US embassy cable - 03RANGOON1364

UNCLAS SECTION 01 OF 02 RANGOON 001364 
 
SIPDIS 
 
SENSITIVE 
 
STATE ALSO FOR EAP/BCLTV 
 
E.O. 12958: N/A 
TAGS: PGOV, PREL, EAID, PHUM, ECON, BM, Human Rights, NGO 
SUBJECT: A RANGOON HIV/AIDS CLINIC 
 
REF: RANGOON 1358 
 
1.  (U) SUMMARY: This NGO clinic, in a government-developed 
slum, provides organized health care despite primitive 
conditions, thanks to the education and dedication of the 
doctor and the support of MSF-Holland.  It provides a glimpse 
of the terrible health conditions faced by the vast majority 
of Burmese, most of whom do not have access to NGO-supported 
Clinics.  Ironically, this clinic is only a short drive from 
newly constructed high rises intended for those better-off. 
END SUMMARY. 
 
CARE PROVIDED 
------------- 
 
2.  (U) On October 21 EAP/BCLTV Director and Poloff toured an 
MSF-Holland HIV/AIDS clinic in the Hlaing Thaya Township 
slums located in a swamp across the river west of Rangoon. 
The GOB established this township following the 1988 uprising 
with the aim of resettling troublemakers to an inhospitable 
area.  At each of their three Rangoon-area HIV/AIDS clinics, 
MSF-Holland also runs a Maternal and Child Care program, a 
nutrition program, and a counseling service for people living 
with HIV/AIDS (PLWHA). The nutrition program feeds about 40 
to 60 malnourished children and about a dozen acute care 
adults a day. Besides malnutrition, the clinic's patients 
commonly suffer from TB, diarrhea, STDs, and HIV/AIDS.  The 
Maternal and Child Care program has registered 54,000 
patients since it opened in August 1994, and provides 
prenatal care, family planning, STD treatment, STD 
counseling, commercial sex worker treatment and counseling, 
Males who have Sex with Males (MSM) and male STD care, and 
HIV/AIDS care and support to about 100 patients a day.  The 
clinic's Burmese director, Dr. Myiet, also noted that the 
clinic had seen cases of cholera. 
 
HIV/AIDS CONFIDENTIALITY 
------------------------ 
 
3. (U) The clinic's director related how the GOB made it 
illegal for foreigners to test for HIV/AIDS. Only government 
labs can do so.  However, if a GOB clinic or lab does the 
test, confidentiality is not provided.  As a work-around, NGO 
clinics will draw a blood sample, assign a random 
identification number, and then send the sample to the GOB 
clinic or lab to be tested.  Patient confidentiality is 
thereby maintained. 
4.  (U) Another problem related to confidentiality is 
involuntary HIV/AIDS testing.  Government hospitals and 
medical clinics routinely test suspect patients for HIV/AIDS 
without the patient's knowledge or permission.  If they test 
positive, the GOB clinic merely informs the unsuspecting 
individual, then leaves them to cope on their own with the 
aftermath.  MSF-Holland has developed a special counseling 
service in their Hliang Thaya Township HIV/AIDS clinics to 
help these new PLWHAs adjust to the shock of being HIV 
positive, how to prevent transmission to others, and help 
them develop a family support plan. 
 
ART 
--- 
 
5.  (U) In April this year, MSF-Holland implemented a 
three-drug-cocktail Anti-Retroviral Treatment (ART) drug 
therapy program with the target of supporting 100 PLWHAs in 
Hliang Thaya Township.  ART is exponentially higher in cost 
than any other drug therapy, such as treatment for malaria. 
To prevent GOB clinics from packing the program with 
relatively wealthy, well-connected patients who can bribe 
their way into treatment, the MSF-Holland clinic mutually 
decides with the referring GOB clinic who actually enters the 
program.  MSF-Holland also requires that candidate patients 
for the program must already reside in the Hliang Thaya 
Township slum. 
 
NO INCREASE IN SEX WORKERS 
-------------------------- 
 
6.  (U) Following the implementation of the U.S. import ban, 
the clinic director, Dr. Myeit, had expected an increase in 
new sex workers showing up at the clinic for treatment and 
counseling.  However, she admitted she had not yet seen any 
sex workers who had previously worked in a garment factory. 
 
7.  (SBU) COMMENT:  The clinic director, not unlike some NGOs 
based in Thailand, had since July expected to see an influx 
of new ex-garment factory workers enter the sex trade.  This 
shows that the GOB's anti-U.S. sanctions propaganda campaign 
has been quite successful by claiming that the U.S. was 
forcing garment factory workers into the sex industry. 
However, according to the clinic director's finding, this 
does not seem to be happening yet on any noticeable scale. 
On the contrary, according to two Korean factory owners who 
have recently fired most of their workers (reftel), the women 
have returned to their home villages or, for the few who 
could afford to stay in Rangoon, are pursuing legitimate 
jobs. 
 
8.  (SBU) The MSF-Holland clinics provide the only medical 
support for Hlaing Thaya Township, and it is very evident 
that humanitarian NGOs operating just in Rangoon alone are 
saving thousands of Burmese children and adults each year 
from preventable extreme malnutrition and from TB, STD, or 
AIDS-related deaths.  But it is only a drop in the bucket. 
The humanitarian situation outside the reach of the few NGO 
clinics is a very different story.  END COMMENT. 
 
9.  (U) This message was cleared by EAP/BCLTV Director Judith 
Strotz. 
McMullen