The Global Fund caused a stir last week by pulling out of Myanmar. The move will phase out funds for HIV/AIDS, tuberculosis, and malaria, cutting off 98.4 million dollars slated for the country over the next 5 years. About 12 million dollars has already been disbursed but will most likely be retrieved by the fund.
The agency says that Myanmar's AIDS epidemic is one of the most severe in Southeast Asia and is complicated by concurrent rises in tuberculosis infections and drug resistant cases as well as limited access to anti-retroviral drugs. Infections have spread beyond high-risk populations and now approximately 2% of all pregnant women are infected with HIV. In addition the country has the highest TB rates worldwide according to the agency's figures, and 71% of the population is at risk for malaria, a disease that is responsible for 3,000 deaths and 600,000 victims yearly. The mosquito born disease tops all causes of overall morbidity and mortality and is the biggest cause of death in children under five.
The Global Fund quit its efforts to work with the military junta, because the government has been increasingly restrictive of the agency's goals, has limited access to victims, and interfered with the importation of essential medicines. If Mynamar wanted to work with the Global Fund in the future the organization said; "...there has to be a substantial change in the attitude and in behaviour towards national and international humanitarian work." The world waits.
The dire straits of the public health situation originally motivated the substantial funding allocations, despite the Global Fund's concern that the government wouldn't be transparent or trustworthy enough to use the aid appropriately. When Myanmar backtracked on its promises in several areas the organization finally decided to leave, publically noting that it was Myanmar's actions, not outside pressure, that motivated the agency's decision.
Yet it is impossible to ignore the political background in which the decision was made. The White House, the US Congress and US Secretary of State Condoleeza Rice have all voiced frustration at the persistent lack of movement by Myanmar towards democracy. The junta has long been condemned for its violations of human rights. Political prisoner and Nobel Prize winner Aung San Suu Kyi fights resolutely to draw the world's attention to the atrocities, while Myanmar has repeatedly defied threats and warnings from the US, Canada, Japan, Germany and others, habitually making short-lived promises under international threat of sanctions or political ostracism, then retracting its vows later. Most recently it chose to cede its position on the Association of South East Asian Nations (ASEAN) rotating chairmanship to "focus its attention on the ongoing national reconciliation and democratization process." Reflexively, individuals and nations are cynical about the sincerity of the statement.
As Myanmar has dodged pressure, US policy towards aid - even for the most devastating infectious diseases - has swerved to reflect the political tenor of the administration. The US announced earlier this summer that it wouldn't send HIV/AIDS aid to any country that didn't condemn prostitution, a move decried by many public health officials, and remained resolute in spite of challenges from Brazil, a economic powerhouse compared to most aid recipients. The Global Fund move may be an independent decision but it resonates easily with current US foreign policy trends.
In the larger context there is a general and longstanding debate about aid, fueled by fervent disparate beliefs about its usefulness. Tied and untied aid is granted for various reasons but generally humanitarian aid philosophy tends to fall between two extremes. There are those who insist that all victims - of wars, disease, political malfeasance and natural catastrophe should receive aid regardless of the political context. To do otherwise they insist, is unconscionable. At the other extreme are those who say that aid is futile and too often recipients are characterized as "innocent victims" - when in some horrific situations much of the adult population is culpable. This stance insists that aid money does nothing except further enable entrenchment of systemic problems such as brutal dictatorships, intractable wars, or even natural catastrophes. While the actual approaches taken by governments and NGOs are more often constructed of subtle variations in these extremes its hard to find any compromise that isn't injurious to some parties, usually the most helpless.
Despite one's views, the fact is that hundreds of thousands of people in Myanmar are relentlessly poor, hungry, and will be further devastated by the decision, even when other aid agencies pledge to step in to fill the gap. The rhetoric from US democracy building affiliates like the IRI urges the Myanmar people to free themselves. Says former deputy Secretary of State Lorne Craner: "I will say it's the people inside the country (Burma/Myanmar) that will cause the change - not because Washington wants something, or London wants it". Pragmatic perhaps, except for the perverse reality that a repressed malnourished, demoralized population seems hardly capable of summoning the vigor necessary to demand democracy. We hope for improvements in the medical situation, since AIDS, TB and malaria are largely controllable via technology, but the endless rampage of these diseases, is highly effected by politics of all stripes.
