In Burma, a Setback on AIDS

Citing New Restrictions, Fund Cancels Treatment Program

A billboard at Rangoon's general hospital warns of the dangers of AIDS. Few Burmese can afford antiretroviral drugs, and fewer than 5 percent of those needing them can get them free from government or international agencies. (By Alan Sipress -- The Washington Post)

RANGOON, Burma -- Dada would have killed herself but she couldn't afford a proper burial.

An orphan with a broad, sweet face and downcast eyes, she recalled the horror of learning two years ago that she had HIV. She had been a prostitute since she was 15 and hadn't saved enough for even a simple funeral, which according to her belief as a Buddhist was vital to reincarnation into a better life. So Dada kept on living.

Now, at age 23, it is what is left of this life that frightens her. Friends and other prostitutes have begun wasting away from AIDS, unable to pay the staggering cost of antiretroviral drugs, and Dada admits with an awkward giggle that she expects the same fate.

"I have no husband. I have no family," she whispered. "I have to stand on my own feet all by myself."

The secretive Burmese government had long denied that this country had a major AIDS problem, but international health experts now say it is among the worst in Asia. With antiretroviral drugs for AIDS costing about 10 times a teacher's monthly salary, few Burmese can pay for them. Fewer than 5 percent of those who need the drugs can get them free from the government and international agencies, according to U.N. estimates.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, a Geneva-based foundation, had planned to expand funding to triple the number of HIV-positive people receiving subsidized medication. But in August, it canceled a program to fight the three diseases in Burma and ended $87 million in funding, because of new restrictions imposed by the military government on travel and the import of medical supplies.

The fund's decision highlights a moral dilemma over how to operate in a country that has one of the world's worst human rights records but is also on the brink of a humanitarian crisis affecting millions of people. This quandary has stoked a sharp, behind-the-scenes dispute between democracy advocates in the United States and Thailand -- who welcomed Global Fund's decision -- and humanitarian officials and many diplomats in Burma.

Critics of relief programs in Burma argue that the country's corrupt, repressive rulers make it impossible to deliver humanitarian aid and that such programs can instead bring reprisals against Burmese who participate in them. Relief efforts, they say, may only enrich the government -- which is facing broad U.S. economic sanctions -- while lending it greater international legitimacy.

U.N. officials and other humanitarian workers inside the country counter that they are able to operate independently of the government. While they acknowledge that travel and restrictions on imports at times hamper their programs, these officials say the efforts have already saved countless lives.

"If we're not able to come up with a successor fund, the termination of the Global Fund will directly lead to deaths," said Charles Petrie, Burma representative of the U.N. Development Program, which would have administered the money.

U.N. officials say the best available figures show that about 1.3 percent of Burmese adults are infected with HIV, but the actual numbers could be as high as 2.2 percent. Recent studies have found that nearly 2 percent of pregnant women are infected. The outbreak ranks among Southeast Asia's worst, along with those in Thailand and Cambodia. But control efforts lag badly.

"The first wave of death has started," a foreign humanitarian official said on condition he not be named for fear of government reprisal. "We are going to lose 10 percent of young people in the next 10 years."