Burma's authoritarian military regime, the State Peace and Development Council (SPDC), is impeding the health community's efforts to control infectious disease threats in Burma, according to an investigation published in PLoS Medicine.
Dr Chris Beyrer (Johns Hopkins Bloomberg School of Public Health) and colleagues carried out field investigations in Burma in 2005 and 2006, and also searched the medical and policy literature on HIV, TB, malaria, and avian flu in Burma.
The researchers found that the SPDC's investment in health care is one of the lowest worldwide and that the health sector has been weakened by widespread corruption. The SPDC has also weakened the country's laboratory infrastructure, say Beyrer and colleagues, due to disinvestment and through creating a dearth of skilled personnel.
The researchers found that Burma's national reporting system for HIV is "too limited in scale and scope to accurately capture HIV/AIDS in this large and diverse country." They cite evidence that around 40% of Burma's population is thought to be infected with TB. "Burma has been rated by WHO," they say "as moving far too slowly to adequately control TB--a problem identified by WHO as far back as 1998 as being due to a lack of political will and commitment." There is also evidence that the government is spending too little on both TB and malaria control, and troubling evidence of rising rates of multidrug-resistant TB and malaria.
Burma's first report of the avian flu (H5N1) virus describes emergence on March 8, 2006, on a farm in the Mandalay district, and 112 birds died in the outbreak. "Veterinary authorities in the country called for international assistance," say Beyrer and colleagues, "but the state-run media did not notify the Burmese people of the threat until March 17, 2006, more than a week later."
The authors say that attempts by the health community to control infectious disease threats by trying to work through the junta are becoming increasingly difficult. As an example, although in 2004 the Global Fund to Fight AIDS, TB, and Malaria awarded Burma US$98.4 million over five years, the fund terminated the grant on August 18, 2005 due to restrictions recently imposed by SPDC. The fund made it clear, say the authors, that the decision was due to the SPDC having imposed restrictions on access to project implementation areas, and having added additional procedures to the procurement of medical supplies.
Health-related programs, such as Population Services International, Médecins Sans Frontières Netherlands, and numerous others that are currently functioning in Burma, are likely to continue conclude the authors, "but from a public health perspective, much more fundamental and widespread change will be required to actually meet the scale and scope of Burma's HIV/AIDS, TB, and malaria epidemics, increasing malnutrition, and other health threats."
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Citation: Beyrer C, Suwanvanichkij V, Mullany LC, Richards AK, Franck N, et al. (2006) Responding to AIDS, tuberculosis, malaria, and emerging infectious diseases in Burma: Dilemmas of policy and practice. PLoS Med 3(10): e393.
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What is the best way to monitor the success of HIV drugs in resource-limited settings?
In industrialized countries, tremendous strides have been made in treating HIV infection with antiretroviral therapy (ART). In these countries, a blood test called a "plasma viral load assay" is a crucial tool in guiding medical decisions about when to initiate therapy and when a particular therapy is failing. Unfortunately, the full benefits of such tests have not yet reached the majority of HIV-infected patients who live in countries with limited resources. In a policy paper in PLoS Medicine, Fiscus and colleagues discuss existing data on the performance of alternative viral load assays that might be useful in resource-limited settings.
Citation: Fiscus SA, Cheng B, Crowe SM, Demeter L, Jennings C, et al. (2006) HIV-1 viral load assays for resource-limited settings. PLoS Med 3(10): e417.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030417
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-10-fiscus.pdf
University of North Carolina at Chapel Hill
Department of Microbiology and Immunology
Chapel Hill, North Carolina 27599, United States of America
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PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
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