In Myanmar, intimate HIV care is focus where isolation and rejection is the norm

Isolated from the outside world, the people of Myanmar are suffering from the consequences of repression and neglect. The crackdown on monks marching for democracy in September brought international attention to this long-suffering population, but it did not expose what ordinary Burmese go through every day. Faced with high malaria and HIV rates, the impoverished population is provided with little healthcare from the government: only 1.4 percent of the regime's budget supports healthcare services. The 8,000 of HIV/AIDS patients who come for treatment at the five MSF clinics in Yangon, the former capital of Myanmar, receive an extremely high level of care. The MSF staff are split into small teams consisting of a doctor, nurse and counsellor. Patients therefore get to know their carers - which is very important for building trust and helping people to stick to a lifetime's course of treatment.

HIV/AIDS in Myanmar

The slow response to Myanmar's HIV/AIDS pandemic has fuelled the spread of the disease. While there is little independent information to shed light on the number of Burmese in clinical need of life-prolonging antiretroviral (ARV) treatment, of the UN-estimated 360,000 people who are living with HIV/AIDS, only 10,000 are believed to be receiving ARVs. MSF provides ARV therapy to 8,000 of them, in several regions of the country. Here three of MSF's Burmese staff explain their involvement in one patient's treatment:

Medical Doctor La La Aye- "Khin May Tway* is 24. Her husband died of HIV/AIDS. After his death she was confirmed as HIV positive in July 2007. She also tested positive for tuberculosis (TB). Khin used to live in a village 40 miles outside Yangon, but to be eligible for antiretroviral (ARV) treatment patients have to stay in Yangon for proper monitoring. She had no other choice if she wanted to survive so together with her mother she decided to move to Yangon.

Renting a house was a huge burden on the family. Her father was not well and therefore not working, so Khin's sister paid to support her. "Because of her weak state and low immune resistance she was very vulnerable to opportunistic infections. In October she developed severe symptoms of a rare blood disorder, and was sent to the government hospital where she received blood transfusions.

"Two weeks later, however, the lesions reappeared and she also developed symptoms of severe bowel obstruction with a very swollen belly. She only weighed 32 kg, and was not able to walk on her own any more. We suspected that her TB drugs were failing, and decided to change her TB treatment. In the meantime the father at home in the village had become very ill and the mother could not cope with two dying family members at the same time. "They were very scared of another long stay in the hospital and did not have money to pay for it. We decided to treat Khin as an outpatient at the MSF clinic, where she needed to come every day for two months to receive her injections, infusions, etc.

After changing the TB drugs, she started to improve. But in the meantime her father had died. Her mother did not dare to tell her until much later because she was so sick. "She has now been on ARV treatment for five months and on the new TB drugs for four months. Her situation has improved dramatically. She weighs 53 kg and is able to walk again and function normally. She expects eventually to move back to her village and start to work again."

Counsellor Whin Maye-"I started counselling sessions with Khin after she moved to Yangon. Before being started on ARVs, patients receive five counselling sessions to make sure that they know what they are getting into. Patients need to understand how the drugs work, that they really have to take all of them and not just half and sell or share the other half.

They need to understand that they will always have to continue taking the drugs even when they start to feel much better. "Initially adherence and social counselling sessions are once a week. When the patient is stable and is taking the drugs properly, counselling is reduced to one session a month and then to once every three months. "I remember the period when Khin became so sick, we all feared for her life. She could not walk by herself and had to be carried into the clinic, she was very weak and could not remember things well. But even under these circumstances she was very motivated and eager to get information and to receive treatment.

"During this period she received daily treatment at our clinic and I had counselling sessions with her on a daily basis. We became close, like friends during this period. She was very open with me. I was afraid that she would not survive and did not want her to give up hope. We are the same age as well, and she has already been through so much. "Luckily she is a very strong person. Even after all the difficult hospital treatments and the pain and later when she heard that her father had died, she still wanted to survive and get better. I was very happy and relieved when the treatment worked and she improved so much. She is now so stable that we decided to reduce the counselling visits from every week to once every month."

Nurse Soe Soe Chan- "I treated this patient from the first day she arrived. We had to send her to the hospital twice for treatment but she did not get better. When she had the abdominal obstruction and a very swollen belly she became very wasted and was in a lot of pain. I was very upset at that time because I thought the girl would die. We treated her in the MSF clinic and I remember that she had to be carried into the treatment room every day, where I gave her the injections. "Her mother was very supportive. She wanted it to work. We don't see patients with that much support very often.

Unfortunately many of our patients are alone or rejected by their families and society and this can be very depressing. Therefore it was very nice to see how much love and support this girl was getting from her mother through all the difficult times, and how this helped her to stay positive."

Dr La La Aye -"I think this particular girl made a big impression on all of us who treated and cared for her because of her positive outlook, her eagerness to get better and the support and kindness she gave and received from her surroundings. It is very rewarding to treat a patient like this and it makes me happy that she now has a future in front of her." *names changed