AIDS IN ASIA: Silent Epidemic; Ethnic minorities are at risk in Burma's hidden AIDS epidemic
AIDS IN ASIA:. Silent Epidemic; Ethnic minorities are at risk in Burma's hidden AIDS epidemic
Enchained by a military dictatorship that ruthlessly suppresses dissent, Burma is gripped by a severe AIDS epidemic. The disease is spreading rapidly in Asia, as Burma has become the conduit for the "AIDS Route" carrying infection from Thailand to remote tribal areas of India and China.
In Burma, AIDS presents a broad threat but may doom the very survival of some ethnic groups, like the 1.3 million Kachins who live in the northern mountains. It could eradicate small tribes like the Dulongs, who live on the China-Burma border and already number only in the thousands.
The AIDS Route winds through mountainous northern Burma to Yunnan, China's border province, where heroin trafficking and prostitution are rife. Asiaweek reported in mid-1991 that 493 mainland Chinese had tested positive for HIV, the AIDS precursor, and 397 of those were in Yunna. Manipur, an isolated state of northeast India neighboring Burma, is also suffering an AIDS epidemic, with 1,076 people testing positive for HIV in 1991, most of the heroin addicts. Manipur is estimated to have over 15,000 heroin addicts, and India as a whole is considered an AIDS crisis country.
AIDS probably reached Burma from Thai border towns via the international trade in prostitutes and heroin. In 1991, the Thai government estimated that 300,000 Thais were infected with the AIDS virus and that up to 150,000 Thais would die from it by 1997. Steven Erlanger, writing in the New York Times Magazine, says other projections are even higher, with over a million predicted dead by the year 2000.
Intravenous drug abuse and prostitution are the major factors in AIDS infection in Thailand, with an especially high rate along Thailand's northern border with Burma. A study conducted in the northern Thai city of Chiang Mai found that 70 percent of prostitutes who had been working for over a year tested positive for HIV.
Burma's epidemic is as silent as it is serious. Although Burma is the largest country in mainland southeast Asia, with an ethically diverse population of some 42 million people, it has only one newspaper, The Working People's Daily. The muzzled Burmese press gives out little word of the presence of AIDS, and foreign journalists and scientists are barred from investigating it.
In Burma, exposure to AIDS comes in several ways. In addition to heroin injection and prostitution, medical procedures and indigenous customs are potential sources of infection.
Burma is the world's primary producer of opium, the raw material for heroin. Increasingly, opium is refined into heroin in Burma, with military authorities turning a blind eye to the processing - or actively engaged in trafficking the product. Narcotics corruption up to the highest levels of the SLORC (State Law and Order Restoration Council) junta has been alleged. SLORC officials openly allow known drug warlords like Pheung Kya-Shin and Lo Hsing Han to operate freely in the notorious Golden Triangle region, which is under government control. Drug addicts in Burma are turning from opium smoking to injecting heroin. Heroin addicts routinely group together, sharing dirty needles.
Intravenous abuse has become especially common among laborers in the north and young people in Burma's cities, including Rangoon, Burma's capital. "Heroin can...be bought openly at the Rangoon Institute of Technology, the Institute of Medicine, and in every township of Rangoon," a Burmese student who recently escaped to Thailand wrote in The Burma Review. "The situation has gradually worsened since the military coup in September 1988. The SLORC is less threatened by people on drugs than by youths agitated for political action to ensure democracy for the country." Student dissidents had led a 1988 uprising that nearly toppled Burma's dictatorship but was suppressed by a "coup" in which the SLORC asserted its power.
The traditionally high status of women in Burma and the lack of flashy nightclubs, discos, or message parlors has led some visitors to believe that prostitution doesn't exist there. But there are numerous brothels, and street prostitution is becoming common. There is also a large-scale traffic in people - including young girls and boys - from Burma to Thailand for prostitution. With the collusion of police and military personnel from Burma and Thailand, gangs bring young Burmese victims across to Thai border towns like Chiang Rai, Mae Sai, Kanchanaburi, and Ranong, where they are sold into forced prostitution for $100 to $560. The slave-prostitutes include ethnic Burmese from the south - some are immigration detainees bought out of Thai jails by brothel owners - and northern ethnic groups like Shans and hill tribes.
Imprisoned in dark brothel rooms and speaking to Thai, the prostitutes from Burma have little chance for escape. They are in demand because Thai customers perceive them as "AIDS-free," coming from a relatively closed country. They don't remain AIDS-free for long, however. Speaking in Bangkok on "How to End Child Sexual Exploitation," the deputy commander of Thailand's Crime Suppression Division, Police Col. Bancha Charuchareet, commented, "These places are sometimes equipped with secret underground rooms. The girls are tortured and forced into prostitution." According to Col. Banchan, "The Burmese mostly come through the border on a day-pass permit. We cracked down on a place in Ranong where these girls were locked up in a house with a sign in front of it reading, `AIDS Free Zone.' Ironically, the Public Health Ministry offices gave them a medical check and found that all of them had HIV."
In June 1991, the Bangkok Post reported a raid on a brothel in Kanchanaburi in which four young Burmese, including a 13-year-old girl, were rescued and found to be "suffering from several diseases." Mechai Viravaidya, a Thai public-health campaigner, spoke in 1991 of a rescue of 19 teenage girls who came from Burma's Shan State from a Chiang Mai brothel, stating that "none of the girls had any knowledge of [AIDS] but 17 were found to be infected with the HIV virus." Often, prostitutes diagnosed with HIV or AIDS are simply sent back to their home villages in Burma, where they may continue to spread the disease due to ignorance of the means of infection. Very few are ever "rescued" or "saved" from the brothels that imprison them.
Medical care in Burma is in dire straits, adding to the AIDS threat as much as responding to it. There is little if any screening of blood for transfusions. Disposable syringes are hard to get, even in city hospitals. Intravenous drip solutions are widely used for rehydration in cases of malaria and diarrheal diseases - both endemic throughout Burma - without regard for the sterility of the drip needles.
Political oppression has forced many medical practitioners into overseas exile, while over 60 percent of government funds goes to military purposes. Government health services neglect ethnic minority areas, some of which are in rebellion, and the SLORC keeps international aid programs away from rebel zones. Quack "injection doctors" travel from village to village, giving vitamin shots to malnourished people, often causing infections with their unsterile syringes. Even trained nurses and doctors use only boiling water to clean syringes and drip needles.
Indigenous customs may contribute to the epidemic as well. Tattooing, usually as a magic charm, is common for men of most ethnic groups of Burma, and for women in many. It is a ubiquitous practice among the Shan and Mon ethnic groups and for indigenous tribes like the Karens. The tattoo is generally a magic potion, injected ritually with a brass-tipped rod, by a specialist in charms and spiritualism. Ear-piercing, for infants, adolescents, and adults, is also common throughout Burma. Tattooing and ear-piercing are rarely performed with sterile instruments, and they may be an unsuspected way for the AIDS virus to spread, even among more isolated ethnic groups.
Protection against the AIDS virus is difficult to obtain. The government has discouraged all forms of birth control. Condoms from China or Thailand are available on the black market but are of questionable quality, and impoverished people in Burma find them too expensive. Household laundry bleach, used in other countries to decontaminate needles, is hard to obtain, even in areas close to the Chinese or Thai borders.
In rebel-held areas, although dissident medics often provide a relatively high standard of health care, they have yet to obtain equipment with which to test for the HIV antibodies that herald the onset of AIDS.
The SLORC has conducted several AIDS tests, with government monitoring beginning as far back as 1985. Burma's first confirmed AIDS case was apparently discovered in 1989. In April 1991, General Khin Nyunt declared the fight against AIDS to be "a national task." (However, Khin Nyunt himself, a SLORC intelligence officer, has been linked to Golden Triangle heroin traffickers.) State-run radio reported in 1990 that of 25,701 people given random blood tests, 324 were HIV positive. Tin U, the chair of the government's Central Committee for the Prevention of AIDS, has stated that in testing conducted between May and December of 1990, 81 percent of the patients in Rangoon's Intravenous Drug Addiction Treatment Department were HIV-infected. An even higher rate of infection may exist at Insein Prison, where many political prisoners are held. In Burma's northern Kachin State, the government has claimed that 1991 tests conducted in the town of Bhamo showed a 96 percent HIV infection rate.
Despite such alarming statistics, the government makes little apparent effort to educate Burmese about the disease or to provide ways to slow its encroachment. Persistent reports may suggest that SLORC police or military personnel have executed people with AIDS who have been forcibly repatriated by Thailand to Burma. While no proof of these reports exists, they come in the context of a regime that routinely tortures prisoners, uses civilians for slave labor, and razes entire villages under its control. According to the Bangkok Post, a Thai anti-AIDS campaigner, Sommart Troy, has stated that "some Burmese girls found to have AIDS, when sent back to their country, are allegedly reported to have been given cyanide injections to execute them."
Another Bangkok Post report, quoting an unnamed Ranong police officer, noted that "Burmese officials...recently rounded up five or six [Burmese] women who tested positive for AIDS and were brought back to Victoria Point [Burma]. There is an unconfirmed report saying that all of them were executed. People say there is no reason for the Burmese to provide these people with treatment."
A PUBLIC HEALTH CRISIS
Not only is medical care for AIDS victims totally lacking, but the SLORC has been accused of letting the disease run rampant among groups it considers security risks. Burma's military rulers have used various tactics to depopulate frontier "buffer zones," such as the tribal southern Shan State and the Muslim north of Arakan. The Burmese army has terrorized villagers until thousands flee to neighboring countries as barely tolerate refugees.
Such policies have led to accusations that the SLORC uses AIDS the way early colonists presented smallpox-contaminated gift blankets to Native American tribes - to wipe out an indigenous population through disease. In a letter to Hong Kong's South China Morning Post, Maung Zaw Tun, an exile from Burma, wrote, "The military dictators, of course, suppress the existence of the `AIDS Route' as it serves their purpose - what better way to eliminate troublesome ethnic minorities without wasting a single bullet! This is tantamount to an extremely cruel and sophisticated genocide."
Burma today endures mass forced relocations by the military, social decay as the regime undermines traditional religious authority, and warfare in which a 250,000-strong SLORC force equipped with Chinese fighter-bomber jets stages scorched-earth campaigns in the forests of frontier tribes. These conditions are conducive to the growth of public-health crises of any kind: cholera, typhoid, plague, malaria, AIDS. These conditions must end, if there is to be any control of the spread of AIDS through Burma and neighboring regions.
A recent UNICEF memo calls for "massive educational efforts, in the languages of the ethnic minorities, on AIDS awareness" as one way to begin to deal with the crisis. This could be done in rebel-held ethnic minority areas of Burma if international agencies were willing to distribute their AIDS education materials to such anti-government groups. In Kachin State, a private organizations has been distributing a 1992 calendar that contains clear and detailed information about AIDS, written in the Kachin language. Also, shortwave radio programs, such as the BBC World Service, Voice of America, and All India Radio, are widely listened to and could increase their AIDS-education programs for their audiences in Burma. Other efforts - testing facilities, condom distribution, and humane treatment programs for AIDS patients - will require creative and radical approaches if they are to actually reach Burma's endangered populations.
Like the prostitutes in their cellars and the prisoners in their cells, all the people of Burma must suffer in silence under the SLORC. The world outside should try to break down the SLORC's barriers, so there can be some treatment for Burma's people who have AIDS and some hope for those who do not.
DESTROYING A CURE:
Even as AIDS threatens Burma, a hope for a treatment, or even cure, may lie in the country's forests. Many modern medicines are derived from forest plants, and scientists are increasingly able to extract botanical medicines or to create copies of them when they are discovered.
Chinese researchers are conducting significant research in the use of botanical medication for AIDS. Asiaweek reports that "at the Sino-Japanese Friendship Hospital in Beijing, Professor Jin Siyuan has found 13 traditional herbs that he says can suppress AIDS development. Chinese medicine is also being used in some U.S. experiments." Burma's Kachin State is renowned in Asia for herbs used in traditional Chinese medicines, and the rain forests of southern Burma may contain important medical plants as well.
Unfortunately, these resources for the world's future are disappearing fast. Burma's living pharmacy is being sacrificed so the SLORC can gain hard currency to buy high-tech weapons. According to satellite mapping, Burma has reached the world's third highest rate of deforestation under the SLORC. The regime has sold off logging rights to foreign firms that are rapidly clear-cutting the frontier forests and trucking the timber for sale in Thailand and China, as well as overseas. The southern rain forests have been ravaged in the first ecocide of the 1990s, and Kachin State's ancient forests may vanish in the next few years.
WHAT YOU CAN DO
Although 90 percent of Burma's people voted against continued military rule in 1990, the SLORC junta has refused to relinquish power. Foreign investors and backers enable the junta to keep its hold on Burma.
China is the main supplier of arms to the SLORC. Letters can be sent to the Chinese foreign minister, stressing that China's support of the SLORC increases the spread of addiction and AIDS from the Golden Triangle into southern China.
Mr. Qian Qichen
Ministry of Foreign Affairs
225 Chaoyangmennei Dajie
PepsiCo is engaged in a joint venture with a SLORC company for sale of its soft drinks. Burmese students have called a boycott of Pepsi-Cola. Letters can be sent to PepsiCo's CEO, informing him that doing business with the SLORC is not good for his company's image.
Mr. Wayne Calloway
Chief Executive Officer
Purchase, NY 10577
The indigenous peoples of Burma's Kachin State are particularly threatened by high rates of drug addiction and AIDS. The U.S.-based Kachin-land Foundation is working to improve health care in that isolated region. For more information, contact Kachinland Foundation, 1490 Smithville Rd., Bloomington, IN 47401.
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