Responding to AIDS, Tuberculosis, Malaria, and Emerging Infectious Diseases in Burma: Dilemmas of Policy and Practice

October 2006 | Volume 3 | Issue 10 | e393 In 2004 the Global Fund to Fight AIDS, Tuberculosis, and Malaria (“Global Fund”) awarded program grants to Burma (Myanmar) totaling US$98.4 million over fi ve years— recognizing the severity of Burma’s HIV/AIDS and tuberculosis (TB) epidemics, and noting that malaria was the leading cause of morbidity and mortality, and the leading killer of children under fi ve years old [1]. For those individuals working in health in Burma, these grants were welcome, indeed [2]. In that same year, Burma’s authoritarian military regime—the State Peace and Development Council (SPDC)—was accused of severe and ongoing human rights violations, and United Nations Secretary General Kofi Annan appointed a Special Rapportuer on Human Rights, signaling a high level of concern about the junta’s governance. Given these occurrences, the Global Fund imposed additional safeguards on their Burma grants— including additional monitoring of activities and expenditures—and requested and received written guarantees from the junta to respect the fund’s safeguards and performancebased grant system. On August 18, 2005, the Global Fund announced termination of the grants, stating that “given new restrictions recently imposed by the government which contravene earlier written assurances it has provided the Global Fund, the Global Fund has now concluded that the grants cannot be implemented in a way that ensures effective program implementation” [1]. The fund made it clear that the decision was due to the SPDC having imposed restrictions on access to project implementation areas, and having added additional procedures to the procurement of medical supplies. Despite the statement from the Global Fund, some individuals involved in health within Burma have argued that political pressure from the United States played a role in the withdrawal. In the same month, the executive director of the World Food Programme visited Burma and called for a relaxation of government controls on the procurement and distribution of food commodities [3]. The World Food Programme reported that one in three Burmese children was chronically Responding to AIDS, Tuberculosis, Malaria, and Emerging Infectious Diseases in Burma: Dilemmas of Policy and Practice Chris Beyrer, Voravit Suwanvanichkij, Luke C. Mullany, Adam K. Richards, Nicole Franck, Aaron Samuels, Thomas J. Lee