Myanmar Shadow Report for the 2006 High Level Meeting on AIDS
Compiles by the Concerned Civil Society Observers (Anon), 1 May 2006
The Union of Myanmar joined all member states of the United Nations in making a Declaration of Commitment on HIV/AIDS at the UN General Assembly Special Session on HIV/AIDS five years ago.
In this 2001 Declaration, member states of the UN promised that they would meet time-bound and measurable goals on HIV prevention and care. Later this month there will be a High Level Meeting on AIDS, also called the UNGASS review, to report on progress over five years. It will be held from 31 May to 2 June at the United Nations in New York.
The UN Joint Programme on HIV/AIDS has stated that it is committed to ensuring the meeting is fully informed and comprehensive. Each member state has been asked by the Secretary General of the UN to prepare a report before the meeting. The UN asked that country reports be developed in collaboration with groups representing civil society.
The Government of the Union of Myanmar did not do this. A draft of the country report indicators was made available to a few UN and nongovernmental stakeholders at a meeting in Yangon in March. It is unknown whether the comments of these organisations were taken into consideration in drafting of the final country report.
The Community Partnership division of the UNAIDS secretariat in Geneva committed itself to publish the submitted national progress reports on its website by the end of April. One hundred and twenty six country reports are posted but Myanmar's report is not one of them.
It is now less than a month before the High Level Meeting. Information to prepare this shadow report had to be obtained from unofficial sources inside the country. Had the official national report been submitted on time and posted, the preparation of this shadow report could have been a transparent, accountable, and effective process.
There are four important issues in the official Myanmar country report that are noted by this shadow report:
1) governmental spending does not demonstrate governmental commitment to an adequate response to the epidemic
2) there is no official strategy for HIV in the armed forces
3) a large proportion of men admit to extramarital sexual relationships
4) exaggerated claims about high quality of care of sexually transmitted infections cast doubt on the reliability of other data
1) inadequate governmental funding
Due to differences in official and unofficial exchange rates, it is difficult to accurately determine official governmental spending for any reason in Myanmar. The government reported 22 million kyat annual spending on HIV/AIDS in an application to the Global Fund against AIDS, Tuberculosis, and Malaria several years ago.
That figure was widely interpreted as representing a real annual expenditure of about 20 thousand dollars. In the Myanmar country report for the High Level Meeting this year the amount reported is 78 million kyat. Using a rough exchange rate of one thousand kyat to the dollar, this represents almost a four fold increase of spending to about 80 thousand dollars.
Few countries have increased spending four fold over the last few years (Russia's spending has gone up twenty fold) so Myanmar deserves congratulations for increasing spending. But the overall amount is too low. Myanmar officially recognises HIV as a priority health issue. Spending one and a half cents per capita on HIV does not demonstrate that it is committed to tackling the problem.
2) lack of a strategy for the armed forces
The Myanmar country report discloses that the country does not have a strategy to address HIV/AIDS issues among its national armed forces. In most countries lack of a strategic plan for the military would not be a big issue. Not so in Myanmar.
The International Crisis Group estimates that there are at least 400,000 armed lower ranks within the armed forces, representing approximately 3 per cent of the adult male population. Armed men in the ethnic forces are estimated to be at least 70,000. Military spending accounts for a large proportion of the central budget.
The armed forces are spread all over the country but are concentrated in areas of unrest or former rebel activity. Not surprisingly, these areas also have a high prevalence of HIV. Men in the military often serve away from their wives and family. Unprotected sex is common in this situation.
Since there is no HIV strategy for the armed forces, observers of the HIV epidemic in the country are not surprised to hear reports of summary dismissal of soldiers found to have HIV and lack of care for infected soldiers and their families. The governmental forces are not the only ones to suffer from lack of an official HIV strategy: rebel ethnic armies also have no HIV plans. They are not included in the governmental country report to the United Nations.
3) sexual behaviour of men
Official reports from Myanmar governmental sources rarely mention sexual behaviour, so it was with a measure of surprise that the official country report documents were found to have new data on men's sexual behaviour.
No one doubts that most Burman women who are not sex workers have just one sexual partner – their husband. But information about the sexual behaviour of men is rarely reported. The new report says that 28.2% of men admit they had sex with someone who were not their wives in the last twelve months. This data was obtained from official sentinel surveillance activities undertaken by the state National AIDS Programme.
The government of the Union of Myanmar deserves praise for it openness in making public this data on men's sexual behaviour.
This figure certainly means the mystery of Myanmar men's sexual behaviour is over. A significant number of men admit that they bought sex in the last year. It is this large number of men having unprotected sex with a smaller number of women who sell sex that drives the epidemic. The prevention goals are clear – partner reduction and increased condom use.
4) quality of care for sexually transmitted infections
The report states that forty thousand men with venereal diseases last year were observed at health care facilities to be appropriately diagnosed, treated and counselled. This is simply untrue. The government does not have the personnel to monitor the quality of care for all these men reporting to doctors with symptoms of sexually transmitted infections.
The last time that a sample of doctors was observed in a study to see how they provided care to a hundred and fifty men with sexually transmitted infections was almost ten years ago. Only 15% of the care observed at that time was adequate. It is impossible that the quality of care has improved to 100% accuracy in a few years and staggering to think that a governmental agency would report that forty thousand doctor-patient interactions were observed by researchers.
The inaccuracy of this data throws doubt on other data in the report. If the Ministry of Health cannot be trusted to publish reliable data on the care provided by health care staff can we believe the Ministry when it reports that that one in five young people knows how to prevent HIV infection?
Outgoing United Nations Secretary General Kofi Annan has stated: "While certain countries have reached key targets and milestones for 2005 as set out in the Declaration, many countries have failed to fulfil the pledges.
"It is up to all of us in civil society to determine whether Myanmar has fulfilled its pledge made five years ago. And whether the state is fully committed to increasing effective action against the epidemic. We think it is not.
Concerned Civil Society Observers
The Union of Myanmar joined all member states of the United Nations in making a Declaration of Commitment on HIV/AIDS at the UN General Assembly Special Session on HIV/AIDS five years ago.
In this 2001 Declaration, member states of the UN promised that they would meet time-bound and measurable goals on HIV prevention and care. Later this month there will be a High Level Meeting on AIDS, also called the UNGASS review, to report on progress over five years. It will be held from 31 May to 2 June at the United Nations in New York.
The UN Joint Programme on HIV/AIDS has stated that it is committed to ensuring the meeting is fully informed and comprehensive. Each member state has been asked by the Secretary General of the UN to prepare a report before the meeting. The UN asked that country reports be developed in collaboration with groups representing civil society.
The Government of the Union of Myanmar did not do this. A draft of the country report indicators was made available to a few UN and nongovernmental stakeholders at a meeting in Yangon in March. It is unknown whether the comments of these organisations were taken into consideration in drafting of the final country report.
The Community Partnership division of the UNAIDS secretariat in Geneva committed itself to publish the submitted national progress reports on its website by the end of April. One hundred and twenty six country reports are posted but Myanmar's report is not one of them.
It is now less than a month before the High Level Meeting. Information to prepare this shadow report had to be obtained from unofficial sources inside the country. Had the official national report been submitted on time and posted, the preparation of this shadow report could have been a transparent, accountable, and effective process.
There are four important issues in the official Myanmar country report that are noted by this shadow report:
1) governmental spending does not demonstrate governmental commitment to an adequate response to the epidemic
2) there is no official strategy for HIV in the armed forces
3) a large proportion of men admit to extramarital sexual relationships
4) exaggerated claims about high quality of care of sexually transmitted infections cast doubt on the reliability of other data
1) inadequate governmental funding
Due to differences in official and unofficial exchange rates, it is difficult to accurately determine official governmental spending for any reason in Myanmar. The government reported 22 million kyat annual spending on HIV/AIDS in an application to the Global Fund against AIDS, Tuberculosis, and Malaria several years ago.
That figure was widely interpreted as representing a real annual expenditure of about 20 thousand dollars. In the Myanmar country report for the High Level Meeting this year the amount reported is 78 million kyat. Using a rough exchange rate of one thousand kyat to the dollar, this represents almost a four fold increase of spending to about 80 thousand dollars.
Few countries have increased spending four fold over the last few years (Russia's spending has gone up twenty fold) so Myanmar deserves congratulations for increasing spending. But the overall amount is too low. Myanmar officially recognises HIV as a priority health issue. Spending one and a half cents per capita on HIV does not demonstrate that it is committed to tackling the problem.
2) lack of a strategy for the armed forces
The Myanmar country report discloses that the country does not have a strategy to address HIV/AIDS issues among its national armed forces. In most countries lack of a strategic plan for the military would not be a big issue. Not so in Myanmar.
The International Crisis Group estimates that there are at least 400,000 armed lower ranks within the armed forces, representing approximately 3 per cent of the adult male population. Armed men in the ethnic forces are estimated to be at least 70,000. Military spending accounts for a large proportion of the central budget.
The armed forces are spread all over the country but are concentrated in areas of unrest or former rebel activity. Not surprisingly, these areas also have a high prevalence of HIV. Men in the military often serve away from their wives and family. Unprotected sex is common in this situation.
Since there is no HIV strategy for the armed forces, observers of the HIV epidemic in the country are not surprised to hear reports of summary dismissal of soldiers found to have HIV and lack of care for infected soldiers and their families. The governmental forces are not the only ones to suffer from lack of an official HIV strategy: rebel ethnic armies also have no HIV plans. They are not included in the governmental country report to the United Nations.
3) sexual behaviour of men
Official reports from Myanmar governmental sources rarely mention sexual behaviour, so it was with a measure of surprise that the official country report documents were found to have new data on men's sexual behaviour.
No one doubts that most Burman women who are not sex workers have just one sexual partner – their husband. But information about the sexual behaviour of men is rarely reported. The new report says that 28.2% of men admit they had sex with someone who were not their wives in the last twelve months. This data was obtained from official sentinel surveillance activities undertaken by the state National AIDS Programme.
The government of the Union of Myanmar deserves praise for it openness in making public this data on men's sexual behaviour.
This figure certainly means the mystery of Myanmar men's sexual behaviour is over. A significant number of men admit that they bought sex in the last year. It is this large number of men having unprotected sex with a smaller number of women who sell sex that drives the epidemic. The prevention goals are clear – partner reduction and increased condom use.
4) quality of care for sexually transmitted infections
The report states that forty thousand men with venereal diseases last year were observed at health care facilities to be appropriately diagnosed, treated and counselled. This is simply untrue. The government does not have the personnel to monitor the quality of care for all these men reporting to doctors with symptoms of sexually transmitted infections.
The last time that a sample of doctors was observed in a study to see how they provided care to a hundred and fifty men with sexually transmitted infections was almost ten years ago. Only 15% of the care observed at that time was adequate. It is impossible that the quality of care has improved to 100% accuracy in a few years and staggering to think that a governmental agency would report that forty thousand doctor-patient interactions were observed by researchers.
The inaccuracy of this data throws doubt on other data in the report. If the Ministry of Health cannot be trusted to publish reliable data on the care provided by health care staff can we believe the Ministry when it reports that that one in five young people knows how to prevent HIV infection?
Outgoing United Nations Secretary General Kofi Annan has stated: "While certain countries have reached key targets and milestones for 2005 as set out in the Declaration, many countries have failed to fulfil the pledges.
"It is up to all of us in civil society to determine whether Myanmar has fulfilled its pledge made five years ago. And whether the state is fully committed to increasing effective action against the epidemic. We think it is not.
Concerned Civil Society Observers
posted by AIDS-Care-Watch at 11:38 am
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