Out of control
Burma has one the fastest rates of HIV infection in the world – which suits the SLORC very well.
Chris Beyrer and Faith Doherty report on how AIDS and addiction are ‘pacifying’ rebellious youth.

The HIV virus came late to densely populated Asia – only at the end of the 1980s. But since then its effect has been explosive. Hardest hit have been India, Thailand, Burma and Cambodia. Isolated under an authoritarian regime, Burma is the least known or understood of these countries. But from what is known it’s clear that HIV has already spread extensively and that the situation is deteriorating very rapidly. Crude and conservative estimates for 1995 put Burma’s number of people infected by HIV at between 350,000 and 450,000 – roughly one per cent of the entire population. Education, prevention and care programs are woefully inadequate. Medical supplies are short and their distribution uneven. Blood transfusion is especially unsafe in rural areas. Condoms were illegal in Burma until 1992 and are still scarce and expensive. To make matters worse, Burma is in the throes of another epidemic – of intravenous drug injection. When the military government of General Ne Win initiated the first HIV-screening programs in 1985 no cases were detected. Then in 1988 drug-users with HIV were found in Rangoon – the first group to be found with the virus.

Although traditionally most of the raw heroin produced in the country is exported, a domestic market for heroin has emerged in recent years and become quite widespread. Rangoon, Mandalay and other major towns and cities now have large numbers of intravenous drug-users. In 1994 the Burmese authorities estimated that one per cent of adult men nationwide were injecting drugs. In the same year a UN report estimated that 60 to 70 per cent of all intravenous drug-users in Burma were HIV-positive. The rapidity of the spread is partly accounted for by the fact that it is illegal to possess syringes except for medical purposes and so needle-sharing is the norm among drug-users. Professional injectors work in ‘tea stall’ shooting galleries, re-using needles and transmitting HIV on a daily basis.

Human-rights investigators who recently visited a ‘shooting gallery’ found what they described as a human tragedy in the making. Addicts came to the stall for their daily fixes and relied on injectors to find veins in their ruined limbs. The witnesses saw one needle used on five addicts without sterilization between uses. When asked why he wasn’t using bleach or boiling to sterilize the needles, the injector replied that he didn’t have time to boil and bleach was ‘too complicated’.

Health professionals point to 1988 as the year in which heroin use became widespread among Burma’s youth. Before then there had been a scattering of addicts and traditional use of smoked opium was common among some ethnic groups. The heroin epidemic coincides with the suppression of the mass movement of 1988 when millions of Burma’s people rose up against years of military misrule and demanded democracy. The rise in domestic heroin use has closely mirrored the SLORC junta’s consolidation of power.

Like the heroin epidemic, the sexual spread of HIV in Burma emerges from a tangle of social and political problems. Men who visit prostitutes can be charged under British penal codes which carry sentences of up to ten years in prison; the severity of these penalties has driven commercial sex deep underground. Meanwhile the long struggle of Burma’s ethnic groups against the junta has fostered prostitution and trafficking of women in some areas. One of the effects of war and social dislocation in Shan State has been a major traffic in Shan women and girls for the Thai sex industry. More than a quarter of all women entering the sex industry in northern Thailand are Shan migrants. Thai brothel recruiters are active in the ethnic Akha, Lahu and Lisu tribal areas of the Thai-Burma border as well as in the southern Tenasserim region – areas marked by extreme poverty, social chaos and forced-labour campaigns by the junta.

The number of people moving around the country in search of work has also contributed to the spread of HIV. In recent years mining camps have sprung up in the Shan and Kachin States. These makeshift communities are seasonal: they have only a few thousand workers in the rainy season but contain up to 150,000 in the drier months. Most of the miners are young men in search of work. They are away from home for many months, working on dangerous job sites; drug use and prostitution are common.

One AIDS clinic reported that the majority of its HIV-positive patients were heroin-users and that most of them started to use the drug while working in the mines. Because such workers typically come from all over the country the potential for HIV-spread after their return home is great. Indeed, without these extensive population movements it would be difficult to explain the rapid and pervasive spread of HIV across a country so large and difficult to traverse.

So what can be done to halt this spread? Without democracy and with the SLORC in control of education, healthcare and the media, it’s hard to put into practice the usual measures. Some aid agencies have decided to ‘bite the bullet’ and work with the SLORC. But so far to little avail. One international agency, with a mandate to assist with HIV prevention, spent more than ten months in 1994 and 1995 waiting for a Memorandum of Understanding from the regime. It was never signed and the aid agency eventually pulled its staff out of Burma.    The democratically elected Government of Burma – Aung San Suu Kyi’s National League for Democracy – is currently exploring ways of tackling a range of issues crucial to the well-being of the people of Burma, including HIV. Working with these leaders should be a priority for any organization seeking to help. But it is unclear whether or not the junta will tolerate such collaborations.

One proposal – recently made at the Third International Conference on AIDS in Asia – is to ‘depoliticize AIDS in Burma’. The idea is that all parties – the opposition and ethnic nationalities included – should join hands in an effort to control what is already a national tragedy.

But the HIV epidemic is inherently political and it may be naive and counterproductive to imagine that its ‘de-politicization’ is possible. Until there is real political movement towards democracy, basic freedoms and respect for human rights, it is difficult to imagine how the HIV epidemic in Burma can be contained. The junta shows no signs of progress on these fronts. But the HIV epidemic will not wait.

Chris Beyrer and Faith Doherty are based in Bangkok where they work with the South-East Asian Information Network (SAIN).

An exile’s story

'My parents always taught us to do the right thing and when we took part in the [August 1988] demonstration they supported us. My father took part too – even though he was a prison officer. He was on duty on the day of the demonstration, but he took off his uniform and marched together with political prisoners. He was later dismissed from his job...

[After the pro-democracy demonstrations were crushed] I told my parents that I would have to leave because you could not walk or work freely inside Burma. It was really painful because I love my parents very much and there is nothing that can replace them. When I told my father I would have to leave he looked so sad. My parents adored us and they knew we were doing the right thing. But it was very sad for them. We were going away from them... but they said we should not give up. I did not realize then that it would be the last time I saw my father alive. After my father was dismissed from his job, the family was forced to move to Mon State and my father died there. I only heard of his death several months later from a friend who brought a message from Burma.

Meanwhile, my two older brothers, who are active in the struggle for democracy, had been arrested and imprisoned in July 1989. I heard from a friend that they were badly tortured. One of my brothers was released in 1992 and the other in 1993. But the older one was re-arrested while taking part in a Burma Human-Rights March. He was given a seven-year sentence for singing a freedom song. Fifty students were arrested for singing the song and nine were badly tortured, including my brother.

My younger brother didn’t take part in the 1988 demonstrations but he was not allowed to attend school for two years all the same.

Just before I left Burma I told my parents to announce that they disowned me. Because you know, if I did something militarily then they would give my family a very hard time. So they had to announce in a newspaper that they disowned me, so that whatever I did would be nothing to do with them.

It was very painful for all of us – for my parents and for me. But it was the best way for all of us. Since I have left Burma I have not met with my family or spoken with any of them. They don’t even know if I’m still alive or not...’

Interviewed by John Pilger in Oslo