Efforts are under way in Myanmar to bolster access to life-prolonging drugs for people with HIV/AIDS, but tens of thousands will probably still be left out, say health experts.
"All the ingredients are there to make this work, but a comprehensive and integrated plan concerning all actors and activities is needed to ensure a proper and rapid implementation," Peter Paul de Groote, head of mission for Médecins Sans Frontières (MSF), told IRIN.
In June, the Global Fund to Fight AIDS, Tuberculosis and Malaria pledged more than US$160 million over the next four years to Myanmar to improve access to anti-retroviral (ARV) drugs for patients, including those in neglected border regions and some controlled by ethnic armed groups.
"The challenge is that some of the areas are not directly managed by the government," Eamonn Murphy, country coordinator for the Joint UN Programme on HIV/AIDS (UNAIDS), explained. "However, I think there is a genuine commitment to provide services in these areas."
According to UNAIDS, there are about 220,000 people with HIV in Myanmar of whom 120,000 are in need of ARVs. From 2011 to June 2013, ARV treatment coverage climbed from 32 percent of diagnosed patients to nearly 50 percent, inching closer to the government target of 85 percent by the end of 2016.
In 2012, Myanmar officials declared that the availability of ARV treatment had expanded to nearly 100 sites - up from 57 in 2008.
Yet, more than 70 percent of those treated were in the nation's two largest cities, Yangon and Mandalay, along with Kachin State, while coverage in other areas remained inadequate.
The Global Fund is currently in talks with various stakeholders on access to war-torn border regions and expects to roll out services in 2014.
"We envisage an expansion of services to these areas with life-saving drugs being brought into the conflict zones and other hard-to-reach areas," said Andrew Hurst, a Global Fund spokesperson.
But despite the Global Fund boost, Myanmar is still looking for other donors to fill a $110 million funding gap in its national response up to the end of 2016, Murphy said.
Furthermore, some health workers claim HIV prevalence - the third highest in the Asia-Pacific region - could be worse than reported as scarce healthcare in border regions, compounded by a fluid migrant population, may have further spread the virus.
"I think that there are thousands of unknown HIV cases," said Aye Aye Mar, founder of Social Action for Women (SAW), a non-profit group that supports Burmese HIV patients in the Thai border town of Mae Sot. "We will never know if they have the virus and many won't know themselves because they don't get tested."
WHO guidelines could boost ARV demand
MSF, the largest ARV provider in Myanmar, also predicts a greater demand for treatment after the World Health Organization set new guidelines in June stating that adult patients with CD4 (a white blood cell that targets infection) counts of 500 or below should receive ARVs when immune systems are stronger.
Myanmar's ARV policy of treating adults with CD4 counts of 350 or below will need to be updated, allowing more infected people to access the drugs, MSF officials say.
"For this, many more treatment sites will have to be opened in areas where so far no treatment is available," de Groote said.
Seeking help in Thailand
Meanwhile, many impoverished Burmese living with HIV/AIDS continue to cross the Thai-Burmese border in the hope of receiving free treatment in Thailand.
Ma Yin Nu left her eastern Karen State village in 2007 when her daughter became severely malnourished after years of being mistakenly treated for tuberculosis.
"She was in very bad shape. I thought she would die and even the doctors expected it," said Ma Yin Nu, adding that she herself probably transmitted the HIV virus to her daughter at birth after a blood transfusion at a Burmese hospital.
With ARV treatment, her daughter, Phyoe Thandar Win (17), has since seen her CD4 count skyrocket from two to more than 1,000, and is now healthy enough to attend school. She lives at a SAW shelter, which teaches women to sew garments that are sold to pay for their ARVs (about $170 per month).
"I would be happier living in my village," she said. "But I need to stay here longer to get treatment."
Under a Global Fund grant, the Thai government offers free ARV drugs to at least 2,700 foreigners nationwide, but many more remain on waiting lists. Only 70 people are eligible in the Mae Sot area, the main hub for Burmese migrants coming into Thailand, health workers say.