THAILAND: Burmese migrants excluded from AIDS treatment
AIDS activists in Bangkok - migrants often overlooked
Khao Lak, 15 January 2007 (IRIN) - Zaw, 30, from Yangon, the former capital of Myanmar (Burma), came to Thailand eight years ago in search of job opportunities unavailable in his impoverished homeland. He found work on construction sites and, more recently, in a sawmill in Khao Lak, a beautiful coastal area where new hotels have been springing up in response to Thailand's booming tourist industry.
While being treated for tuberculosis around a year ago, Zaw learned he was HIV positive. After losing his appetite and becoming increasingly sick and weak, he began taking life-prolonging antiretroviral (ARV) drugs provided by the charity Medicins Sans Frontiers (MSF) in November 2006.
Although still frail and battling multidrug resistant tuberculosis, Zaw's strength is returning and he is now able to work two or three days a week. Small bags of pills attached to a home-made calendar hanging on the wall of his room in the workers' barracks at the sawmill remind him to take his ARV medication every day.
"I feel so relieved that I am getting treated," he said. "I feel that I will get better and I am confident about the future."
Zaw's story is far from common. Thailand has won accolades for its commitment to providing ARV drugs to all Thai citizens who need them, but the policy does not extend to the Burmese migrant workers who play a crucial role in the economy.
An estimated two million people have fled poverty, lack of opportunity and oppression in military-ruled Myanmar to work on Thai construction sites, fishing boats, farms, factories and in kitchens, often taking dirty, dangerous or dull jobs that Thais are unwilling to do. They are highly vulnerable to exploitation, frequently paid less than the legal minimum wage and live in constant fear of deportation or abuse by Thais harbouring deep-rooted prejudices against migrants from Myanmar.
The Thai government began registering the Burmese migrant workers several years ago, granting them access to public health services in an effort to improve their legal status.
So far only about half those believed to be working in Thailand have come forward for registration; the rest are thought to be deterred by their employers' refusal to formally sponsor them, the cost involved, or fears that the authorities in Myanmar would learn of their flight to Thailand and punish their families.
Although those who are registered have the right to access public healthcare, ARV drugs are not part of the package: only pregnant women receive the drugs necessary to prevent transmission of the virus to their babies.
The Thai authorities argue that workers from Myanmar are simply too transient to start a course of treatment that must be monitored and taken regularly to avoid drug resistance; health activists counter that the migrants are often no more mobile than many working-class Thais who do seasonal work.
"They [Thai authorities] say that they cannot follow up, that they [migrants] move often, change their names and the area where they live," said Suksri Saneha, coordinator of an MSF project in Khao Lak.
According to Saneha, local health workers frequently urged migrant workers found to be infected with HIV, whether registered or not, to return to Burma; advice that few heeded, given the lack of jobs or basic medical care in their home communities.
It is impossible to say how many Burmese migrant workers are living with HIV in Thailand, but Myanmar has one of South-East Asia's most serious AIDS epidemics. UNAIDS estimates adult HIV prevalence at between 1.3 and 2 percent, with up to 570,000 people infected in a population of 47.3 million, and treatment largely unavailable.
Migrant workers are constantly fearful of arrest and deportation by Thai police, who often pay little attention to whether they are registered, and are unwilling or unable to organise themselves into social support groups or press for access to ARV treatment.
Prejudice against people from Myanmar has also impeded prevention efforts. In the coastal areas of southern Thailand, where tens of thousands of migrants work on construction sites and in the fishing industry, MSF wanted to use local community radio to broadcast Burmese-language programmes about how HIV is transmitted and how to protect against it. Local authorities refused, saying broadcasting programmes in a foreign language constituted a "national security threat".
Saneha, a Thai national, said she sometimes encountered outright hostility in her efforts to address the problem of HIV among the workers from Myanmar. "They say, 'why do you care for migrants? Why not care for Thai people?' They don't think it's a disease that can spread from Burmese to Thais that has to be controlled."
Efforts by MSF and groups representing the Burmese workers to provide them with ARV treatment have met resistance, not only from Thai authorities but also from the migrants themselves, many of whom are poorly educated about the disease.
"They have a very low knowledge about antiretrovirals," said Saneha. "They want to go for the traditional drugs or to see the magic doctor. They don't believe in ARVs."
With the assistance of a Burmese translator, MSF has nevertheless begun providing ARV drugs to a few willing migrant workers in the Khao Lak area. Part of MSF's strategy is to encourage Thai health workers to view Burmese migrant workers the same as other HIV patients, and treatment is being delivered at the local hospital.
However, progress has been painfully slow. The MSF team is monitoring around 70 HIV-positive Burmese, about half of whom would benefit from starting treatment. Only two have begun taking ARVs so far, and two others died after starting treatment too late.
According to Saneha, the perception of many patients "is that they will die anyway - they have no example of somebody who takes ARVS and gets stronger and lives", but she believed this attitude would eventually change as treatment reached more Burmese workers, and gave others hope.