500 ART patients (43,000 adults, 3,500 children), has screeched to a halt. Without this increase in funding doctors will continue to be forced to make impossible choices about who they can and can’t treat.

This is a preventable fate – a crisis that can be mitigated if the appropriate funding is made available. 

Meanwhile, another – all too often – related crisis is raging- Tuberculosis, and the emergence of Multi- Drug Resistant Tuberculosis (MDR-TB). Many people in Myanmar go undiagnosed and untreated for MDR-TB because of the difficulties involved in getting a correct diagnosis, and the expensive and complex treatment. It takes around two years to treat an MDR-TB patient, compared with the usual 6 months for non-resistant TB patients. 

In 2011 it was estimated that 9,300 new MDR-TB cases occur each year in Myanmar. In 2010, only 192 MDR-TB cases received adequate diagnosis, treatment and care. 

Global Fund Round 11 funding was intended to target new geographic coverage for MDR-TB, to bring treatment centres to every state and region, reaching 10,000 MDR-TB patients in 5 years.

With the cancellation of Global Fund Round 11 tens of thousands of people living with HIV and TB in Myanmar will be left without access to treatment.

There is only one adequate answer to the HIV and TB crisis in Myanmar: treatment. With treatment, people’s symptoms disappear, they can return to work, the fear and stigma surrounding these diseases reduces, as does transmission.

The only answer to ensuring access to treatment is sustainable funding. Government’s must not shy away from their responsibilities. 

First on the to-do list must be for Global Fund to hold an emergency donor conference so that affected countries, such as Myanmar can apply for new grants and continue in their efforts to scale-up the provision of treatment.

If Global Fund money is not forthcoming, it is essential that alternative solutions are found to plug Myanmar’s treatment gap. Without it people will continue to needlessly suffer and die. In Myanmar, tens of thousands of lives hang in the balance. 

It does not have to be this way. The elements to close the gap between need and treatment for HIV/AIDS and MDR-TB now exist in Myanmar. There is renewed political will and in anticipation of additional funding, the Myanmar Ministry of Health has taken positive steps to enable scale-up of treatment. 

There cannot be a reverse in the gains made. Myanmar cannot be left to tumble further into a gap crisis.

The decisions taken by donors are – quite literally – the difference between life and death.

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