Donald E. Messer

Few places on earth more epitomize the conspiracy of silence that propels the global HIV/AIDS pandemic than Burma. Renamed Myanmar by its military dictatorship, a silent epidemic of explosive proportions is escalating behind the Teak Curtain. Governmental denial in the past decade has been pervasive. The junta has claimed United Nations' estimates were exaggerated, the disease never would spread due to the conservative culture and behavior of the people, and condom usage was not only discouraged, but mere possession deemed a reason for arrest.

Extreme poverty exacerbates the AIDS crisis among the 50 million people of Burma. During its 42 years of dictatorship, the Burmese leaders have squandered the country's resources. Once considered a prosperous "rice bowl" in Southeast Asia, now it is classified as one of the least economically developed countries in the world. Yearly government health care expenditures represent only sixty cents per capita, while more than 60% of the national budget is lavished on military expenditures.

Breaking the Conspiracy of Silence

Belatedly, officials have broken their silence and announced a nation wide HIV/AIDS campaign. The Ministry of Health recently welcomed Thailand's gift of generic anti-retroviral medicine to treat 200 patients for a year, plus one million condoms. Now the government claims a goal of promoting 100 per cent condom use and the distribution of 40 million condoms in 2004. HIV/AIDS is ranked beside malaria and tuberculosis as the nation's worst health problems.

Having just returned, however, from Rangoon (now called Yangon) I saw far more public billboards warning citizens to "beware of stooges" advocating democracy rather than alerting them to the imminent threat of an international terrorist called HIV (human immunodeficiency virus). When I asked an articulate, well-educated, "hip-hop"-loving nineteen-year-old Burmese student, whether he had received any education about global AIDS, his crisp response was "Never."

Silence inevitably leads to more disease and death. Since the government tightly controls all information, and the health infrastructures are extremely limited, no one really knows precisely the prevalence of HIV/AIDS in ethnically diverse Myanmar. Government statistics released in 2003 citing 45,968 infected persons proved radically lower than UNAIDS estimates of 330,000 and possibly 620,000. Epidemiologist Chris Beyrer of John Hopkins University has suggested 687,000 Burmese, or nearly 3.5 percent cent of the adult population, were HIV- positive in 2003. Hidden are any numbers of AIDS-associated orphans but some projections suggest 40,000.

Factors Fueling Burma's Pandemic

Factors fueling Burma's pandemic highlight behavior elsewhere in Asia but with acute intensity in Myanmar. First, the practice of men who buy sex is more widespread than generally acknowledged. Commercial sex opportunities flourish openly in Yangon. One nightclub I visited was crowded with Burmese patrons, international businessmen, and about 150 female sex workers. An articulate, attractive 22 year old college student indicated she was by day majoring in psychology and business, but by night she had no option but to engage in survival sex in order to feed her impoverished and unemployed rural parents and siblings. At least 50% of all sex workers in Myanmar are believed already to be HIV positive.

Second, few Asian countries have reliable estimates of the number of people who inject drugs, but it is known there is widespread needle-and syringe sharing. At the heart of the Golden Triangle, Burma not only is the world's leading exporter of opium and heroin, but also has the highest injected drug-associated HIV/AIDS rate in the world. Despite denials, the government is widely believed to be involved in the promotion and profits of this drug traffic. In some areas of Myanmar almost 75% of injecting drug users are infected.

Third, Asian countries generally under-report the prevalence of men who have sex with men. Since this activity is ignored in Burmese prevention programs, education about safer sex practices is not encouraged. Silence combined with ignorance about how HIV is transmitted helps create a "kaleidoscope of risk" since human behaviors interact in various ways. A man, for example, may be infected by HIV from drug injections, and then unknowingly pass it on to his wife or a sex worker. In turn, that person may later have an unprotected same sex or a heterosexual relationship that transmits the disease.

Corruption, Economic Sanctions and Humanitarian Assistance

Gross human rights violations have led Burmese pro-democracy forces to support economic sanctions. While this keeps money away from corrupt officials, it also limits international humanitarian assistance. Both President George W. Bush and Senator John Kerry support the USA 2003 Burmese Freedom and Democracy Act, which ban all imports, foreign assets, and blocks remittances to Burma until democracy is restored and human rights protected.

A bi-partisan resolution, adopted unanimously by the United States Senate, asserts that the unchecked spread of HIV/AIDS also has been fueled by the military junta's use of rape as a weapon of war. It calls Myanmar a "serious threat" in the region and calls for the UN Security Council to address the nation's health.

Persons living with HIV/AIDS in Burma face an impossible dilemma. Traveling to the outskirts of Yangon one evening, I sat on the floor of a wooden shack literally sharing bread and water with persons living with HIV/AIDS. Uncertain where they would get money for the next day's meal, international talk of getting anti-retroviral drugs to the poor is a cruel hoax. No matter how low the price, they could not afford it. If, by a miracle, they received one set of the 200 doses offered by Thailand, their lack of a reliable food supply inevitably would prompt serious side effects and probably worsen their condition.

As I bade farewell to my hospitable HIV positive host, holding his 5-year-old daughter and 15-month-old son, my broken heart pondered their future and the fate of hundreds of thousands more like them throughout Burma. I kept hearing the proverb from the Hebrew Bible: "Speak up for those who cannot speak, . . . defend the rights of the poor and needy." (Proverbs 31:8-9)

The Church As A Bridge Between A Rock And A Hard Place

Caught in this conundrum between a rock and a hard place, can a humanitarian bridge be built, so the powerless poor can receive assistance without the ruthless rich becoming more entrenched in wealth and power? Without a breakthrough in the foreseeable future, the Burmese AIDS pandemic will prove unstoppable and the genocide by indifference of Sub-Sahara Africa will be replicated in South East Asia.

Mother Teresa often reminded people that just because economic and political circumstances appear so overwhelmingly hopeless, it does not excuse ordinary persons from doing what they can. She said if she had not picked up the first sick person suffering in the streets of India, she might have never reached out to another. The day I visited her first home for the destitute and dying in Calcutta, patient number 77, 441 had been brought for compassionate care.

While advocating for human rights and democracy in Burma, let us also seek ways like Mother Teresa's for helping persons "one by one by one." As Nobel Peace Prize winner, Aung San Suu Kyi, still under house arrest in Yangon, has written: "You should never let your fears prevent you from doing what you know is right."

In that spirit, some Burmese Christians and Buddhists are breaking the conspiracy paralysis and discovering ways of reaching out in programs of prevention and ministries of mercy. World Vision and the Myanmar Council of Churches, for example, have dared to reach out to persons living with HIV/AIDS, providing programs of awareness and education. Faith-based groups currently lack funding, but form a trustworthy cadre of committed persons scattered throughout the country.

Some Christians are exorcizing their fears and expressing their faith by confronting stigmatization and discrimination. Theological educators are working to incorporate HIV/AIDS education into the training of pastors. After her brother died of AIDS from injecting drugs, and she witnessed row after row of new graves in her rural home village, one Protestant student redirected her pastoral care studies to HIV prevention and treatment programs. Yangon's Catholic Archbishop Charles Maung Bo in a pastoral letter has instructed the nation's priests, bishops and religious to learn more about HIV/AIDS.

Some even are daring to examine some of the theological taboos that have prohibited open sex information and education. Moving beyond a simplistic AIDS theology equating disease with personal sin, focus has shifted to the complexities of those "sinned against"-people imprisoned by poverty, political oppression, gender inequality, and other societal structures over which they have no control. While endorsing abstinence and partner fidelity, one Burmese Baptist pastor boldly predicted that if the apostle St. Paul were facing the current life-and-death emergency, he would have endorsed the correct and consistent use of condoms!

While diplomatic wheels grind exceedingly slow towards a just political solution, hopefully humanitarian interventions can be found to empower faith-based groups and other humanitarian organizations to cope with this catastrophic crisis.

Fortress Press