- The Washington Times - Friday, July 31, 2009

YANGON, Myanmar

Shrunken to 30 pounds of skin and bones, Ma Moe could barely walk when she arrived on the doorstep of the clinic nearly two years ago. Her husband had died from AIDS complications three years earlier, and it was slowly killing her.

If not for the free medicine she receives, she would be dead, the 35-year-old widow said as she waited for her monthly visit. “I had no money, my house was destroyed by [Cyclone] Nargis, I had nowhere else to go.”

The modest one-story wooden clinic, one of two dozen run by international aid group Doctors Without Borders, is on the front lines of Myanmar’s struggle against HIV/AIDS, a disease that often spells a slow death sentence for Burmese because of a shortage of anti-retroviral medicines.

As foreign donors largely shunned this isolated military-run nation, its AIDS epidemic, one of the most serious in Asia, steadily worsened out of the spotlight.

But now Western governments and donors have begun reassessing their approach after years of tough sanctions failed to yield much progress.

The Global Fund for AIDS, Tuberculosis and Malaria, a major international donor that pulled out in 2005, is considering returning to Myanmar, a decision that could inject millions of dollars in funding and triple the number of people getting life-saving medicine.

Donors have long feared that aid would only bolster the iron-hand rule of the military government. Myanmar receives only about $3 per capita in aid, compared with $23 for Vietnam and $50 for Laos.

An estimated 240,000 people are infected by HIV, which causes AIDS. Of those, about 76,000 are in need of the life-saving antiretroviral treatment, but less than a quarter of them - about 18,000 - are getting it. The lack of accessible treatment translates into about 25,000 deaths a year.

At $30 a month, roughly equal to the average monthly salary here, the cost for the medication is beyond the reach of many. A lucky few get it free from Doctors Without Borders, also known as Medecins Sans Frontieres, which provides drugs and treatment to about 12,000 people across the country. A handful of smaller nongovernmental organizations cover about 4,000 patients, while the government provides for about 1,800.

“There’s such huge need but so little money from donors that we end up being the main provider of [anti-retroviral treatment],” said Luke Arend, the head of Doctors Without Borders in Myanmar. “It’s probably the only place in the world where an NGO is effectively running the country’s HIV program, as the national AIDS program has such limited funding. That’s a sad state of affairs.”

After years of silence and denial, the regime finally acknowledged the AIDS scourge in early 2000.

Some aid groups say privately that government health officials are now keenly aware of the problem but that the regime’s priorities lie elsewhere. Myanmar, with one of the world’s largest armies, spends the least amount of any country on its national health budget - just 0.3 percent of the gross domestic product, of which a small amount goes toward AIDS.

The lines start early outside the AIDS clinic set in the middle of farmland on the outskirts of Yangon. By midmorning, the waiting room is jammed with patients - mothers holding babies, young couples, men visibly frail and emaciated.

The anti-retroviral drugs have returned Mrs. Moe, the AIDS widow, to a visibly healthy glow. Her weight has rebounded to normal. Sitting in a small room off the main clinic, she talked candidly about the disease she didn’t know existed until after her husband died in 2006.

“I was scared to take a blood test. I didn’t know anything about AIDS,” she said. “The doctors warned me ahead of time that if I had HIV, I might die.

“My health has gotten better, but I know in my mind I am still HIV positive. I know I can die without the drugs.”

In mid-2007, overwhelmed and beyond its capacity, Doctors Without Borders temporarily stopped taking new patients for more than a year. The result was starkly painful, said Dr. Soe Yadanar, who has been working in the clinics for a decade.

“While they waited, some died,” she said.

The situation could be very different by next year. The Global Fund, a U.N.-backed fund for three key diseases, is considering an application by Myanmar for $320 million in funding, with the goal of treating 42,000 new AIDS cases within five years. A final decision could come by this fall.

Increasingly, Western nations have realized that broad sanctions are hurting their interests because the military junta is prepared to forego any aid with political strings attached, according to a report last fall by the International Crisis Group.

The European Union, including Britain, has reviewed its assistance policy to Myanmar. Even the United States, perhaps the strongest supporter of ever-tightening aid restrictions, has said it is in the process of reviewing its overall Myanmar policy. During a trip to Asia earlier this year, Secretary of State Hillary Rodham Clinton spoke plainly: “Clearly, the path we have taken in imposing sanctions hasn’t influenced the Burmese junta.”

The shift marks a turnaround in the political climate from even a few years ago, when Myanmar was treated as a complete pariah state.

In 2005, the Global Fund abruptly announced that it was withdrawing from the country after less than a year. Spokesman Jon Liden said government restrictions barring access to certain areas of the country made it impossible to monitor how the $100 million in funding was being used.

“For us, there was no direct political considerations,” he said. “We’d always be willing to provide funds regardless of the government, as long as we can ensure that it’s being used effectively.”

But other aid groups believed the decision was more likely the result of heavy political pressure exerted by the United States, the largest donor to the Global Fund and one that strongly opposed any kind of aid.

Regardless of the reasons, the government read it negatively, said Andrew Kirkwood, country director for Save the Children in Myanmar.

“It sent a message to the [Myanmar] government that humanitarian assistance was political, despite the rhetoric that it was not linked. It did a great deal of damage to the relationship between international aid groups and the regime,” he said.

For humanitarian groups, the key shift came in the aftermath of last year’s devastating Cyclone Nargis, which claimed at least 138,000 lives and was impossible for other nations and aid groups to ignore.

After an initial bottleneck by Myanmar’s military leaders, aid groups have flooded into the country, said Choo Phuah, country director for the British-based International HIV/AIDS Alliance, which works with grass-roots organizations in Myanmar.

“I think Nargis did shift people’s perspective about working in the country. Following the cyclone, many organizations started programs in the country,” she said.

In the wake of Nargis, huge amounts of aid funding flowed into the country, she said, money that ultimately “has a momentum of its own.”

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