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Burma has made enormous strides in addressing its HIV epidemic, slashing infection rates by 72 percent in little over a decade, but vulnerable groups including sex workers and gay men remain at risk, the UN warned on Tuesday.
Marking the launch of a major regional conference on HIV/Aids in the Asia-Pacific, the UN praised regional efforts to tackle infection rates but called on governments to reform punitive laws against sex workers, drug users and sexual minorities.
“Punitive and discriminatory legal environments continue to hinder effective HIV responses in almost every country in the region – despite evidence as to the public health and human rights issues raised by such environments,” said the report.
Although Burma successfully curbed HIV infections to 200,000 or approximately 0.33 percent of the population in 2012, rates continue to rise among certain vulnerable groups.
Nearly one third of intravenous drug users in the Kachin capital Myitkyina were estimated to be HIV positive, along with 21.3 percent of men who have sex with men. The report noted a decline in infections among female sex workers, although rates remain disproportionately high — reaching 15 percent in Bassein.
UNAIDS credited the work of community-based organisations, such as the sex worker-led Targeted Outreach Programme (TOP), for making “remarkable progress” in access to services for traditionally excluded communities.
According to the report, TOP runs nine drop-in centres across the country, reaching an estimated 50,000 sex workers every year. Over 90 percent of its staff are sex workers or men who have sex with men, which the UN says boosts access to individuals criminalised under Burmese law.
“[Such programmes] illustrate how innovative community-led efforts have empowered sex workers to assert their human rights, take control over their work environments and improve their health and social conditions,” said the report.
Homosexual acts are punishable by life imprisonment in Burma, while individuals found guilty of prostitution face up to three years in jail. Sex workers also report constant harassment and extortion from authorities, along with violence and abuse from clients – who conversely can legally purchase sex.
Earlier this year, the Burmese parliament rejected a motion to discuss the decriminalisation of sex work, with a senior minister insisting that jail time works as an effective deterrent. Meanwhile, drug addicts face compulsory detention if arrested and even risk the death penalty if prosecuted.
“If I feel frustrated, I come to this centre and rest or talk to friends or sing songs or watch movies. We can raise issues with our peers and get information on how to resolve problems,” a sex worker, who regularly visits TOP’s drop-in centres, explains in the report.
Addressing stigma and discrimination against HIV victims is high on the agenda of this week’s conference, to which Burma has dispatched a 50-member delegation including senior government officials and health professionals.
“Because of stigma, many people do not come to receive life-saving treatment or prevention services. This is costing lives,” Burmese opposition leader Aung San Suu Kyi said in a message to the conference. “We need an Asia-Pacific community of compassion to end discrimination.”
The UN also praised Burma’s efforts to boost access to anti-retroviral treatment for HIV-infected persons, noting that nearly half of eligible patients currently receive therapy. However, nearly one in five reported being denied access to health services based on their status, while one in four said they felt suicidal and over 60 percent ashamed.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has offered US$315 million to Burma to improve the “strategic expansion of services” for those affected by HIV/Aids. But global health activists insist that legal reform must take precedence.
“Punitive laws fuel stigma and discrimination, undermining our efforts to bring an end to AIDS,” said Ratu Epeli Nailatikau, President of Fiji. “This is why legal reform is crucial to the AIDS response.