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Burma at the crossroads of HIV epidemic 22/6/03 -- Financial Times

The small town of Aung Ban, a community of 22,000 people in mountainous central Burma, is a crossroads for migrant workers, small traders, truckers and travellers heading east to booming Thailand. While pedlars along the two main streets tout vegetables, clothing and household goods, Aung Ban's economy depends on providing meals, shelter, and other services - including sex - for travellers. But Aung Ban's profits have come at a heavy price. The town has an emerging HIV/Aids epidemic that has orphaned at least 20 children. United Nations experts fear the virus will wreak havoc on the community and those passing through, most of whom still lack basic facts about the disease. Since 1999, the Aung Ban Community Group has had a team of about 40 volunteer counsellors, some HIV positive themselves, working to inform residents of the town and surrounding villages how to prevent the spread of HIV/Aids. Myo Kyaw, a 33-year-old betel nut seller who volunteers as a peer educator, says many people have misconceptions about the virus - some believe it is transmitted by mosquito bites, or haircuts. But while Myo Kyaw says he and fellow educators are working hard to dispel such myths, it is already too late for many. Myo Kyaw, a thin, weathered man with a six-year-old son, is infected with HIV; his wife died from Aids. The boy is not infected but faces a bleak future as one of Burma's growing number of Aids orphans. The Community Group, which operates with the financial support of the UN Development Programme, also runs a spartan clinic providing minimal medical care - mostly treatment for opportunistic infections and pain relief - to 80 adults, most aged 25-30, suffering from full-blown Aids. Conditions in Aung Ban reflect the uphill struggle facing Burma as it belatedly tries, after years of inaction, to rein in what the UN describes as one of Asia's most serious epidemics. Through most of the 1990s, Burma's military junta dismissed warnings of an impending HIV/Aids epidemic as politically motivated, arguing that Burmese society's "impeccable morals" would protect it. Western donors, frustrated by the generals' obstinacy on Aids and political reform, said there was little they could do to help a pariah regime. But over the last several years the generals appear to have woken up to the dimensions of the epidemic and its potentially devastating impact. And while western countries remain aggrieved by the military's refusal to ease its oppressive rule, donors are pouring money into the battle. Burma has little time to lose. Of its 50m people, UNAids estimates that about 330,000 - and maybe as many as 620,000 - are infected with the virus. Adult HIV prevalence is estimated at 1.2 per cent, a generalised epidemic, and the virus is known to have spread widely. Treatment options in Burma are almost non-existent for most and prevention remains the priority. Condoms, once confiscated as evidence of prostitution and subject to advertising bans, are now widely available thanks to organisations such as US-based Population Services International, which distributes heavily subsidised condoms. In 2003, sales of PSI condoms, retailing at about 1 cent, hit 18.5m; by 2008 it hopes they will reach 50m. PSI and Sail Marketing, its local partner, devised a subtle marketing campaign that finally won government approval. Condom advertisements featuring a chameleon in a jaunty pith helmet can now be seen from popular magazines to roadside billboards. Burmese are increasingly aware of Aids, Mr Murphy says, as they watch friends sicken and die. But health workers aim to get the message to all Burmese so they can protect themselves from a similar fate.

UN Human Rights Envoy Impressed with Junta's Anti-AIDS Efforts 11/6/03 -- Associated Press

A visiting UN human rights envoy critical of Myanmar's junta for jailing political activists had a rare word of praise for its efforts to fight HIV/AIDS. "I was very impressed to see the commitment of the government in addressing the issue of HIV/AIDS," Paulo Sergio Pinheiro said late Wednesday. He also said he was impressed by the junta's cooperation with development agencies. Pinheiro made the comments after visiting Myanmar's first- ever HIV/AIDS exhibition in the capital city of Yangon. The seven-day event that began Monday is designed to create awareness about the epidemic by highlighting the work of the government and voluntary agencies. Pinheiro said he was heartened to see hundreds of school children attending the exhibition and was also impressed by the involvement of monks in the HIV/AIDS programs. "This is great because it shows that they can also give a lot of legitimacy to the campaign because it is a delicate subject to deal with. In many countries it is difficult to deal with the distribution of condoms," Pinheiro noted. Myanmar's government, which had previously denied prostitution existed in the country, has recently made great strides in combating AIDS. The World Health Organization has lauded the country's condom distribution program. The government says 45,968 people had HIV as of March 2003. But WHO estimates 180,000-400,000 individuals are living with HIV/AIDS. Government figures indicate HIV/AIDS is the third- biggest health problem in the country, behind malaria and tuberculosis.

Thailand to Give Myanmar 1 Million Condoms, AIDS Medicine 03/09/29 -- Agence France Presse

Thai Health Minister Sudaret Keyurphan announced Monday that Thailand will give Myanmar 1 million condoms and HIV/AIDS medicine worth 1 million baht (US$24,900) to help fight the disease. Sudaret met Sunday with her Myanmar counterpart, Kyaw Myint, in Thailand's Chiang Rai province to discuss health conditions in the two nations, particularly along the 1,490-mile border they share. The Thai minister warned that HIV/AIDS is among the biggest problems on the border and asked everyone along the frontier to use condoms. She also said Thailand would send specialists to help upgrade Myanmar's HIV/AIDS laboratories. The UN estimated in January that up to 400,000 people were infected out of Myanmar's 48 million population, while independent experts working in Yangon said the incidence could be twice as high.

Burma's Leaders Slowly Moving to Combat HIV 03/04/03 -- San Francisco Chronicle

In Burma, an impoverished nation of 48 million, only two hospitals have AIDS wards, and few citizens can afford the average $300-a-month cost of antiretrovirals. Many observers blame Burma's dire situation on a military government that has allowed the nation's health care system to decay and that practically ignored AIDS until last year. The World Health Organization ranked Burma 190 out of 191 member countries in 2000, above only Sierra Leone. Burma's life expectancy is 55 years, while the rest of Asia's is 63. Because the government tightly controls information, no one knows how many Burmese are HIV-positive. UNAIDS estimated 400,000 people were infected by the end of 2001 - just under 1 percent of those ages 15-49. The junta has long insisted the real numbers are much lower because they say Burmese culture stresses abstinence before marriage and fidelity afterward. The state AIDS campaigns have urged monogamy and fidelity while excluding the discussion of condoms or clean needles for drug addicts. However, a 1999 study by Chris Beyrer, an epidemiologist at the Johns Hopkins University School of Hygiene and Public Health who worked with the WHO in Burma, suggests that 687,000 Burmese, or nearly 3.5 percent of adults, are HIV-positive. According to UNAIDS, heterosexuals account for 57 percent of HIV infections in Burma, followed by IV drug users at 22 percent. Tainted blood donations account for 4 percent; homosexual transmission for 1.2 percent; and the cause of the remaining 13.5 percent was unknown. Some experts blame the international community in addition to the junta. Most foreign assistance ceased after the junta suppressed Burma's democracy movement in 1988 and ignored the results of the 1990 election. But Tony Lisle, UNAIDS director for Southeast Asia, said he sees an "absolute groundswell of change in Myanmar [Burma] in the last 18 months" in the military's willingness to finally face up to the AIDS crisis.

Myanmar: The HIV/AIDS Crisis 08/04/02 -- The International Crisis Group

HIV prevalence is rising rapidly in Burma/Myanmar, fuelled by population mobility, poverty and frustration that breeds risky sexual activity and drug-taking. Already, one in 50 adults are estimated to be infected, and infection rates in sub-populations with especially risky behaviour (such as drug users and sex workers) are among the highest in Asia. Because of the long lag time between HIV infection and death, the true impact of the epidemic is just beginning to be felt. Households are losing breadwinners, children are losing parents, and some of the hardest-hit communities, particularly some fishing villages with very high losses from HIV/AIDS, are losing hope.

The National AIDS Program, while professionally competent, is woefully under staffed and under funded and struggles beneath the weight of its tasks. It gets a little help from international NGOs and more from the United Nations system but the major donors are largely absent. Recently, there have been signs that the government is crawling out of its deep denial about the true magnitude of the HIV epidemic in Myanmar and is preparing to take real measures to stem its spread.

AIDS Hidden in Myanmar, Expert Says 06/25/01 -- New York Times

At today's UN special session on AIDS, Johns Hopkins School of Hygiene and Public Health epidemiologist Chris Beyrer presented a study concluding that 3.46 percent of adults in Myanmar are HIV-infected, and that the nation's military government is falsifying statistics to hide the epidemic. Though this infection rate is well below that of the worst-hit African countries, it would make Myanmar's epidemic the second-worst in Southeast Asia.

Myanmar, Laos: H.I.V. Spreading 02/09/00 -- New York Times

New research from the Johns Hopkins School of Public Health shows that HIV is spreading in the Asian region known as the Golden Triangle. According to the report, the virus is moving along heroin trafficking routes from Myanmar and Laos. Lead researcher Chris Beyrer said the data show "a clear and urgent need" for neighboring countries like China, India, and Vietnam, in addition to Myanmar, to focus more on HIV prevention.

In Myanmar, Officials Raise Alarm on AIDS 5/7/99 -- Fox News Online

Myanmar has announced that it is aggressively moving to address the spread of AIDS. Official statistics from 1997 show there were 10,000 HIV-infected people in Myanmar, with 2,000 people with AIDS. The World Health Organization believes, however, that there are more HIV and AIDS patients than the statistics show. Officials intend to organize more HIV-free blood-donation campaigns and education efforts.

AIDS Runs Rampant in Myanmar 26/8/98 -- Earth Times

Prison conditions are reported to favor the spread of HIV in Myanmar. According to one former prisoner, a single needle may be used by up to 200 patients, with a new needle costing too much for the majority of inmates. According to United Nations statistics, there are 440,000 HIV-positive individuals in Myanmar; however, some health workers estimate the number is higher. Last year, 29,000 people in the country died from AIDS. Seventy-two percent of the country's intravenous drug users are reported to carry the virus, with infection rates among IDUs reaching as high as 95 percent in some areas. Burmese prostitutes have a 21 percent infection rate, up from 4.3 percent in 1992. The government is beginning to take steps to counter the spread of the virus, instituting anti-HIV and risk-reduction campaigns.

The Failing Health of Burma's People 15/6/98 -- Boston Globe

Burma's health status has deteriorated since a military junta in 1988. Furthermore, the World Health Organization estimates that half a million people in the country are infected with HIV--nearly 1 percent of the population. Some experts believe the actual number of HIV infections is much higher.

Opium Puts Myanmar in Crisis Over AIDS 3/5/98 -- New York Times

Myanmar, the world's leading exporter of opium, is also seeing skyrocketing rates of heroin use within its own borders. With many of the addicts sharing the same syringes for their injections, the country--formerly called Burma--has also seen soaring numbers of HIV infection and AIDS. While the government reports only 60,000 addicts--including 17,000 who have AIDS--foreign medical experts estimate the number of addicts is closer to 500,000, with several hundred thousand infected with HIV. Some estimate that Myanmar has the highest injection drug-associated HIV/AIDS rate in the world. The World Health Organization's Global Program on AIDS has reported that by 1994, 74 percent of drug users in Yangon, 83 percent in Mandalay, and 91 percent in Myitkyana were infected with HIV.

BURMA: Myanmar's secret plague Aug, 23 1997

AS IF life in Myanmar was not grim enough, with its poverty and its brutal government, it now turns out to have an AIDS epidemic. Thousands of young adults have died without ever having heard of the disease that killed them, let alone of ways to prevent it. In parts of Myanmar, funerals of people in their 20s or 30s are an everyday occurrence.

The disease took root in the late 1980s, among intravenous drug-takers. Myanmar is at the heart of the "golden triangle" of poppy farming. The use of opiates has long been common, but addicts started injecting refined heroin rather than smoking opium. Many shared dirty needles, or visited professional injectors who would use one syringe for a number of customers. As early as 1989, 96% of drug-injectors tested in a prison in the town of Bahmo were HIV-positive, destined therefore to get AIDS. Now almost two-thirds of Myanmar's drug-injectors are estimated to carry the virus, the highest rate of infection in the world.

Sexual contact has transmitted the disease from drug-takers into the general population. The rate of HIV infection among prostitutes, people with venereal diseases and pregnant women suggests that heterosexual contact has become the most common form of transmission. However, there are indications that, among homosexuals, the infection rate has reached 30-40%.

The government has not acknowledged that there is an epidemic. It says that, up to September 1996, Myanmar had 13,773 people with HIV and 1,612 had AIDS. Myanmar has a population of about 44m, so these figures would not seem to be too alarming. However, the government's own National Aids Programme offers a different picture. Since 1992 its small but dedicated staff has been testing high-and low-risk groups in 19 places in the country twice a year. Its unpublished results indicate that at least 500,000 people in Myanmar are carrying HIV. Even that figure is probably an under-estimate, since it does not include children and homosexuals. It also omits those, believed to be many thousands, who have died of AIDS.

So far, Myanmar has taken few effective measures to limit the epidemic. The strain of HIV prevalent in Myanmar is probably similar to that found in neighbouring Thailand, which is relatively easily spread by sexual contact. Myanmar, however, has preferred to deny that promiscuity and commercial sex thrive in a Buddhist society.

Some of the current counter-measures are actually counter-productive. Heroin-takers and prostitutes are simply put in jail. And new quarantine centres to house people with HIV are being built. Myanmar's military junta is sadly a government of concealment. -- EC

Burma Headed for Health Crisis Aug, 13 1996

Political isolation, ethnic conflict, and censorship in Burma has led to a health crisis and increased the spread of HIV, the London- based International Center Against Censorship reports. The group said accurate statistics concerning public health in the country are rare or non-existent. It also noted that HIV has spread rapidly over the past decade due to drug abuse and prostitution. Burma's military government has been criticized for its authoritarian policies and alleged human rights abuses. The World Health Organization estimates that half a million people in the country of 46 million were infected with HIV in 1995, although official statistics say only 9,885 people carry the virus.-- Reuters


Authors: Bo Kywe,Nyunt Nyunt, Khin Nu Nu, Kan Oo, May Hla Nwe, Hla Myint, Soe Win. AIDS/STD Control, Yangon

Commercial sex work is culturally and legally discouraged in Myanmar, but remains a problem. In December 1992, the Central STD Clinic established a Special UnitÓ as a CSW-friendly method for reaching CSWs. Objectives: To develop a mechanism for communicating with active CSWs; to train CSWs as peer educators; to promote awareness of STD/HIV; to encourage safer sex practices; to promote proper health seeking behavior.

Methods: CSWs are selected on the basis of interest in becoming a peer educator; requirements include: must be non-mobile, 30+ yrs of age, influential among peers, have regular STD team contact, be literate, be self confident. CSWs are trained to be peer educators and given condoms and IEC supplies. The STD team monitors/supervises all outreach work, and provides referrals when appropriate. Activity records are kept for each peer educator and effectiveness is assessed every 3 months. Results: 325 CSWs are involved in the peer education network; attendance at the STD Clinic has increased, as have visits for check- ups. Preventive education opportunities have increased. CSW acceptance has been good.

Conclusions: The CSW-friendly approach has enabled development of a network where peer education and outreach services for active CSWs has flourished.

Address: Dr. Nyunt Nyunt, STD Control Program, Department of Health, Yangon, Myanmar -- ABSTRACT FROM THE XI INTERNATIONAL CONFERENCE ON AIDS, VANCOUVER


Authors: Bo Kywe, Min Thwe, Hla Naing, Ti Ti, Goodwin DJ, Khin Ohnmar San, Edward Zan, Myint Zaw, Thandar Lwin, Ohn Kyaw. National AIDS Program, Yangon; Tuberculosis Control Program, Yangon; WHO/AIDS-STD, Yangon.

HIV surveillance began in Myanmar in 1985; the first HIV infection was indentified in January 1988. Standardized sentinel surveillance administered by the National AIDS Program began in 1992. Tuberculosis patients were added as a sentinel population in 1995.

Objective: To measure HIV prevalence among sentinel populations in selected locations and develop epidemiological data needed to guide HIV prevention interventions.

Eight sentinel populations (IDUs, CSWs, Male STD, Female STD, TB patients, MCH patients, military recruits, & blood donors) located in 20 geographical areas are surveyed twice yearly. Sentinel prevalence rates are used to develop estimates of total HIV infections for 1992-95. Results: HIV prevalence rates in IDUs peaked in 1993 (mean of 67%) and have since declined (to 55.2% in 1995). HIV prevalence associated with sexual transmission continues to increase (CSWs 18.2%, Male STDs 10.0%, and Female STDs 5.2% in 1995). In 1995 HIV prevalence in TB patients, MCH patients, military recruits and blood donors respectively were 4.2%, 2.2%, 0.7% and 0.53%. Estimates of total HIV infections rose until Sept 1994, after which they began to decline.

Conclusions: Myanmar's NAP has a useful HIV sentinel surveillance system which is helping characterize/monitor the nature and scope of the HIV epidemic in high interest subpopulations. Estimates based upon sentinel surveillance rates suggest total HIV infections may have peaked in 1994.

Address: Dr. Bo Kywe, Deputy Director AIDS/STD Department of Health, Yangon, Myanmar -- ABSTRACT FROM THE XI INTERNATIONAL CONFERENCE ON AIDS, VANCOUVER

Ignorance Helps Spread of AIDS Dec 30, 1995

THAILAND/BURMA BORDER-- Dr. Chamnarn Harnsutwechakul, provincial health chief, said that lack of knowledge among hilltribes and Burmese people is allowing the spread of AIDS. Many Karen and Shan illegal immigrants carried the virus, he said, and Burmese workers were transmitting the virus in Mae Hong Son. Dr. Chamnarn also said that the Burmese government was not promoting AIDS awareness around the border.

Mae Hong Son health stations have been ordered to run continuous awareness campaigns with information in Burmese, Karen and Shan languages. But it has been difficult to convince provincial women of the danger because of the attraction of money paid for sex. -- Bangkok Post, © The Post Publishing Public Co., Ltd. All rights reserved 1996.


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