South and Southeast Asia has over 4 million people living with HIV and about 300,000 people died last year while another 300,000 were newly infected. This sounds awful, which it is, but it pales in comparison with sub-Saharan Africa where there were over 23 million infected and over a million deaths in the same period. The point I am trying to make is that the epidemic is still a very nasty development issue even in its fourth decade and even though Asian policy makers have been able to avoid an African-scale pandemic.
Myo Thant is principal economist at ADB’s Office of Regional Economic Integration
Myanmar is ranked as a high-burden country in Asia with an estimated 216,000 people living with HIV, of whom roughly a third are women. The epidemic is concentrated in a few key affected populations. The good news is that HIV prevalence in the adult population peaked at .94% in 2000 and has declined to .53% as of 2011. Having said that, it is important to note that prevalence among key affected groups remains high: 21.9% for male intravenous drug users, 9.4% for commercial sex workers, and 7.8% for MSM (men who have sex with men).
Furthermore, the treatment gap in Myanmar remains large as only one-third of the estimated 120,000 people in need of treatment have access to antiretroviral therapy. This is a huge improvement in over just 3 years but it is still very low compared with Africa where approximately 50% of those in need have access to treatment.
Let there be no mistake: AIDS is the enemy of the Asian promise. The epidemic has definitely had an adverse impact on the Myanmar economy and will continue to do so at a macro, regional, and household level. The methodology that we developed at ADB almost 20 years ago allows us to understand the economic impacts of the epidemic. Generally speaking, and this is true for other countries as well, there will be four layers of impacts:
Myanmar faces many development challenges. The health sector will have to vie with other sectors for scarce resources. Within the health sector, there are many other pressing issues that require urgent attention, some of which have regional impacts as well, such as drug-resistant malaria, fake drugs, and dengue fever.
Myanmar has to devote more resources to preventive measures to fight the HIV epidemic. Government interventions in the past decade are paying off. Still, 8,000 people are estimated to have been infected in 2011. In the absence of a vaccine or a cure and given the high costs of treatment therapies, increased expenditure on prevention is warranted. At the same time, treatment for HIV also has to be scaled up from the current low level. Frankly speaking, given the high costs of these drugs, the country will not be able to do this without massive and sustained external help.
We should also remember the non-government sector and the critical role that it can play. Myanmar has made a very good start in using civil society and private sector groups to fight the epidemic. However, there are a number of difficult issues that the country as a whole needs to grapple with, such as how to help intravenous drug users, men who have sex with men, and commercial sex workers.
I am hopeful that we can assist the country in two areas. First, provide assistance on health sector reform, which is the only way that the country will be able to mobilize the needed financial and human resources in a sustainable manner. Second, there is a great need for innovative approaches on dealing with the epidemic in border regions. The Greater Mekong Subregion is an obvious conduit for channeling such assistance, but there is plenty of work to be done on the border with Northeast India as well.