Heroin Puts Burma in Crisis Over AI

[moe@xxxxxxxxxxxxx]

Dear Friends and Associates,
                                                         The following
article is from today's New York Times.

Sincerely,

Julien Moe
-------------------
May 3, 1998


          Heroin Puts Burma in Crisis Over AIDS
        

          By CHRISTOPHER S. WREN

               ANGOON, Burma -- At sidewalk tea stalls where Burmese men
socialize over cups of fragrant
               black tea, proprietors in some towns have added a lucrative
sideline -- heroin -- and use the same
          syringe to inject as many as 40 customers. 

          The surreptitious practice, described by several Western diplomats
and doctors, illustrates how Burma,
          the world's foremost exporter of opium, has developed its own
domestic heroin habit, with potentially
          disastrous consequences. 

          So many young Burmese are injecting heroin that some medical
experts say Burma, also known as
          Myanmar, has the world's highest rate of HIV infection and AIDS
contracted from dirty needles. By
          1994, the Global Program on AIDS of the World Health Organization
reported, 74 percent of drug
          addicts in Rangoon (also known as Yangon), 84 percent in Mandalay
and 91 percent in Myitkyina, in
          the north, had HIV, the virus that causes AIDS. 

          This compares with about one-third of New York City's 150,000 to
200,000 intravenous drug users who
          are HIV-positive, according to Donald Des Jarlais, research
director for the Chemical Dependency
          Institute at Beth Israel Medical Center in New York. 

          The Burmese government has reported registering only 60,000
addicts, with as few as 17,000 infected
          with AIDS. Foreign medical researchers put the total number of
addicts closer to 500,000, and estimate
          that several hundred thousand heroin injectors have become
HIV-positive. 

          Another study, financed by the United Nations Drug Control
Program, a terse abstract of which was
          released by the Burmese Health Ministry, found drug abuse
prevalent in 1.7 percent to 25 percent of
          the population studied in three dozen Burmese townships. With 88
percent to 99 percent of drug
          abusers identified as male, the study implied that up to half of
the men in some townships could be
          addicted. 

          Both studies are cited in a new book, "War in the Blood: Sex,
Politics and AIDS in Southeast Asia," by
          Dr. Chris Beyrer, an American epidemiologist who has worked in the
region and interviewed health
          workers, addicts and people with AIDS. 

          "It's going to be one of those situations where people will say,
'How could the world not have known,
          because hundreds of thousands of people have died there?"' he said
in a telephone interview from his
          office at Johns Hopkins School of Hygiene and Public Health in
Baltimore. 

          Burma offers a harrowing example of drug-producing or transit
countries that find their own people
          growing addicted to heroin or cocaine intended for foreign markets. 

          The military government's own AIDS statistics have been suspect
since 1996, when it wooed foreign
          tourists with a "Visit Myanmar" campaign that portrayed the
country as a vacation paradise. 

          Beyrer said he knew of Burmese researchers who were punished for
being too candid about the
          country's AIDS problem. Beyrer also said the military junta's
credibility was so suspect that even if
          they told the truth, many Burmese might not believe them. 

          Although for years older hill people smoked opium to relax or as a
treatment for illnesses like malaria, it
          is younger, lowland Burmese who are injecting opium's refined
derivative, heroin. 

          Dr. Ba Thaung, director of the Drug Dependence Research and
Treatment Unit in Rangoon, said that
          heroin was widely available, inexpensive and devastatingly pure.
"Before, we had very few social
          problems, but now we have a lot of problems connected to drug
use," he said. 

          Dr. Gyaw Htet Doe, a psychiatrist in the research unit of the
Rangoon drug treatment center, estimated
          that 62 percent to 65 percent of younger heroin patients are
HIV-positive. "As a doctor at the Ministry
          of Health, I have to be concerned because there is no cure for
this," he said. "It will kill or harm a lot of
          young people in our country." 

          Other medical specialists made available by the government confirm
the problem. "The majority of
          intravenous drug users are HIV-positive," said Dr. Martin Joseph,
a consulting psychiatrist at the
          general hospital in Lashio, a town in northeastern Burma. "We
estimate about 80 percent." 

          The epicenter of Burma's AIDS pandemic is Hpakan, a jade-mining
town northwest of Myitkyina,
          where heroin injection is said to be rampant and clean needles a
rarity. When seasonal rains halt the
          digging in Hpakan's open-pit jade mines, thousands of migrant
miners return home, carrying the HIV
          virus back to their wives. 

          The relatively late arrival of AIDS in Burma has contributed to
widespread ignorance about the
          disease. By 1988, only a single case of AIDS, brought back by a
dying sailor, had been diagnosed. By
          1989, doctors were discovering hundreds more Burmese infected. 

          Yet as late as 1995, a survey of 714 Burmese prison inmates found
that only 11 percent knew that HIV
          could be contracted by injecting drugs. Dr. Than Zaw, medical
superintendent of the Lashio general
          hospital, said that patients there "may have heard of AIDS but
they don't know how it's contracted."
          "All they know is when they have AIDS, there is no cure," he
continued. 

          The government has opened 30 drug-treatment centers since 1975.
But many heroin users stay away,
          because detoxification means undergoing agonizing withdrawal with
little more than modest doses of
          tincture of opium and meditation lessons from Buddhist monks. 

          "Sometimes when they learn they are HIV-positive, they leave
treatment," Than Zaw said. "They don't
          want their families or other people to know, because they are
looked down on."