Isolated Myanmar is grappling with one of the worst HIV/AIDS epidemics in Asia - a struggle made all the harder by the tiny amounts of international aid received by the military government.
Although condom use has more than tripled since 1999, and access to antiretroviral treatment has increased markedly, HIV/AIDS services need to be significantly scaled up, according to Brian Williams, UNAIDS Country Director in Myanmar.
"The government is now taking the epidemic seriously here, but much more needs to be done nationally to have real impact on containing the virus," he said.
UNAIDS estimated that 360,000 people were living with the virus in 2005, and national adult HIV prevalence stood at 1.3 percent. The official HIV/AIDS programme has a budget of US$200,000 - just 60 US cents per person in a population of 30 million.
The populations most at risk of contracting HIV/AIDS are sex workers, their clients, injecting drug users, migrant workers and men who have sex with men (MSM). There have been problems in accessing these groups, but UNAIDS points out that more support has been forthcoming from the authorities.
An internal police directive issued several years ago said carrying condoms could not be used as evidence of prostitution, but some anecdotes suggest this policy has not been fully internalised at all levels. "There's still an urgent needed to explain the importance of safe and trusting outreach activities to so-called 'decriminalised' populations," Williams said.
At one of the very few drop-in centres for sex workers and MSM, outreach staff make sure they have plenty of leaflets and condoms as they prepare to visit three local brothels.
"There has been a definite increase in condom use over the past five years - we have seen it, and we are working to increase it further," said one of the workers, who asked to remain anonymous.
The United Nations Children's Fund (UNICEF) has been working to help combat HIV/AIDS since the early 90s. In the last five years it has significantly expanded one project aimed at reducing mother-to-child transmission of the virus. "But such services are still only available in less than one-third of the country," said Yasuda Tadashi, an HIV/AIDS project officer in the capital, Yangon. "There is an urgent need to scale up."
A relatively new UNICEF project in Myanmar, long-established in neighbouring countries, involves working with Buddhist leaders to promote HIV prevention and reduce stigma.
"It is not uncommon for villagers ... to shun a family where a member is believed to be HIV positive," said Tadashi. "But when a monk demonstrates that he is happy to visit the family, and to accept food and rice from them ... this one act does an enormous amount to reduce stigma and discrimination in that community."
Observers say the political situation complicates the fight against the disease. Epidemiologist Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health in Baltimore, in the US, points out that in countries such as Myanmar "political and human rights considerations limit both what we know about HIV and what a UN agency can say".
A group of foreign and local nongovernmental organisations (NGOs) is now offering a range of care and prevention services. "Well over a million people will be assisted by the programme. We're going to work in disease hot-spots, like the northern states, where there is high migration and high vulnerability," said Andrew Kirkwood, head of Save the Children Myanmar, one of the NGOs spearheading the initiative.
Stigma and discrimination are serious impediments to fighting the epidemic. The self-help groups that confront prejudice, common in many other countries where HIV/AIDS is prevalent, are rarely seen in Myanmar - mainly due to the government's dislike of any organised activity outside their control.
But the number of such groups is growing and there are now more than 30 in the country. "The government remains suspicious of the few informal [HIV/AIDS support] groups that do exist," said Choo Phuah, Myanmar country director of the International HIV Alliance. "But we are working to bring them together to form a body that can influence the response and reassure the state that we just want to help those with the virus."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions