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POVERTY AND HEALTH

Topics:
1. What is health?
2. What is poverty?
3. Social indicators
4. Types of social indicators
5. Social indicators and development
6. Voices of the poor
7. Overview of global health risks
8. Four problems with the system
9. Health for all
10. Different views on health
11. Communicable diseases
12. Tuberculosis
TB and Burma
13. Malaria
Malaria statistics for India, Thailand and Burma
14. HIV/AIDS
HIV/AIDS statistics
HIV/AIDS and Poverty
HIV/AIDS – The case of Uganda
HIV/AIDS - Burma
15. Child health
16. Primary health care
17. Heroin and Burma
18. Burma’s social indicators
19. Burma – A country in crisis
20. Women’s health in Burma

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1. WHAT IS HEALTH?

Health can be defined in different ways:


The absence of illness

The ability to cope with everyday activities

Fitness and well-being

According to the World Health Organisation health is “a state of complete physical, mental
and social well-being and not merely the absence of disease.”

So health isn’t only about diseases and medicine. When considering health issues it is
necessary to consider the environment, people’s standard of living, economic situations, and
social situations.

It is also important to consider the different ways that people understand health and illness.
Different societies around the world and throughout history have had different beliefs that
explain the causes of ill health. Many cultures believed illness to be caused by witchcraft,
spirits or the will of the gods. The modern day medical profession focuses on scientific
explanations.

Today, health care is a huge industry: hospitals, along with doctors and nurses provide
curative care to patients; scientists and pharmaceutical companies work to develop newer and
more advanced techniques and medicines; preventative health care provides vaccinations and
health education; charities and volunteers work to improve health in the poorer countries;
alternative, traditional treatments and remedies cure illness.

Despite the progress that has been made, there are still millions of people around the world
who suffer from preventable diseases and poor health, and have no access to health care or
medical treatment. Hundreds of thousands of people in the developing world die from
diseases that are easily treatable, because they cannot afford treatment.

For these people ill health is often the result of poor living conditions, economic insecurity
and poverty.

What do health and illness mean to you? Write your own definitions of health and
illness:

Health means
____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Illness means
_____________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

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2. WHAT IS POVERTY?

What is poverty?
Poverty is hunger. Poverty is lack of shelter. Poverty is being sick and not being able
to see a doctor. Poverty is not being able to go to school and not knowing how to read.

Poverty is not having a job, fearing for the future, living one day at a time. Poverty is
losing a child to illness brought about by unclean water. Poverty is powerlessness, lack of
representation and freedom.

Poverty has been described in many ways, changing from place to place and across
time. But it is important to change the world so that many more people may have enough to
eat, adequate shelter, access to education and health, protection from violence, and a voice in
what happens in their communities.

Measuring poverty within countries


Poverty in a country is usually measured according to how much money people earn,
or how much people can buy.

If a person earns less money than they need to meet their basic needs, they are said to
be living “below the poverty line”.

The poverty line is the minimum income that a person needs to survive, or to support
his/her family. The understanding of basic needs is different in different countries, depending
on a country’s development. So, the poverty lines of different countries tend to be different.

Which country do you think would have a higher poverty line (i.e. higher
expectations for basic needs), India or France?

__________________________________________________________________________________

Measuring poverty at the global level


Although each country has its own poverty line, when different countries are being
compared it is important that one common poverty line is used.

For comparing countries around the world the World Bank uses two reference lines:
$1 per day and $2 per day.

It has been estimated that in 1998 1.2 billion people world-wide lived on less than $1
a day and 2.8 billion lived on less than $2 a day.

If the population of the world is now 6 billion people, approximately what


percentage of the population were living on less than $1 per day in 1998? What
percentage was living on less than $2 per day?

_________________________________________________________________________________

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3. SOCIAL INDICATORS
“Social indicators” are data, information and statistics that help people to learn about
the standard of living of people within a society.

Each social indicator provides a way to analyse part of the overall situation of a
society. Taken together, a collection of social indicators can help researchers to understand
the quality of life of people in a particular place, or among a particular group of people.

Social indicators allow researchers, government officials, civil society organizations


and others to evaluate and compare living standards.

Social indicators also allow for comparisons between places and populations, so that
the quality of life in one region of a country can be compared to another region, or basic
differences can be measured between men and women or between one ethnic group and
another.

Social indicators are also used to compare the general quality of life between nations
and between global regions. As a result, researchers can compare the social indicators
between the United States and Japan or between France and Peru, or between Europe and
Africa.

Social indicators can also be used to see how living standards have changed over
time. In this way, social indicators can show progress, or lack of progress, in a region or a
country.

Over the last 50 years, experts have developed increasingly sophisticated systems of
social indicators. These measures are now accepted and used to document and analyse the
quality of life around the world.

Vocabulary

Look up the meanings of the underlined words in the dictionary, and write them
below:

Data ___________________________________________________________________________

Statistics________________________________________________________________________
__

Analyse _________________________________________________________________________

Evaluate
_________________________________________________________________________

Progress
_________________________________________________________________________

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Sophisticated
____________________________________________________________________

4. TYPES OF SOCIAL INDICATORS

There are many types of social indicators. The following are some of the social indicators
used around the world:

Total fertility rate – The average number of children born by each woman as measured in
children per woman.

Under-five mortality rate – The number of children who die between birth and five years of
age as expressed per 1,000 live births.

Infant mortality rate – The number of children who die in the first year of life as expressed
per 1,000 live births.

Life expectancy at birth – The number of years a person is expected to live. The average life
expectancy in a country is the average age a person in that country is expected to live to.

Maternal Mortality Rate – The number of woman who die either while pregnant or soon after
giving birth as expressed per 100,000 live births.

Access to Health Care – Percentage of the population living within a reasonable distance of a
health facility that provides adequate service.

Access to Safe Water – Percentage of households with a direct or nearby connection to safe
water.

Access to Sanitation – Percentage of households with a direct or nearby access to sanitation


facilities.

Adult literacy rate – Percentage of persons aged 15 and over who can read and write

Radios per 1,000 people

Televisions per 1,000 people

Primary school enrollment – Percentage of children who are in primary school, often divided
between boys and girls.

Secondary school enrollment – Percentage of children who are in secondary school, often
divided between boys and girls.

Adult HIV prevalence – Percentage of adult population who are living with HIV/AIDS.

GDP per capita – Total national production (money the country makes per year) divided by
population.

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Social Indicators - Worksheet
According to the UN Statistics Division – http://unstats.un.org/unsd/demographic/
1. The statistics below show the rate of change for each country’s populations per year.
Afghanistan - 3.88% Armenia - -0.45%
Burma - 1.28% India - 1.51%
Germany - 0.07%
In which country is the population increasing most quickly? ____________________
In which country is the population decreasing? _________________________

2. These statistics show the percentage of countries’ populations that are under 15 years
of age (in 2004).
Afghanistan - 43% Burma - 32%
United Kingdom - 18% Niger - 50%
China - 15%
In which country is half the population children? ______________________
Which country has the smallest percentage of children? ____________________
What reasons can you think of to explain why some countries have a large percentage of
children in their population, and some have a small percentage? _______________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

3. The next statistics show % population that have access to clean drinking water.
Total population Urban areas Rural areas
Afghanistan 13 19 11
Burma 72 89 66
India 84 95 79
United Kingdom 100 100 100
Ethiopia 24 81 12
Which country has least access to clean water? ______________________
What is the difference between access to clean drinking water in rural and urban populations?
___________________________________________________________________________
___________________________________________________________________________

4. These statistics show life expectancy for different countries.


Male Female
Afghanistan 43.0 43.3
Burma 54.6 60.2
India 63.2 64.6
United Kingdom 75.7 80.7
Sierre Leone 33.1 35.5
What can you say about the life expectancies of men and women? _____________________

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___________________________________________________________________________
What reasons can you think of to explain different life expectancies in different countries?
___________________________________________________________________________
___________________________________________________________________________
5. Below are statistics for infant mortality rate (per 1,000 births)
Afghanistan 162
Burma 83
India 64
United Kingdom 5
Sierre Leone 177
What reasons can you think of for the differences in infant mortality rates? ______________
__________________________________________________________________________
__________________________________________________________________________

6. The next statistics show the average number of years children spend in school.
Average Male Female
Burma 7.4 7.3 7.4
United Kingdom 16.3 15.8 16.7
Bangladesh 8.4 8.4 8.4
Iraq 9.1 10.3 7.7
Mali 2.1 2.7 1.4
In which countries do girls spend less time in school than boys? _______________________
What reasons can you think of why girls in some countries get less education than boys?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

7. These statistics show % unemployment rates.


United Kingdom 5.1
USA 5.8
Armenia 36.4
Cambodia 1.8
Sri Lanka 8.7
Cambodia is a very poor country, but its unemployment rate is very low. Why do you think
this could be? _______________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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5. SOCIAL INDICATORS AND DEVELOPMENT

Development around the world means that there have been improvements in many
areas relating to health. However, for millions of people, the situation has not improved.

For many Africans, living conditions have become much worse over the last decade.

Many people believe that progress has been too slow, and the International
Development Goals for improving health and education are unlikely to be achieved. These
goals include reducing infant and child mortality rate by two-thirds, reducing maternal
mortality rates by three-fourths, access to primary education for all by 2015, and gender
equality in education by 2005.

Population
 In 1999, the world’s population reached 6 billion. It is expected to reach 7 billion in 2014.
 More than half the world’s population (3.7 billion) live in urban areas. This number is
expected to rapidly increase, particularly in developing countries.
 Within cities in developing countries there are dramatic differences between the rich and
the poor, in terms of living standards, health status and death rates.

1. Why do you think the populations in urban areas will increase rapidly?
__________________________________________________________________________________
__________________________________________________________________________________

Life expectancy
The average life expectancy in rich countries is 78 years, in developing countries it is 64
years.
In thirty-eight countries the life expectancy has decreased. Mostly these are countries hit
by the AIDS epidemics.

Infant, child, and maternal mortality


 Child mortality rates in the developing world are decreasing too slowly to achieve the
target of a two-thirds reduction by 2015: rates should have come down roughly by 30
percent in the 1990s, but they declined by only 6 percent.
 In some countries the child mortality rate has increased.
 In twenty developing countries, more than 1,000 women die for every 100,000 live births.

2. What reasons can you think of for why the child mortality rates in some
countries increased?
__________________________________________________________________________________
__________________________________________________________________________________

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Health status and health care services for the poor
Children born into poor families have a higher chance of dying before their 1st and 5th
birthdays than children born into richer families.
 The poor are less likely to obtain health care than are the rich:
 Between 1990 and 1998, in forty developing countries, only 34 percent of the poor
suffering from acute respiratory infections were treated in a health facility, compared to 57
percent of the non-poor

3. What are reasons why the poor would have less access to health care than the
rich?
__________________________________________________________________________________
__________________________________________________________________________________

The problems of AIDS


 UNAIDS has estimated that in 2000 there were 3 million deaths due to AIDS, the highest
global total since the beginning of the epidemic, and 5.3 million newly infected
individuals. In all, 36.1 million individuals are estimated to be living with HIV or AIDS.
 AIDS is a disease of poverty in the sense that most people with HIV or AIDS are poor.
The disease struck very hard in poor countries: 96 percent of infected people are in the
developing world.

Environment
 The links between environmental conditions and human welfare are strong. Many people
depend on environmental resources for their basic survival. Diseases associated with
environmental factors more often affect the poor. The poor are much more vulnerable to
natural disasters – droughts, floods, storms, earthquakes, and forest fires.

4. Why do you think the poor are more vulnerable to natural disasters such as
droughts and floods?
__________________________________________________________________________________
__________________________________________________________________________________

Water and sanitation


 Lack of clean water and sanitation are causes of many diseases in developing countries.
 Access to improved water sources and sanitation facilities increased since 1990, but in
2000 about half of the population of the developing world still lacked adequate sanitation.
 In 2000, 1.5 billion people lacked access to safe water supplies.
 In Sub-Saharan Africa fewer than half the population has access to safe water.
 The poor are less likely to have access to water than are the rich.

5. What diseases do you know of that are caused by a lack of clean water and
sanitation?
__________________________________________________________________________________
__________________________________________________________________________________

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6. VOICES OF THE POOR

The material presented below comes from a study conducted by the World Bank entitled,
Voices of the Poor. It is the result of 60,000 interviews with poor people in over 60 countries.

1. Material Wellbeing

“We eat when we have, we sleep when we don’t.” – Ethiopia.

Lack of food, shelter, clothing, poor housing and uncertain livelihood were important
and mentioned everywhere. Having enough to eat the whole year round was mentioned again
and again in many countries, as was the possession of assets.
In rural areas people wanted land with secure tenure, and assets that allowed
cultivation and a good harvest. In urban areas they wanted capital to start a business, access
to loans, and dependable work.
The research team in Russia wrote, “A woman told us that sometimes she did not have
food for several days and was only drinking hot water and lying in bed not to spend energy.”

2. Physical Wellbeing

“My children were hungry and I told them the rice is cooking, until they fell
asleep from hunger.” – Egypt.

“Poor people cannot improve their status because they live day by day, and if
they get sick then they are in trouble because they have to borrow money and
pay interest.” – Vietnam.

Bad living and working conditions, together with poverty, make a person highly
vulnerable to sickness, or to permanent disability or death through illness and accident.
Shortage of food and sickness cause pain and weakness. Poor people are sick more often and
sick for longer periods of time. Unlike wealthier people they are less able to afford treatment.
Poverty is driving many women to deeper and deeper exhaustion, as they struggle
with paid work as well as their duties in the home.
Illness can plunge a household into destitution. Anguish and grief over watching
loved ones die because of lack of money for health care is a silent crisis of poverty.

3. Security

“Security is knowing what tomorrow will bring and how we will get food
tomorrow.” – Bulgaria.

Many people described security as peace of mind or confidence in survival. Survival


referred not just to livelihood, but also to physical survival when faced with corruption,
crime, violence, lack of protection from the police, wars between ethnic groups, tribes and
clans, frequent natural disasters, and the uncertainties of season and climate. In the Kyrgyz
Republic people said, “peace is the most important.” In Russia, it was “the absence of
constant fear.” In Ethiopia, women said, “We live hour to hour, worrying if it will rain.”
In many countries, women spoke about widespread domestic violence.

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4. Freedom of Choice and Action

“The rich is the one who says: ‘I am going to do it’ and does it. The poor, in
contrast, do not fulfill their wishes or develop their capacities.” – Brazil.

“Poverty is like living in jail, waiting to be free.” – Jamaica.

Wellbeing for many people means freedom of choice and action, and the power to
control one’s life. It means the power to avoid the exploitation, and humiliating treatment so
often meted out to the poor by the rich or the more powerful in society.
It includes the ability to acquire skills, education, loans, information, services and
resources; to live in good places; and not slip further into poverty. Wellbeing was frequently
linked to moral responsibility, and to having the means to help others in need.
Lack of freedom or powerlessness leads to the inability to control what happens.
The voices of the poor are seldom heard and sometimes silenced. They are to
challenge authority or unfair practices. To add to these disadvantages, they frequently live in
areas characterized by remoteness and isolation.

5. Social Wellbeing

“It is neither leprosy nor poverty which kills the leper, but loneliness.” –
Ghana.

Social wellbeing was defined as good relations within the family and the community.
In post-conflict and transitional economies, the need for good social relations across the
nation was also mentioned. Being able to care for, raise, marry and settle children was
stressed over and over again.

Social wellbeing included social respect and being part of a community. The stigma of
poverty was a recurring theme, and participants frequently spoke about the shame of asking
for help and accepting charity. Many spoke of how their poverty prevented them from
participating fully in society, and the humiliation brought on by being unable to follow the
traditions and customs of their culture. They spoke about their inability to exchange gifts and
presents, and how in consequence they stay away from celebrations, weddings and festivities.

The poor also spoke about discrimination, being denied opportunities and facing
humiliating treatment by officials. There was a widespread experience of being treated badly,
whether by guards or by uncaring doctors, nurses, schoolteachers, and traders.

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7. OVERVIEW OF GLOBAL HEALTH RISKS

The following selection is from the World Health Report 2002 published by the World Health
Organization. The report identifies the top ten risks to health, globally and regionally, in
terms of the burden of disease they cause.

The ten leading risk factors globally are:


1. underweight
2. unsafe sex
3. high blood pressure
4. tobacco consumption
5. alcohol consumption
6. unsafe water, sanitation and hygiene
7. iron deficiency
8. indoor smoke from solid fuels
9. high cholesterol
10. obesity

Underweight
In the world today there are 170 million children in poor countries who are under weight,
and 3 million of them die each year as a result. 27% of all children below five years of age
are under weight.
At the same time there are 1 billion adults who are overweight, and half a million people in
the US and Western Europe die each year from diseases caused by obesity.

Unsafe sex
Unsafe sex is the main factor in the spread of HIV/AIDS, and the biggest impact is in the
poor countries of Africa and Asia. 70% of the people infected with HIV are in Africa, but
the number of new cases is increasing rapidly in Eastern Europe and central Asia

1. Why do you think HIV infection is much higher in poor countries than in
rich countries?
__________________________________________________________________________________
__________________________________________________________________________________

In both Africa and Asia, unsafe water, sanitation and hygiene, iron deficiency, and
indoor smoke from solid fuels are among the ten leading risks for disease. All are much more
common in poor countries and communities than elsewhere.

Unsafe water, sanitation and hygiene


About 1.7 million people die each year because of unsafe water, sanitation and hygiene,
mainly through infectious diarrhea. Nine out of ten such deaths are in children, and almost
all of the deaths are in developing countries.

Iron deficiency
Iron deficiency is one of the most common nutrient deficiencies in the world, affecting an
estimated two billion people, and causing almost a million deaths a year. Young children
and their mothers are the most commonly affected because of the high iron demands of
infant growth and pregnancy.

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Indoor smoke from solid fuels
Half the world’s population is exposed to indoor air pollution, mainly the result of burning
solid fuels for cooking and heating. Globally, it is estimated to cause 36% of all lower
respiratory infections and 22% of chronic obstructive pulmonary disease.

2. What are examples of solid fuels used for cooking and heating?
__________________________________________________________________________________

Meanwhile there are other diseases caused by “over nutrition” or, “over
consumption”. Overweight and obesity effect health and lead to increases in blood pressure,
high cholesterol levels, heart disease, strokes, diabetes, and many forms of cancer.

Obesity
Obesity is killing about 220,000 men and women a year in the United States of America
and Canada alone, and about 320,000 men and women in 20 countries of Western Europe.
High blood pressure and high blood cholesterol are closely related to excessive
consumption of fatty, sugary and salty foods.

Alcohol
Global alcohol consumption has increased in recent decades, with most or all of this
increase occurring in developing countries. Worldwide, alcohol caused 1.8 million deaths in
2002; the proportion was greatest in the Americas and Europe. Alcohol was estimated to
cause, worldwide, 20–30% of esophageal cancer, liver disease, epilepsy, motor vehicle
accidents, and homicide and other intentional injuries.

3. What diseases are caused by alcohol consumption?


__________________________________________________________________________________
__________________________________________________________________________________

Today there are new problems for health. The rapid increases in international travel
and trade in the last few decades mean that infectious diseases can spread from one continent
to another in a matter of hours or days, whether they are conveyed by individual travelers or
in the cargo holds of aircraft or ships.

Increasingly, tobacco, alcohol and some processed foods are being sold by
multinational companies to low and middle income countries. These changes of consumption
and lifestyle are associated with a rise in obesity and hence, diseases such as cancers, heart
disease, stroke, mental illness, and diabetes.

Until recently, diseases related to high blood pressure, high cholesterol levels,
tobacco, alcohol and obesity, had been thought to be most commonly found in developed
countries. Unfortunately, these diseases are now becoming more common in developing
nations. For many countries, these new diseases are creating a “double burden”. Not only do
countries have to struggle to control the diseases that burden the poor, they also have to
respond to rapid growth in ‘modern’ diseases.

What is the double burden that many developing nations now face?
__________________________________________________________________________________
__________________________________________________________________________________

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8. FOUR PROBLEMS WITH THE SYSTEM

Poor people describe four problems that affect their lives: corruption, violence,
powerlessness, and insecure livelihood.

1. Corruption
Corruption is a central poverty issue. In country after country, and community after
community, poor people spoke of corruption: in the distribution of seeds; in medicines and
social assistance for the destitute and vulnerable; in getting loans; in getting teachers to teach;
in getting permission to move in and out of cities; in street and market trading; in identity
cards.
In many places, the poor reported having to pay managers, hooligans and the police
protection money to save themselves from the worst forms of harassment, theft and abuse.
Since the poor lack money they cannot afford justice. People laughed at the idea of
getting support from political representatives. In Egypt, people said, “when they reach their
seats the parliamentarians forget us.”

1. What examples of corruption do people face in the community you live in?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

2. Violence, Civil Conflict and Public Safety


“I do not know whom to trust, the police or the criminals. Our public safety is ourselves. We
work and hide indoors.” – Brazil.

In many countries in both rural and urban areas poor people reported increases in
crime, lawlessness, selfishness and violence. This is reflected in violence and public safety
issues both outside and inside the home.
In Nigeria, old men said, “We poor men have no friends. Our friend is the ground.”
In Zambia the poor said, “When food was in abundance relatives used to share it. These days
of hunger not even relatives would help you.”
A startling finding was the extent to which poor people experience police as a cause,
of harm, risk and impoverishment. In Nigeria, the poor associated the police with illegal
arrests, intimidation and extortion; in Bangladesh, the poor feared the police because of false
cases that they can bring, especially when the poor try to file cases against the rich.

2. Why do you think the police in a community might intimidate and harm
the poor, instead of protecting them?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

3. Powerlessness

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The poor want desperately to have their voices heard, to participate, to make decisions
and not always be handed down the law from above. They are tired of being asked to
participate in other people’s projects on other people’s terms. Participation to them has costs
with few returns. In Egypt the poor said, “We are tired of self-help initiatives.”
People in Ecuador, said: “We are a community abandoned by the governmental
authorities. They don’t consider us. We seem not to exist, we are an imaginary community.”
Most important and trusted were people’s own local organizations, including unions,
farmers associations, midwives, traditional institutions, and religious institutions.
The Voices reveal that in much of today’s world there is a hunger among the poor, not
only for food, but for freedom, dignity, voice and choice.

3. “To the poor, participation in other people’s projects has costs with few
returns.” What does this statement mean?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

4. Insecure Livelihood
The poor typically have few assets to make a living. Many people do low paying,
dangerous work for low returns. All over the world, the poor said that insecurity had
increased, and that economic opportunities had decreased. Most blamed are: governments for
mismanaging the economy and for high taxes, and privatization; declining agricultural
productivity; corrupt government services; lack of government care for the poor.
People survive through an enormously wide range of activities – small-time vending,
doing odd jobs, carrying bricks and sand, working in quarries and mines, borrowing from
neighbors and moneylenders, working two or three jobs, growing vegetables on little plots,
collecting grass, herbs, and bamboo shoots, catching wild animals, selling cooked food,
making crafts, working in factories, begging, putting children to work, praying for rain,
surrendering to prayer, reducing the number of meals, selling their own blood, and in
desperation engaging in criminal activities, including prostitution.
In most countries, the poor value education as a potential route out of poverty. But
sending a child to school can imply serious costs, both in terms of school fees, clothes,
supplies and in the form of income loss.

4. How do the poor in your community find ways to earn money for their
survival?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

9. HEALTH FOR ALL

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About WHO

The World Health Organization (WHO) is the United Nations specialized agency for health.
It was established on 7 April 1948. WHO's objective, as set out in its Constitution, is the
attainment by all peoples of the highest possible level of health. Health is defined in WHO's
Constitution as a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.

WHO is governed by 192 Member States through the World Health Assembly. The Health
Assembly is made up of representatives from WHO's Member States.

Countries
All countries that are Members of the United Nations may become members of WHO by
accepting its Constitution. Other countries may be admitted as members when their
application has been approved by a simple majority vote of the World Health Assembly.

Health for all (HFA) in the 21st century


Over half a century ago, in 1946, the Constitution of the World Health Organisation was
adopted by the Member states.

The constitution proclaimed that "the enjoyment of the highest attainable standard of health"
was " one of the fundamental human rights of every human being without distinction for
race, religion, political belief, economic or social condition". The Constitution also noted that
"the health of all peoples is fundamental in the attainment of peace and security and is
dependent upon the fullest cooperation of individuals and states".

Health for All was adopted in 1977. In 1978 there was an international conference on Primary
Health Care, held in Alma Ata in Russia. Health for All was launched at this conference.
Although the WHO Constitution claimed there should be health for everyone, large numbers
of people and even whole countries were not enjoying an acceptable standard of health. The
Declaration of Alma Ata was created. By the late 1970s nearly 1 billion people were living in
poverty.

The HFA renewal process was launched in 1995 to ensure that individuals, countries and
organisations were prepared to meet the challenges of the 21st Century. All participants have
emphasised the need for Health for All to remain the central vision for health in the next
century.

The WHO believes that achieving health for all people is important for the world
to have peace and security. Do you agree with this statement? Why / why not?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

10. DIFFERENT VIEWS ON HEALTH

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Across cultures and throughout history, health and the causes of illness have been understood
in different ways.
Modern western medicine understands health and illness from a scientific point of view.
The science of medicine uses knowledge of body systems and diseases, and the causes
of diseases.
Doctors use many techniques including physical examination, laboratory tests, analysis
of data, and medical knowledge to diagnose illnesses and decide on treatment.

There are many other medical practices, often classed as alternative medicine, or traditional
medicine. These practices are often based on cultural, spiritual or religious beliefs, and reflect
different cultural understandings of health and illness.

TraditionalChinese medicine is the name given to a range of traditional medical practices


developed in China over several thousand years. Chinese medicine considers both the
human body and its relationship with the environment when attempting to explain illness,
treatment and prevention of disease.

Ancient Egyptians believed that ill health was caused by demons, and treatment took the
form of chanting and foul lotions to drive out the demons.

Faith/spiritual
healing is the use of spiritual means to cure disease. It is the belief that some
people can cure disease through a ‘healing force’.

Some cultural variations in health concepts:

Black Americans understand health as maintaining feelings of well-being, the ability to fulfil
role expectations, and freedom from pain and excessive stress.

Chinese understand health as maintaining a balance between Yin and Yang in the body and in
the environment. Harmony is important to the body, mind and spirit.

Gypsies (Roma) understand health as maintaining moral purity and practicing good
behaviour. Good health also means prosperity and large families.

Hmong understand health as being able to perform expected routines and duties.

Samoans understand health as related to the mind, body and spirit; and good relationships
with the family, environment and spiritual world.

How do people in your community understand ‘health’?


__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

11. COMMUNICABLE DISEASES

17
What is a disease?

A disease is an illness that affects humans, plants or animals. It has a specific cause, such as
infection, and can be identified by certain symptoms.

What are symptoms?

A symptom is a change in your body or your mind that shows that you are not healthy. For
example, coughs or fevers are symptoms of various diseases.

What cause diseases?

A cause is the reason why something happens. The cause of a disease is the reason why the
disease happens. There are many causes of diseases, for example, viruses, bacteria, and
parasites are causes of diseases.

What are micro-organisms?

A micro-organism is a tiny, single celled living thing, which usually can only be seen under a
microscope.

What are communicable diseases?

A communicable disease is a disease caused by a microorganism or a parasite, and can easily


be transmitted from one person to another.

Parasites, bacteria, and viruses can all cause communicable diseases.

What is transmission?

Transmission is the way the cause of a disease is passed from one person to another. Different
diseases are transmitted in different ways.

Some diseases are air-borne. This means the disease is spread when we cough, sneeze, laugh,
or speak. Air-borne diseases include: common cold, flu, sore throats and TB
Other diseases are water-borne. This means the disease is spread in water. Water borne
diseases include typhoid and cholera, hepatitis A and E
Typhoid, hepatitis A and E and food poisoning are also spread through contaminated food.
Some diseases are spread through blood, others can be carried by insects.

Remember, some diseases are not communicable. This means they are
not caused by micro-organisms and cannot be transmitted from one
person to another. Cancer, heart disease and diabetes are not
communicable; you cannot ‘catch’ these diseases from another person.

Bacteria
Bacteria are single cells. They are found everywhere – in the air, land and water, and most are
harmless. Bacteria occur naturally in our intestines, and are important to the digestive system.
But some bacteria cause diseases. These bacteria produce toxins that harm the body.

18
Normally the body can fight harmful bacteria, but if it can’t, medicines called antibiotics are
necessary.
Bacterial illnesses include: infections, sore throats, TB, cholera, typhoid, food poisoning,
tonsillitis, and pneumonia

Viruses
Viruses are much smaller than bacteria. Viruses invade the cells of living organisms and
reproduce. They then damage and destroy the cell, and the new viruses are released into the
body. Viruses are covered by a protective shell.
Many drugs have been developed to fight bacteria, but there are not many to treat viruses.
Some diseases caused by viruses can be prevented by immunization.
Viral illnesses include: Common cold, flu, Chicken pox, polio, rabies, hepatitis, HIV/AIDS
and dengue fever
These diseases cannot be cured using antibiotics.

Parasites
Parasites are organisms that live on or in another living creature, causing the creature harm.
Some parasites cause few symptoms, while others cause disease or even death.
Parasites that effect humans include worms, leeches, lice and mites.
Viruses and fungi can also be considered parasites.

Antibiotics
Antibiotics are a type of medicine used to treat diseases and infections caused by bacteria.
Penicillin is a well known example of an antibiotic drug.

Some common illnesses – Fill in the blank spaces using your own knowledge.

Influenza – flu
Cause Virus
Symptoms Fever, headache, muscle ache
Transmission By infected droplets from coughs or sneezes

Dysentery
Cause Bacteria or parasite
Symptoms Diarrhea (often with blood) and abdominal pain
Transmission _________________________________________________________

Common Cold
Cause Virus
Symptoms _________________________________________________________
_________________________________________________________
Transmission _________________________________________________________

Malaria
Cause Parasite
Symptoms _________________________________________________________
_________________________________________________________
Transmission Carried by mosquitoes

12. TUBERCULOSIS

19
Name of disease: Tuberculosis (TB)

Cause: Bacteria called Mycobacterium tuberculosis

Symptoms: Early infection does not usually display symptoms.


Later there are symptoms including: coughing
(often bringing up blood), chest pain, shortness of breath, fever
and sweating, poor appetite, and weight loss.

Transmission: TB bacteria is spread through the air, from one person to


another. This occurs when an infected person coughs or
sneezes. When a person breathes in TB bacteria, the bacteria
can settle in the lungs and begin to grow. From there the
bacteria can move through the blood to other parts of the body,
such as the kidney, spine, and brain.
TB in the lungs or throat can be infectious. TB in other parts of
the body, such as the kidney or spine, is usually not infectious.
People with TB disease are most likely to spread it to people
they spend time with every day. This includes family members,
friends, and co-workers.

Latent TB
For most people who breathe in TB bacteria and become infected, the body can fight
the bacteria to stop them from growing. The bacteria become inactive, but they remain
alive in the body and can then become active later. This is called latent TB infection.
People with latent TB infection have no symptoms, don't feel sick and can't spread TB
to others.
Many people who have latent TB infection never develop TB disease. In these people,
the TB bacteria remain inactive for a lifetime without causing disease. But in other
people, especially people who have weak immune systems, the bacteria become active
and cause TB disease.

TB disease
TB bacteria become active if the immune system can't stop them from growing. The
active bacteria begin to multiply in the body and cause TB disease. Some people
develop TB disease soon after becoming infected. Other people may get sick later,
when their immune system becomes weak for some reason.
Babies and young children often have weak immune systems. People infected with
HIV, the virus that causes AIDS, have very weak immune systems. They are more
vulnerable to TB disease.
TB and Burma
Treatment: Treatment is through taking a course of drugs, and takes 2-6 months.
TB is no longerTB
Unfortunately a bacteria
big problem in developed
are becoming countries,
resistant and most
to the drugs used, children are vaccinated
which makes it
against TB. But to
more difficult in cure.
developing countries
If the drugs TB is correctly,
are taken still a big most
problem.
patients recover. One
problem is that many patients do not take the course of drugs correctly.
According to the World Health Organization (WHO), there is a very big TB problem in South
East
TB Asia.
can beThere are 8 by
prevented million casesvaccination.
the BCG of TB in the world, and about 40 percent of these cases
live in South East Asia. Every year there are 3 million new cases. The countries in South East
Asia with the biggest TB problems are: Bangladesh, Burma, India, Indonesia, and Thailand.

20
Burmese government sources claim that there are about 100,000 new TB cases in Burma
each year. But, non-governmental organizations in the region estimate the number of cases to
be much higher than the government's figures. The WHO estimates that about 20,000 patients
are dying of TB each year in Burma.

The Burmese government claims to have its own national TB program, but it is extremely
understaffed, and most patients cannot afford the drugs that the government claims to be
providing free of charge. Some TB clinics in Burma are operated by Medicines Sans
Frontiers (MSF) and WHO programs.

Some patients were found to have multi-drug resistant TB. This means the drugs used to treat
TBName
wouldof disease: Malaria
no longer work to kill the TB bacteria in some patients. Many people are very
concerned about this problem. One reason for this problem is the misuse of TB drugs. If
Cause:do not take the Parasites
patients medicinecalled Plasmodium.
correctly, forget to There
take it,are
or 120
stoptypes
takingof the
Plasmodia,
medicine too
soon, the medicine cannotandwork
4 types cause
properly. Thenmalaria. Most
it is very common
difficult andthedangerous
to cure person of isTB.
Plasmodium Falciparum.
To try to stop the problem of drug resistancy the WHO has been helping Burma to set up TB
control centers to implement
Symptoms: Fever,a Directly Observed
shivering, pain inTreatment Shortheadache,
the joints, Course (DOTS)
and maybestrategy in
every township. DOTS vomiting
strategy means that health workers monitor TB sufferers and make
sure that they take their medicine correctly, and for the prescribed length of time. DOTS has
shown an 80% success rate,
Transmission: andparasites
Malaria could greatly reduce thefrom
are transmitted mortality rate and
one person infectionbyrate of
to another
TB. mosquitoes. The type of mosquitoes that carry the malaria
parasite are called Anopheles. Only the female Anopheles
Meanwhile, a report of the Burma Ministry
mosquitoes of Health revealed that it spends 25 million Kyats
spread malaria.
annually in funding medicines for TB.
Remember, theBut, the WHO
mosquito doesestimates
not cause that US$3.2but
malaria, million is needed
it carries
to treat TB in Burma. the parasite that causes malaria.
The female Anopheles mosquito bites humans because it needs
the proteins in human blood to be able to produce eggs. If the
human that the mosquito bites has malaria, some of the malaria
parasites will enter the mosquito.
If the same mosquito then bites another human, some of the
parasites will enter the blood stream of this human, and s/he
will develop malaria.

After malaria
References: parasites
Burma throughenter a human’s
a volunteer bloodeyes,
doctor’s system they are carried Mizzima
http://nrdgp.org.au, to the liver.
NewsIn
the liver
Group they enter
– March the and
24 2000 cellsWHO
and multiply
- 2002 (reproduce). After 9-16 days they return to
the blood and enter the blood cells. In the blood cells they multiply again and destroy
the blood cells.
13. MALARIAof the blood cells causes the victim to suffer fevers and anaemia.
The destruction

Sometimes the infected cells obstruct the blood vessels in the brain. This is called
cerebral malaria.

Malaria is diagnosed by the symptoms and by examining the blood under a


microscope.

Treatment: Malaria can normally be cured using anti-malarial drugs. The


symptoms, fever, shivering, pain in the joints and headache, quickly disappear once
the parasite is killed.
Unfortunately malaria parasites in some regions are becoming resistant to some of the
drugs used, particularly chloroquine. This means the drugs can no longer kill the
parasite, which makes it more difficult to cure. One reason for this is that many 21
patients do not take the course of drugs correctly.
Patients in these areas require treatment with other more expensive drugs.
Malaria around the world

Approximately 300 million people worldwide are affected by malaria and between 1 and 1.5
million people die from it every year. Malaria used to affect many parts of the world, but now
it is mainly confined to Africa, Asia and Latin America. It is difficult to control malaria in
these countries because the countries are poor and have inadequate health structures.

Malaria has been known throughout history, but it is only in the last 120 years that the true
causes were understood. Previously, it was thought that malaria was caused by bad air or gas
from swamps.

The malaria parasite was discovered in 1889 by Laveran. In 1897 Ross demonstrated that the
mosquito carried the malaria parasite. After these discoveries people began to work to
eliminate malaria. During World War II, DDT was invented, and the cheap, effective drug
chloroquine was developed.

But, by 1969, it was realized that malaria would never be completely eradicated. Although
malaria had been eliminated from some areas in the world. There are still many programs
around the world to try to control malaria. Malaria is still found in 91 countries.

22
Eighty per cent of the cases of malaria occur in tropical Africa, where malaria accounts for
10% to 30% of all hospital admissions and is responsible for 15% to 25% of all deaths of
children under the age of five, making this disease one of the major causes of infant and
juvenile mortality.

In 1990, 75% of all recorded cases outside of Africa were concentrated in nine countries:

• India, Brazil, Afghanistan, Sri Lanka, Thailand, Indonesia, Vietnam,


Cambodia, China

Malaria is still a serious health problem in many parts of the world. The problems are
generally associated with poverty and deteriorating social and economic conditions. The main
victims are poor rural populations. A lack of adequate health services frequently results in
sufferers self-administering drugs, which means they often take an incorrect or incomplete
treatment. This is a major factor in the increase in resistance of the parasites to previously
effective drugs.

Reference:http://www.micro-msb.le.ac.uk/224/malaria.html

Malaria statistics for India, Thailand and Burma

Malaria is a public health problem in Thailand.


Country population: 60.6 million
Population in malarious areas: 41.5 million
No. of deaths due to malaria : 625 reported and 687 estimated deaths in 2000
No.of malaria cases: 81,692 reported and 200,000 estimated cases in 2000

The data showed a decrease in total cases since 1989. But the malaria situation became worse
after 1995. The reported cases went up from 82,743 in 1995 to 131,055 in 1998.
A high malaria transmission area was found along the international borders where more than
40,000 imported cases were reported in 1998. The majority of cases were forest-related and
reported from Thai-Myanmar border and Thai-Cambodia border.

Malaria is a health problem in forest related areas of India, particularly in the North East –
states of Bihar, Orissa, Gujarat, Maharastra, and Mdya Pradesh.
Population: 1,027 million in 2001
Population in malarious areas: 973.1 million in 2000

23
No. of deaths due to malaria: 946 (reported) and 20,000(estimated) deaths in 2000
No. of malaria cases: 2,019,066 reported and 15,000,000 estimated cases in 2000

Around 2,500,000 confirmed cases are reported annually. The situation was deteriorating
until 1991 but then started improving.

Malaria is a health problem particularly in the border and forest areas, in Burma.
Country Population: 50.125 million in 2000
Population in malarious areas: 35.5 million in 2000
Name
No. of disease:
of deaths Acquired
due to malaria: immune
2,748 deficiency
reported syndrome
and 5000 (AIDS).
estimated deaths in 2000
No. of malaria cases : 120,029 reported and 2,931,305 estimated cases in 2000
Cause: Human immunodeficiency virus (HIV). HIV infects cells of the
immunecases
More than 1,500,000 clinical system and(the system laboratory
120,000 that fights diseases)
confirmedand destroys
cases or
are reported
annually reduces their function. HIV infection slowly destroys the
immune system, so the body cannot fight disease. Someone
infected with the HIV virus is said to be HIV positive.
Look at the statistics above.
Symptoms: Many people do not show any symptoms when they are first
1. Which country hasinfected
the biggest population?
with HIV. Some may display flu-like symptoms.
__________________________________________________________________________________
Most people infected with HIV develop symptoms of AIDS
within 8 – 10 years (although the length of time can vary).
2. Which country hasSigns
the highest
of AIDSestimated number
include a range of cases
of illnesses, of malaria
which in
are the result
relation to the size of its population?
of a deficient immune system. These include cancers,
_________________________________________________________________________________
infections, pneumonia and diarrhea.
Diagnosis
3. What is the difference of HIV
between theinfection
reportedis through
numbersa blood test. estimated
and the Diagnosis of
numbers? AIDS is based on a positive HIV test, and the presence of
diseases common to AIDS sufferers.
_________________________________________________________________________________

Transmission: The HIV virus is transmitted through sexual intercourse; blood


transfusion; the sharing of contaminated needles in drug
Reference: http://w3.whosea.org/malaria
injection; and, between mother and infant, during pregnancy,
14. HIV/AIDS childbirth, and breastfeeding. Sharing of infected blood through
blood transfusion or injecting drugs is the most efficient way of
transmitting HIV. The virus is not transmitted through air or
water or by casual contact.
The most common mode of transmission of HIV is
sexual. Lesions caused by rough sex or rape can also increase
the probability of HIV transmission. The virus tends to be more
easily transmitted from males to females during sexual
intercourse than vice versa.

Treatment: Currently, there is no cure for HIV/AIDS. But, there are drugs
called, antiretrovirals, that slow down the effect of the HIV virus, and increase the
time between HIV infection and development of AIDS.

VCT: VCT stands for Voluntary Counseling and Testing. VCT is very
important and it is hoped that it can help to reduce the spread of HIV.
One problem with the spread of HIV is many people who are infected with the virus
do not know they have the disease and are afraid to take a test to find out. VCT
encourages people to take a voluntary, confidential HIV test, to find out whether they
have the virus.
Before the test they are counseled about the facts of the disease and the implications if
they are positive. After the test, if someone is found to be positive, they can get 24
support and advice on how to cope with the disease. Where drugs are available they
can receive medical support.
HIV/AIDS statistics

HIV/AIDS was first identified in the early 1980s, but it took another ten years for the world
to realize how serious the disease was, and to work together to try to prevent HIV
transmission.

In 2000 it was estimated there were 3 million deaths due to AIDS, and 5.3 million newly
infected individuals. 36.1 million individuals were thought to be living with HIV or AIDS.

The vast majority of people living with HIV/AIDS are in Africa and South and South-East
Asia: 70 percent of people living with HIV or AIDS are in Sub-Saharan Africa; about 15
percent of people living with HIV or AIDS are in South and South-East Asia.

About 11 million people in Asia could become HIV-infected in the next five years (2003-
2007) unless action to reduce HIV/AIDS is dramatically increased.

One-third of the people living with HIV/AIDS are young people aged between 15–24
years. The new infections included an estimated 800,000 children - over 90% of them
infected through mother-to-child transmission (MTCT).

25
Average life expectancy is now 47 years in sub-Saharan Africa – compared to the 62 years
it would have been without AIDS. In the early 1950s, life expectancy in South Africa was
44 years. By the early 1990s, it had risen to 59 years. Now a child born between 2005 and
2010 can once again expect to die before his or her 45th birthday.

As of end 2002, 1.6 million people were estimated to be living with HIV/AIDS in high-
income countries: North America (980,000), Western Europe (570,000), Australia and New
Zealand (15,000).

HIV/AIDS and poverty

As with so many diseases, it is the poor that are worst effected by AIDS. The vast majority of
people living with HIV/AIDS are in developing countries, and their families are often unable
to cope financially with medical expenses and loss of earnings. AIDS inflicts the poor and
deepens and spreads poverty.

Sub-Saharan Africa is the worst affected region in the world. Of the estimated 29.4 million
people living with HIV/AIDS in Africa, 10 million are between the ages of 15-24 and 3
million are below the age of 15. AIDS could claim the lives of around a third of today’s 15
year-olds in Africa unless actions are taken to slow the epidemic.

AIDS also increases poverty through the rise in the number of children who lose one or both
parents. Evidence shows that orphans have significantly lower enrollment rates in schools
and are more likely to be malnourished than non-orphans. Lack of schooling and inadequate
nutrition makes it more difficult for orphans to escape poverty.

Poverty increases vulnerability to HIV infection. Poor people are less educated, lack health
education, and do not know about HIV or how to protect themselves. Around the world

26
people are dying from a disease they have never heard of. Poverty forces women into the sex
trade, and often these women lack the knowledge or rights to protect themselves from HIV
infection.

HIV prevalence in some countries has rapidly increased due to governments’ denials of the
seriousness of the problem. Social stigma, misunderstandings and discrimination hinder
projects to educate and reduce the spread of HIV.

Economic problems and under-funded health services in many countries in the developing
world means that there is insufficient education, treatment, and care to bring the spread of the
disease under control.

Human Rights and HIV/AIDS

People living with HIV/AIDS don’t just have to live with a disease they also have to live with
the stigma associated with the disease. A stigma is the feelings of disapproval that other
people in society have, in this case, towards people with HIV/AIDS.

Because of this, people living with HIV face discrimination, and very often, denial of their
rights. They are often denied equality before the law, work, access to education, access to
health care, and social security.

One reason for this stigma and discrimination is that HIV/AIDS is often associated with
drugs and prostitution, so there is the – incorrect - belief that people with the disease are
immoral or bad. Another reason is the lack of understanding and fear that surrounds
HIV/AIDS. It is a very deadly disease, and people are afraid of it.

Unfortunately, this fear and discrimination makes it more difficult to control the disease.
Therefore, an important part of reducing the spread of HIV is educating people with the facts
of the disease, working to overcome discrimination and stigma, improving the rights of
sufferers, and providing a social system that supports people living with HIV/AIDS.
HIV/AIDS – The Case of Uganda

Uganda is one of the countries hardest hit by HIV/AIDS. It is estimated that there are 1.6
million people with HIV living in Uganda. Fortunately the government has a policy of
openness on AIDS, and there is a lot of political support for controlling the disease. There
are many strategies to reduce the spread of HIV, encourage community involvement, and
promote research.

In 1996, Uganda had a population of about 21.3 million people with four main ethnic groups
and over twenty tribes. Civil wars have directly affected the economic status of the country,
resulting in high poverty levels in some areas.

Ninety-one percent of Ugandans live in the rural areas, with the majority involved in
subsistence farming. There is a clear difference between the urban rich and the rural poor,
with the literacy level low in rural areas. About 49% of the people have access to basic health
services.

27
The first AIDS cases in Uganda were recognized in 1982. At this time there was a ‘silence’
about the disease, until 1986. This silence may have contributed to the rapid spread of AIDS
in the country.

When President Museveni came to power he acknowledged the existence of AIDS in the
country. He immediately requested a conference and this led to the establishment of the
National AIDS Control Program (NACP), supported by WHO’s Global Program on AIDS.

A huge AIDS prevention campaign soon followed. This campaign dealt almost exclusively
with prevention of transmission and advised people to ‘love carefully’ and ‘love faithfully’. It
gave little regard to the fact that there were already people being diagnosed with HIV/AIDS.

The impact of this campaign increased fears among the population and resulted in
discrimination and stigmatization of people with HIV/AIDS. Families failed to care for their
loved ones and many health care workers expressed prejudice in using resources to care for
AIDS patients who were ‘going to die anyway’.
Then, community groups began to be formed to fill the gap in services. In early 1987,
Christopher Kaleeba, who had been diagnosed with AIDS died at Mulago hospital. Before his
death, he and his family had experienced stigma and rejection, which had led them to seek
support and to need to share their agony with other families with similar experiences.

They formed a support group named TASO (The AIDS Support Organization) and began to
advocate for care and support, not only for AIDS patients, but also for persons and families
living with HIV. They did this by example and practically demonstrating what could be done.
This triggered a powerful care and support movement under the slogan ‘living positively and
dying with dignity’. AIDS service organizations, covering activities ranging from awareness
promotion, counseling and testing, legal advice, and care and support of infected and affected
persons sprang up. Moral support and technical guidance was provided by the government
through the NACP.

Today, over 80% of people in Uganda are aware of HIV, and there has been a change in
sexual behaviour within the country.
Measures of success
The political commitment of the Government of Uganda, combined with the efforts of
the donor agencies, international and local NGOs, PLWHAs (people living with HIV/AIDS),
and religious organizations in the struggle against HIV/AIDS in the last decade has
contributed to the following successes:

The HIV/AIDS awareness level is above 80%.


All health units demand sterile and/or disposable syringes and needles.
Traditional Birth Attendants demand protective hand gloves for delivery.
Traditional surgeons for circumcision use sterile or one knife for each candidate
instead of the old tradition of one knife for many candidates.
There is an increased demand for voluntary testing and testing facilities.
More and more couples are being screened before marriage.
Also a high demand for condoms is reported at testing sites.
A decline in HIV incidence among the age groups of 13–19 and 19–24 years.
Increased counseling services have increased coping mechanisms for the PLWHAs.

28
Formation of independent networks of PLWHAs has led to increased self-esteem, a sense of
belonging, shared confidentiality and breaking of the stigma associated with HIV/AIDS.
Recent studies have shown declining prevalence rates among women.
Other studies have also shown declining HIV prevalence rates.
68% of survey respondents reported change in behavior in the last five years in response to
HIV/AIDS. Changes included faithfulness, abstinence, and condom use.
There has been a significant delay in the age at first sexual intercourse. A smaller proportion
of the 15–19 years age group report sexual intercourse compared with 1989.

1. What may have been an effect of the ‘silence’ in Uganda about the disease?
__________________________________________________________________________________

2. What was the result of the huge AIDS prevention campaign in Uganda?
__________________________________________________________________________________
__________________________________________________________________________________

3. List everything that was done in Uganda to increase awareness and reduce the
spread of HIV/AIDS.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

HIV/AIDS and extractive industries in Kachin State.

There is a strong correlation between the incidence of HIV/AIDS in Burma and the presence
of extractive industries including logging and mining, particularly on the China-Burma
border. There are serious health implications for China as well as Burma, as most of the
labourers are migrant Chinese workers. The speed and extent of HIV/AIDS spread
throughout the Chinese population is compounded by the presence of truck drivers,
transporting timber and other resources hundreds of miles from Burma to Kunming.

Working conditions can be severe and men frequently use drugs to escape from these
hardships. Drugs are readily available and drug use is on the increase, not only amongst the
logging and mining communities but also in the local population. This further increases the
risk of HIV/AIDS infection particularly through the sharing of dirty needles.

Seasonal migrant workers are particularly at risk of contracting HIV/AIDS. Workers in the
timber industry, and in the jade and ruby mining areas of Shan and Kachin States and
Mandalay Division are mostly young single men or married men living away from home.
Commercial sex workers have been attracted by the large numbers of potential clients. This

29
also increases the risk of infection. All the Chinese towns on the China-Burma border have
large numbers of prostitutes servicing the logging industry. Sex workers interviewed by
Global Witness in towns such as Tengchong, Pian Ma and Dian Tan had a very poor
understanding of how HIV/AIDS is contracted.
BURMA: Myanmar's secret plague Aug, 23 1997
AS IF life in Myanmar was not grim enough, with its poverty and its brutal government, it
now turns out to have an AIDS epidemic. Thousands of young adults have died without ever
having heard of the disease that killed them, let alone of ways to prevent it. In parts of
Myanmar, funerals of people in their 20s or 30s are an everyday occurrence.

The disease took root in the late 1980s, among intravenous drug-takers. Myanmar is at the
heart of the "golden triangle" of poppy farming. Addicts started injecting refined heroin rather
than smoking opium. Many shared dirty needles, or visited professional injectors who would
use one syringe for a number of customers. As early as 1989, 96% of drug-injectors tested in
a prison in the town of Bahmo were HIV-positive, destined therefore to get AIDS. Now
almost two-thirds of Myanmar's drug-injectors are estimated to carry the virus, the highest
rate of infection in the world.

Sexual contact has transmitted the disease from drug-takers into the general population. The
rate of HIV infection among prostitutes, people with venereal diseases and pregnant women
suggests that heterosexual contact has become the most common form of transmission.

The government was slow to acknowledge that there is an epidemic. It says that, up to
September 1996, Myanmar had 13,773 people with HIV and 1,612 had AIDS. However, the
government's National Aids Programme offers a different picture. Since 1992 its small but
dedicated staff has been testing high-and low-risk groups in 19 places in the country twice a
year. Its unpublished results indicate that at least 500,000 people in Myanmar are carrying
HIV. Even that figure is probably an under-estimate, since it does not include children and
homosexuals. It also omits those, believed to be many thousands, who have died of AIDS.

15. CHILD HEALTH

Many social indicators that evaluate the quality of life in the developing world deal
with children. Indeed, children are the most vulnerable members of society and they suffer
more from the effects of poverty. Children are also very important to the future of society.
The way children are raised today can have a big impact on the future.

“Much of the next millennium can be seen in how we care for our children today.
Tomorrow’s world may be influenced by science and technology, but more than anything, it is
already taking shape in the bodies and minds of our children.” – Kofi Annan, Secretary-
General of the United Nations

Why is focusing on child health important?

The world community has recognized that children need special care and protection.
This is because young children are very dependent on adults for their survival and for

30
guidance to become independent healthy human beings. Children suffer, more than adults,
when faced with poor living conditions, poverty, lack of safe water, and pollution.

Changes around the world, such as the global economy, floods and droughts, and
recurring armed conflicts have forced many people to leave rural areas and move to cities.
People dream of better futures in the cities, but these dreams are often not realized. People
live in poverty in slums and children are forced to scavenge and beg.

The Convention on the Rights of the Child is the most widely accepted human rights
document. It has been ratified by every country in the world, except two. Governments have
committed themselves to protecting and ensuring children’s rights. But, despite a lot of effort
from organisations around the world, and many achievements, in many countries children
still live in appalling conditions.

Statistics on child health

− Globally, an estimated 12 million children under the age of five die every year, mostly of
easily preventable causes.
− Some 130 million children in developing countries are not in primary school and the
majority of them are girls.
− About 160 million children are severely or moderately malnourished.
− In some States children are beaten and arbitrarily detained by police and forced to share
prisons with adults in inhumane conditions.
− Many unwanted children languish in orphanages and other institutions, denied education
and adequate health care. These children are often physically abused.
− An estimated 250 million children are engaged in some form of labor.
− Last year, about 300,000 children served as soldiers in national armies. Many of these
children were killed or maimed in combat; and many children were forced to kill and
maim others.

As is often the case, improvements in child health have mostly been in wealthier countries.
Children who live in poorer countries suffer and die more often from diseases that can easily
be prevented. According to the World Health Organization (WHO), 70% of all childhood
deaths are due to five easily preventable and/or treatable causes.

Perinatal/Neonatal Deaths
The perinatal period is the first week after birth and is the most risky time of all. 22%
of all child deaths occur during this period, nearly all in developing countries.

Malnutrition/Low Birth Weight


Malnutrition is an underlying factor in the majority of childhood illnesses, and being
underweight and/or being deficient in essential vitamins and minerals greatly increases child
mortality. Vitamin A deficiency increases the risk of dying from diarrhea, measles and
malaria, and zinc deficiency increases the risk of death from diarrhea, pneumonia and
malaria.

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Diarrheal Disease
Diarrheal diseases kill an estimated 2 million children each year. Children are more
vulnerable to dehydration than adults, and diarrhea may quickly lead to death in the young.
Millions of children live in overcrowded communities with no access to safe water and
adequate sanitation.

Breastfeeding is the preferred way to prevent diarrhea in infants, as it avoids exposing


the infant to unsafe water during the early months of life. Nearly all deaths caused by
diarrhea can be prevented by using an inexpensive solution called oral rehydration solution
(ORS), and by safe water and improved hygiene practices. But, without these, diarrhea will
remain a leading global health threat for the world’s children.

Routine Vaccination
Vaccinations greatly reduce child deaths from certain diseases. Routine vaccination
has greatly increased, but in some countries there are great numbers of children who still do
not receive vaccinations. For example, measles immunization is still not accessible for 50%
of children residing in more than a dozen countries.

Malaria
Over 1 million people die each year from malaria. Most of these are children.
Although malaria deaths can be prevented by use of insecticide impregnated bed nets,
spraying of insecticides and effective treatment options, far too many children do not have
access to these lifesaving measures.

HIV/AIDS
3.2 million children, of whom approximately 90% reside in sub-Saharan Africa, are
living with HIV/AIDS. Without antiretroviral treatment, approximately 25-35% of children
born to HIV-positive mothers will contract the virus before or during birth or through
breastfeeding. Despite the risk of contracting HIV through breastfeeding, children in poor
areas are often at even greater risk of death from other diseases if they are not breastfed.
Infants who are not breastfed are far more likely to die of diarrhea or pneumonia than infants
who are exclusively breastfed.

A single dose of an antiretroviral drug costing only about US$1 can cut the mother-to-
child transmission (MTCT) of HIV by 50%. Yet only 1% of women in need have access to
this treatment.

Protecting children from disease, blindness and death doesn’t require expensive medical care.
Providing Vitamin A tablets, ORS, vaccinations, correct courses of antibiotics, are basic and
inexpensive ways to improve child health. It is inexcusable that children continue to die
because these basic needs are not met.

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16. PRIMARY HEALTH CARE

Primary health care uses preventative rather than curative methods to promote health.
Conventional medicine focuses on curing diseases, while primary health care aims to stop the
diseases from occurring. Methods to prevent disease include improved sanitation, improved
living conditions, and health education. Most importantly, primary health care seeks to teach
the people how to stay healthy. As a result, primary health care can lead to big improvements
in the health of communities.

Improving sanitation greatly reduces many diseases. Poor sanitation means a dirty living
environment, which can be caused by a polluted water supply, rubbish, or unclean cooking
facilities. Poor sanitation causes illnesses such as diarrhoea and vomiting, and diseases such
as dysentery and gastro-enteritis. Bacteria and parasites cause these illnesses, and improving
sanitation reduces the bacteria and parasites in the living environment.

Improving diet is another way to reduce disease. People who eat a nutritious diet, which is
high in vitamins and minerals, will be healthier. In addition to a good diet, cleanliness when
preparing and keeping food is important. Teaching people about bacteria and how food
poisoning occurs, as well as about nutrition, helps them to improve their health.

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Health education is very important. Another aspect of primary health care is teaching people
how to take control over their health. Instead of being dependent on doctors and medics, the
people can take action to improve their health. By improving their living environment and
improving sanitation people can reduce the incidences of intestinal diseases in the
community. Understanding the causes of mosquito borne diseases such as malaria and dengue
fever helps the community to take measures to protect themselves. Knowledge of nutrition
and the importance of a healthy diet informs people of the food they should be eating to stay
healthy. In this way, the people have more control over their health.

Another way to reduce disease is through immunisation. Immunisation helps our bodies to
develop resistance to certain diseases. If we are immunised against a disease our bodies are
then able to fight the virus or bacteria causing the disease and destroy it. This has greatly
reduced the prevalence of diseases in many parts of the world.

Another benefit of primary health care is that it is not expensive. Medical health care can be
very expensive. Medicine, medical equipment and running hospitals cost a lot of money. By
improving health, primary health care reduces the number of patients needing curative health
care. So, primary health care can reduce the cost of health care, and improve the health of
huge numbers of people for very little cost.

17. HEROIN AND BURMA

Under the rule of the SPDC, Burma has become one of the biggest producers of heroin and
methamphetamines in the world. Burma is second only to Afghanistan in heroin production.
Burmese drug production is fueling an alarming global increase in heroin use. Never before
has such pure and cheap heroin been so readily available in Burma and around the world. The
production of heroin is bringing huge financial benefits for Burma's drug lords and, allegedly,
Burma's army rulers.

The "Golden Triangle," where the frontiers of Burma, Laos, and Thailand meet along the
Mekong River, has long been an important heroin producing area. The area is now also
becoming a major illicit manufacturer of methamphetamine, or "speed."

In 1989, the Burmese military began to negotiate cease-fire agreements with several ethnic
groups. Among the first were opposition armies comprised of Wa and Kokang peoples that
had formerly served the Communist Party of Burma and were deeply involved in heroin
trafficking. The agreements also allowed opium cultivation - the main source of income for
many poor farmers - to continue.

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In many cease-fire areas opium cultivation has risen sharply, promoting a massive expansion
of Burma's heroin production. Around the world, the drug is available in greater quantities
than ever before. The epidemic of addiction has also spread within Burma and neighboring
countries. Along with it has come an explosion of AIDS spread by the sharing of needles
among heroin users. In Burma's northern Kachin State, tests found that over 90% of heroin
users were HIV-positive, and that most acquired the disease within a few weeks of beginning
intravenous drug use.

Hard evidence to support allegations that the junta takes huge profits from heroin exports is
not publicly available. But analysts believe earnings from heroin smuggling may now exceed
those from all of Burma's legal exports, and are in effect criminalizing much of Burma's
economy.

There is little hope that Burma's heroin production, and the suffering and destruction that
rising addiction is causing around the globe, will diminish as long as the army rules Burma.
Lasting peace and genuine economic development in a democratic environment are keys to
providing local farmers with viable alternatives to poppy growing. But even a democratic
government in Burma would be hard-pressed to end narcotics trafficking. However, a freely
elected government would receive considerable international aid in both drug control and
rural development.

Drug abuse and treatment

Opium was the primary drug of abuse in Burma until the 1980s, when a shift occurred to
intravenous heroin injection, particularly in urban areas. Drug addiction has also increased in
the mining regions in the north at Mong Hsu and Mogok, and in other populated areas in the
Shan and Kachin States. Government of Burma records show that there are approximately
90,000 addicts However, the United Nations and nongovernmental organizations believe that
the number of addicts probably ranges from 400,000 to 500,000.

Typically, heroin retailers are found at established locations where addicts obtain heroin
injections that are most often administered with the same needle that was used by the
previous addict. This shift to intravenous heroin injection is resulting in a spiraling HIV
infection rate.

Phensidyl, a codeine-based cough syrup, is also a commonly abused controlled substance. It


is smuggled from India and Thailand and sold on the streets of Burma illegally.
Methaqualone and diazipam, common sedatives manufactured in China, are also abused.

Both the Ministries of Education and Information carry out preventive education. The
Ministry of Health primarily oversees drug detoxification and the Ministry of Social Welfare
operates rehabilitation programs. The country has six major drug treatment centers and 24
outpatient treatment facilities. Basically the GOB sees the drug problem from four
perspectives: law enforcement, supply elimination, demand reduction, and treatment.

Treaties and conventions

Burma is a party to the 1961 United Nations (U.N.) Single Convention, the 1971 U.N.
Convention on Psychotropic Substances, and the 1988 U.N. Convention Against Illicit Traffic
in Narcotic Drugs.

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Burma joined with Cambodia, China, Laos, Thailand, and Vietnam in signing a UNDCP
Memorandum of Understanding, covering a sub-regional action plan aimed at controlling
precursor chemicals and reducing illicit drug use in the highlands of Southeast Asia.

1. In which countries is the ‘Golden Triangle’ found?


__________________________________________________________________________________

2. Why have so many heroin addicts in Burma contracted HIV?


__________________________________________________________________________________

3. How many drug addicts do the United Nations estimate there are in Burma?
__________________________________________________________________________________

4. Other than heroin, what drugs are abused in Burma?


__________________________________________________________________________________

5. Why do you think increasing numbers of people in Burma are becoming


addicted to drugs?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

18. BURMA’S SOCIAL INDICATORS


Population 48 million (2001)
GNI per capita $220 (2001)
Life expectancy 48 years (1970)
56 years (2001)
% of population in urban areas 28% (2001)
Under-5 mortality 252 per 1,000 live births (1960)
130 per 1,000 live births (1990)
109 per 1,000 live births (2001)
Infant mortality rate 169 per 1,000 live births (1960)
77 per 1,000 live births (2001)
% of infants with low birth weight 16% (1995-2000)
% of under-5 who are:
moderate/severe underweight 36% (1995-2000)
severe underweight 9% (1995-2000)
% of population w/access to clean water:
total 72% (2000)

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urban 89% (2000)
rural 66% (2000)
% of population w/access to adequate sanitation:
total 64% (2000)
urban 84% (2000)
rural 57% (2000)
Adult literacy
total 85% (2000)
male 89% (2000)
female 81% (2000)
Net primary school attendance
total 68% (2000)
male 68% (2000)
female 69% (2000)
% of primary school attendees reaching grade 5
69% (1995-99)
% of government expenditure for:
health 3% (1992-2001)
education 8% (1992-2001)
defense 29% (1992-2001)
% of women receiving prenatal care
76% (1995-2001)
Maternal mortality 230 per 100,000 (1985-2001)

19. BURMA: COUNTRY IN CRISIS

Health and Education


Burma is today in the midst of a health and education crisis. All social services in Burma,
including the country's health and education systems, have suffered terribly under military
dictatorship since 1962. Basic infrastructure has been neglected, while the military has been
prioritized. Since the current military junta reasserted direct army rule in 1988, health
services have further deteriorated, and universities have been closed for most of the last
thirteen years.

Like many developing countries, Burma faces an enormous task of bringing modern medical
care, sanitation standards, and basic health education to a predominantly poor and rural
population of about 50 million people. In many areas, malaria and malnutrition are very
common. And according to the World Health Organization (WHO), over 530,000 people may
already be HIV-positive.

Burma's military junta has made the social welfare of Burma's peoples a low priority. In its
''World Health Report 2000,'' the WHO ranked Burma next to last -190th of 191 countries
surveyed -in terms of overall health system performance. United Nations statistics show that
the regime spends over 200% more on its military expenditure than for health and education
combined.

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Of 174 countries rated by the United Nations Development Programme (UNDP) in 2000,
Burma ranked 125th. Forty percent of Burmese have no access to safe water, and sixty
percent lack basic sanitation.

Since 1991, a handful of international non-governmental organizations have begun work in


Burma. However, the regime's controls over health assistance programs are so strict that
many others refuse to operate in the country. This has prevented crucially needed AIDS
awareness programs, which are already taking place in neighboring Thailand and India,
which also face HIV crises.

The AIDS epidemic is most intense in Burma's northeast, where HIV is spread both by
intravenous heroin use and sexual transmission. The military regime has failed to act to stem
the epidemic. The junta's cease-fire agreements with some ethnic groups allow the
production and trading of heroin. Burma's border areas are awash with cheap supplies of the
drug, which is also plentiful in the country's largest cities, Rangoon and Mandalay. Heroin is
far cheaper than the syringes required to inject it, and so addicts routinely share needles.

The epidemic is also spreading through sexual contact. Many young women from Burma's
ethnic minorities have been forced or lured into prostitution in Thailand. As many as 40,000
may be working as prostitutes in Thailand. Tragically, a large percentage become HIV-
positive within a few years. The Burmese military has taken no action to reduce the
trafficking of women into prostitution, and local commanders are accused of helping the
trade.

These and other health problems are increased by the military junta's brutality and repression.
Torture, other physical mistreatment, and the effects of long years of warfare with armed
ethnic opposition groups are obvious problems. The Burmese army is also one of the last in
the world to use landmines.
There is no free press in Burma, and the few independent publications that comment on
social issues are heavily censored. Criticism of the regime or its policies is not tolerated. In
this atmosphere, Burma's peoples are neither informed nor educated regarding health matters
and have no say in how these problems are addressed.

Access to education is most restricted in impoverished rural areas where families cannot
afford to pay school fees. In ethnic minority areas, army offensives have also disrupted
normal life, and children are often forced to serve as laborers or even as military porters in
combat areas. Hundreds of thousands of people have fled their homes. Even where schools
exist, the ethnic-Burman dominated army has often banned teaching in local languages,
raising fears of a "cultural cleansing" of non-Burman peoples who make up 40% or more of
the population.

Among at least 250,000 Burmese refugees who are today in Thailand, India, and Bangladesh,
health and educational services are even more limited. The National Health and Education
Committee (NHEC) which includes representatives of 27 groups opposed to military rule,
was created in 1995 to serve refugees and people inside Burma who could be reached from
border areas. The NHEC is seriously constrained by a lack of resources and uncertain
security along Burma's frontiers. Its efforts have emphasized basic literacy and primary
health care for people almost entirely without social services.

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The junta remains largely in denial regarding the scale and urgency of Burma's AIDS crisis.
Universities are seen as an enemy, rather than an engine for development. The military
regime's spending priorities focus on procuring weapons and expanding its army. Until
Burma enjoys a responsible and accountable government, significant change is unlikely.

Reference: http://burmaproject.org/crisis/health.html.

20. WOMEN’S HEALTH IN BURMA

Pregnancy and Childbirth:

Women in Burma face considerable health problems due to poor living conditions,
inadequate health services, and lack of basic education. Deficient health care is more evident
in the ethnic minority regions, where constant relocation and the heavy losses of men's lives
have left women with the responsibility of providing for their children.

Maternal mortality rates, which are an important indication of the quality of women's health
care, are 580 per 100,000 live births. Compare this to 80 per 100,000 for Malaysia and 10 per
100,000 for Singapore. Most maternal deaths in the country are due to induced abortion often
conducted secretly, and in unsanitary conditions.

It is important that access to basic reproductive health information and to birth spacing and
contraceptive methods currently provided in only select areas of the country, be increased.

The percentage of women of reproductive age who use modern contraceptives is estimated to
be between 17 and 22 percent, with great variations from region to region; rates are even
lower in border and remote areas. Rather than using contraceptives, women frequently resort

39
to abortion to control family size. It is estimated that 14 percent of married women between
15 and 49 years have undergone abortions.

Pregnancy and childbirth highlight particular health concerns for women, including iodine
and iron deficiency and anemia. Lack of iodine in pregnant women can lead to low-birth-
weight babies, and miscarriages and stillbirths. Goiter (the most visible form of iodine
deficiency) is a major public health problem affecting all segments of the population,
especially women of childbearing age.

Anemia, particularly that caused by iron deficiency, is also prevalent among pregnant
women. Women are at special risk of having this type of anemia because of their blood loss
during menstruation, or when they have closely spaced pregnancies. An estimated 60 percent
of Burmese pregnant women, or over 700,000, are affected by this condition.

There is a shortage of midwives, who are the main providers of health care to women in rural
communities, particularly in rural areas of minority states. Only ten percent of the rural
population has direct access to maternity care provided by a midwife. 32 percent of Burmese
women deliver their babies without the assistance of a trained health worker.

1. List the health problems mentioned in this reading that women face in Burma.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Women, malaria, leprosy and tuberculosis:

The prevalence of malaria is particularly high in border areas, and among children and
women of reproductive age. Malaria, can lead to high rates of early deliveries, as well as to
low birth weight babies.

Effortsat eradicating malaria are made more difficult by the migration of labor into high
malaria transmission areas, and by the resistance of some species of the mosquito to
frequently used insecticides. Other problems are the lack of diagnostic facilities, and the
absence of reliable information.

Burma is one of only six countries in the world where leprosy is still a problem. There are
35,000 patients with deformities due to leprosy in the country, 20 percent of which are
children and 50 percent women or adolescent girls. Burma began its leprosy eradication
program only in 1992, and the medications needed for treatment depend mainly on
voluntary donor agencies.

The presence of drug resistant tuberculosis has been demonstrated in Burma. Tuberculosis
is the most frequent opportunistic infection among AIDS patients in the country.

40
Approximately 10 percent of the people in Burma are carriers of the virus for hepatitis B.

Women, prostitution, and AIDS:

Women in Burma often have difficulties getting work because of their poor educational
levels, particularly in rural areas. Community leaders estimate an 80 percent illiteracy rate
among women from some border areas. In many remote mountain regions girls are often
never able to attend school. In order to survive these conditions, some women have been
forced to resort to prostitution, primarily outside their own country.

The total number of Burmese women working as prostitutes has increased significantly over
the past decade. Many are from rural families, and have no formal education. It has been
estimated that between 25 and 35 percent of women who work as prostitutes in northern
Thailand are from Burma's Shan State. Many young women from Shan State were brought
into the sex trade when they were as young as twelve or fourteen years old. They did not
know what was happening.

It is estimated that there are between 800,000 and 2 million sex workers in Thailand. Many
of these are women from Burma, Laos and China. When women are recruited along the Thai-
Burma border many believe they are going to legal employment in Thailand, others are
forcibly recruited with threats to their lives.

Family members or friends who accompany the women to the border receive payments of
between US$400 to US$800 from the recruiting agent. This payment then becomes a debt
that the women must repay through sexual servitude.

These women are completely dependent on their captors who force them to work long hours
and make it impossible for them to refuse customers. In most brothels, health care and birth
control education are minimal or non-existent.
Prostitutes rarely have routine contact with health care workers. Any contact is mainly for the
provision of birth control methods and to test for sexually transmitted diseases. Many other
serious illnesses normally go untreated.

When pregnant, women are forced to abort illegally or to continue serving clients even late
into pregnancy. Many brothels are surrounded by electric fences and armed guards to avoid
escape. The recruiting agent, brothel owners and pimps often conduct their activities with the
agreement of the local police or government officials. In addition to women from Burma,
Thai agents also recruit women from Laos and China.

Conditions in the brothels are abhorrent. To quote a report from one of Bangkok's leading
newspapers, The Nation, which covered a police raid on brothels in the southern Thai city of
Ranong, "Each of the cubicles, measuring two by two-and-a-half meters, contained a cement
bunk where the girls were forced to prostitute themselves. Hidden doors, concealed by secret
passageways where the girls could be hidden in case of raid.... The stench of the place was
terrible. There were no proper toilets. It was a hell hole."

Many prostitutes are totally uninformed about the risks of contracting AIDS. A study showed
98 percent had no knowledge of AIDS or how it could be prevented. Because of the
circumstances in which Burmese women practice prostitution (forced labor, involuntary and

41
often unprotected sex with brothel clients, rape) their rate of HIV infection is much higher
than in Thai prostitutes.

2. Why are many women from Burma forced into prostitution?


_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

3. Why are Burmese women forced into prostitution in Thailand often unable to
escape?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Reference: http://www.burmaproject.org/burmadebate/spring98health.html

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