About 25,000 people will die in Burma of AIDS in the next twelve months unless more is done immediately to provide them with medical care, according to an international aid agency.

Medecins Sans Frontieres (MSF), or Doctors Without Borders, claims the military government has provided help to only a fraction of those in need of treatment and it warned that the lives of around a quarter of a million Burmese are at risk in the next few years.

Of those infected, 76,000 are believed to be in urgent need of medical help in the form of accessible antiretroviral treatment (ART) – which helps repress the disease and allows individuals to live normal, active lives.

"More than 25,000 people died from AIDS-related diseases last year, and even more will die in the next twelve months, unless the Myanmar government and international organizations increase their support for antiretroviral treatment," Frank Smithuis, the MSF head of mission in Rangoon told Mizzima.

Only one in four people living with HIV is receiving ART, that is only 15,000 people, said Mr Smithuis. MSF currently provides treatment to 11,000 of the 76,000 people who need immediate treatment.

The Burmese regime and other nongovernmental organizations supply the additional 4,000 people with ART, according to Mr Smithuis.

But recently MSF has been forced to make the "painful decision" to drastically reduce the number of new patients it can treat. "We can only continue to provide treatment for patients that have already registered at our clinics," he said.

In the last two years, Burma's Department of Health has only treated an estimated 1,800 patients with ART in 22 hospitals across the country, according to MSF's latest report on HIV/AIDS in Burma, "A Preventable Fate". Last year, the report said, the Burmese government spent a paltry $US 200,000 on those living with HIV and AIDS patients.

MSF said that during its five years of operation in the country, the Burmese regime and the international community's response has been inadequate to what is the most serious HIV/AIDS epidemic in Asia. "It is unacceptable and impractical for a single NGO to treat the vast majority of HIV patients in a crisis of this magnitude," Mr Smithuis told Mizzima.

The Burmese government and the international community need to do far more if thousands of lives are to be saved. One of those waiting to die is a 28-year-old male patient: "I think that I am going to die. I cannot do anything to get better. Even if there is a treatment, I am not able to afford it, as I do not have money. So I think that I will die from AIDS."

According to MSF it only takes some $120 per patient a year to provide this life-saving treatment. "There is an urgent need for the Myanmar authorities and the international donors to step up to the plate and provide increased treatment for these patients and prevent the needless death of thousands of Burmese," warned Mr. Smithuis.

Few of the big international donors provide resources because of concern about whether aid would be used appropriately and effectively. But it is the Burmese people who suffer as a result, says MSF. The fight against HIV/AIDS should be everyone's concern, as one of their patients – a 29-year old male receiving antiretroviral (ARV) treatment – put it: "It's everyone's responsibility to fight against this disease. All people must have a spirit of humanity in helping AIDS patients, regardless of nationality, organization or government," he said.

MSF is convinced that the health infrastructure is available in Burma to provide the treatment – all that is needed is more ARVs. Of course that means working through the government system, but MSF believes that remains the most effective delivery system. "We did it with anti-malarial treatment in northern Rakhine state [in Western Burma]," said Mr Smithuis. MSF have treated more than two million malaria patients there over the last ten years. "Under our scheme doctors and hospitals increased the number of 'fever patients' from 30 to 1,800 a month," he said. At least half of these were malaria cases.

MSF insists that there are also private doctors who would also happily help people living with HIV.

One local doctor in Rangoon is treating 50 patients free in his own clinic – supported by MSF, who provides the drugs. "What is needed is a network of doctors and local groups who could deliver the treatment," said Mr Smithuis, who is currently trying to establish such scheme.

While some theft and corruption is inevitable, MSF is confident that their monitoring system has proven effective in keeping the system transparent. From the start the organization made regular inspection visits to all clinics involved in the scheme. Any health center found involved in stealing or providing fake drugs was immediately cut off. The organization even sent "fake patients" to the centers as part of the monitoring scheme.

With ARVs, MSF has the government approve its import requests, and from the moment the drugs arrive in the country they are under MSF supervision until they are given to their clients in the clinics. "There's no space for abuse," Mr Smithuis insisted. The drugs are also exempt from government taxes.

But most analysts are more skeptical. "Much aid provided to Burma is simply wasted – including disappearing into organizations like the USDA [Union Solidarity and Development Association]", Professor Sean Turnell, an expert on Burma's economy at Macquarie University in Australia, told Mizzima. "We know that aid only really works against a backdrop of institutions and economic 'fundamentals' that can leverage such aid into genuine development. Such institutions are not in place in Burma," he added.

Since devastating Cyclone Nargis hit the Irrawaddy Delta and parts of Rangoon last May, there has been a burgeoning of local NGOs and independent community organizations involved in the provision of humanitarian relief and assistance.

Many of course have been discouraged by the government crackdown on activists who tried to help after Nargis. The 45-year jail sentence handed out to comedian Zarganar last week for his relief efforts has deterred many from continuing their community work.

But many others are still operating in the delta, says Mr Smithuis. "The secret is to work quietly and not draw unnecessary attention to your activities – that has been the lesson of the last ten years."

In the end though, western aid donors are understandably reluctant to give substantial assistance to Burma. In its report, MSF points out that Burma receives a fraction of the aid that its neighbors Cambodia and Laos enjoy. International assistance is less than $3 a person to Burma compared to around $40 and $50 a head in Cambodia and Laos, respectively. More than ninety percent of HIV-patients in need of ART in Laos receive the treatment through the government system, funded by the international community.

Yet, Burma cannot expect to receive similar support. "Leadership in countries like Cambodia and Laos, for all of their faults, has a 'modernizing' outlook, which emphasizes economic progress," said Professor Turnell. "We just don't see that in Burma, where the regime mostly acts in ways that seem quite indifferent to economic progress and modernization -- in favor of perceived threats to national unity and security."

In the end, MSF subtly points to the real problem when its report suggests the Burmese government must do much more to help those infected with HIV and the health system as a whole. The Burmese generals spend 70 cents a person a year on health care – much less than even its neighbors Cambodia and Laos.

"The paltry $200,000 spent by the Burmese government on HIV/AIDS a year is one tenth of what the government earns per day from the sale of natural gas," Professor Turnell points out. "With around $US4 billion in reserves, Burma is no longer a country without the financial wherewithal to meet the pressing health, education and social needs of its people."

It is, in the opinion of many aid experts, this flagrant disregard for its people that is the main obstacle to the junta's receiving more assistance – until it does more for its people, the international community cannot be expected to be more generous. As it is, the regime has the resources to do much more than it is. In the meantime, thousands a year will continue to die from AIDS-related diseases and maladies such as malaria, tuberculosis, infant mortality and malnutrition.

The greatest tragedy, however, is that all these deaths could easily be prevented.

Larry Jagan