While most of the local and international aid workers in Myanmar are scrambling to meet the immediate needs of 2.4 million people left stranded by Cyclone Nargis, several organisations are working to ensure that survivors living with HIV are included in the response.
According to the latest estimate by UNAIDS, around 242,000 people - about 0.7 percent of Myanmar's population - are living with HIV, but only about 1,500 of them are receiving life-prolonging antiretroviral (ARV) treatment via a government programme. Another 10,500 people are receiving ARV drugs from non-governmental organisations (NGOs), mainly the international medical charity, Médecins Sans Frontières (MSF) Holland.
Speaking on the phone from Yangon, the country's largest city and former capital, MSF country director Frank Smithuis said most of the people in their treatment programme were based in urban areas that had escaped the worst of the storm.
"We have a large programme in Rangoon [Yangon], where there are more displaced people than dead people," he said. "There were patients who lost their ARV treatment, or they came in with a plastic bag full of wet powder [from dissolved tablets], but it was easy to resupply them with medicine. Our clinics [in Yangon] were open again by the next day after the cyclone."
With 10,000 HIV-positive patients in Yangon alone, MSF decided to provide all of those who made it to one of their clinics with a one-off cash grant of about US$10 to buy food. Anti-AIDS treatment must be accompanied by an adequate diet.
"It would have been too difficult to make a private assessment for everyone, so we thought: 'let's keep it simple'," said Smithuis. "There's plenty of rice here [in Yangon], so there's not really a food shortage, but prices did go up."
With assistance from the handful of international AIDS organisations working in Myanmar - such as the International HIV/AIDS Alliance and the Association Francois-Xavier Bagnoud (FXB), a Switzerland-based NGO that fights poverty and AIDS - local networks of people living with HIV have tracked down their members and organised relief supplies for them.
|They're very aware and experienced in community solidarity in the face of adversity|
"They're very aware and experienced in community solidarity in the face of adversity," said Brian Williams, the UNAIDS coordinator in Myanmar. "They were immediately out there, spreading the word about the cash grant and where to get more drugs." He noted that aid agencies were careful not to add to already high levels of stigma against people living with HIV by giving them more assistance than other cyclone survivors.
"We’re not interested in creating stand alone, vertical programmes," he said. "But we do want to watch out for the reverse, that you’re not getting help because you’re HIV positive and you’re being discriminated against."
Myanmar's health department reported that its methadone [a synthetic substitute for heroin] programme for injecting drug users in Yangon had not been interrupted by the cyclone. As many as 50 percent of injecting drug users in Myanmar are HIV-positive, according to UNAIDS figures from 2003. The goal of the methadone programme is to reduce the spread of HIV through needle sharing.
Williams said it was only a pilot programme and needed to be significantly scaled up. "The government doesn't spend nearly enough on health care in general," he commented. "It should be providing more resources, but so should the international community."
In the Irrawaddy Delta, the area worst affected by the cyclone, aid organisations who have been allowed into the country are trying to respond to survivors' most basic needs for food, water and shelter, but most international NGOs are still navigating government restrictions that prevent foreign aid workers entering the country.
MSF, which already had about 1,000 employees in Myanmar, was well placed to respond rapidly to the disaster. "We didn't have staff in that part of the country, but we moved them there," said Smithuis. The medical charity has delivered 1,000 metric tonnes of food, 60,000 shelters and several water treatment machines.
Despite Myanmar's relative isolation, levels of knowledge about HIV and AIDS are about average for the region, and the availability of condoms had improved dramatically in recent years. "There is a national plan here - the government considers AIDS to be a problem and lots of NGOs are working on it," Williams said.
However, the cyclone could set back Myanmar's HIV prevention efforts. "We're quite worried about women's protection issues," Williams told IRIN/PlusNews. "There are a large number of homeless people living in informal settlements, where access is quite limited and we don't know if measures are being taken to ensure that there are secure areas for women."
Mobile clinics equipped with reproductive health supplies, including post-exposure prophylaxis (PEP) kits, which can prevent HIV infection after a rape, have made it out to a few villages, but Williams said more reproductive health services were needed.
"Like in many emergency settings, we are also worried about women who might find themselves lacking alternatives and resorting to sex work."