Myanmar: "HIV/AIDS is still a taboo subject"

Dr Calorine MEKIEDJE specialises in the treatment of HIV/AIDS and has worked in Mozambique and Cameroon, among other places. She talks about her experience as a medical advisor at the Dawei clinic in the south of Myanmar, where MSF has been treating patients infected with HIV/AIDS and co-infected with tuberculosis (TB) since 2000.

Can you describe the main activities of the Dawei clinic?
Calorine Mekiedje: The teams carry out between 80 and 90 consultations a day, sometimes 100. We offer free treatment as well as diagnoses and voluntary testing for HIV/AIDS and TB. We also have a programme for the prevention of mother-to-child transmission of HIV/AIDS. There are about 3,000 HIV positive patients and an average of 30 to 40 new patients on antiretroviral drugs (ARVs) a month. Very few treatments are available in Myanmar, and patients sometimes come from far away because they’ve heard that we offer care and treatment for HIV/AIDS. We also give HIV positive patients food support which includes soya, salt, oil and beans.

Has your experience in Myanmar been very different to your experience in Africa?
I was surprised to see how little is known about HIV/AIDS here. The situation is different in Africa, where prevalence rates are levelling off but people really know about the disease. Here, there’s still a lot of ignorance about HIV/AIDS and, consequently, fear of stigmatisation.  Here there is quite a traditional and religious society, where people don’t talk readily about their personal and sex lives. It’s a taboo subject. In this context, it’s difficult to talk openly about the disease. When there’s a low awareness and understanding of the disease and how it’s transmitted, there is a risk that prevention will be delayed and there will be exponential growth in the number of new infections.

What is the objective of the Dawei programme?
The main objective is to offer free, good-quality care and treatment, but also to encourage people who have just found out they’re HIV positive and think their lives are over. To avoid feelings of guilt, we don’t focus on the origin of their infection but on the options they have for looking after themselves and protecting their families. Our aim is to improve their understanding of the disease and how it’s transmitted, and let them know that treatment is available. The fact that there’s still a lot of ignorance about the disease is a challenge in itself.

In your opinion, what makes this project unique?
It’s the fact that we’re offering care to a very mobile population: fishermen and poor migrants with little or no education. Time between appointments is long because people come from far away and then go away again for long periods.

Under normal circumstances, patients should come back every two or three months, but in our context, once the tests have been completed, patients might return to the clinic once every six months. They work in Malaysia or Thailand and are the only source of income for their families. In the fishing season, they set off in boats where they live for up to six or seven months. We give them the necessary drugs to cover the period of absence and monitor them regularly while they’re back home.

What have you gained from this experience, professionally and personally?
It’s very gratifying to see how grateful the patients are for the care and attention we give them. Our input isn’t only medical, it also consists of moral support, as many of the patients are having a hard time and have lost their hope in life. Seeing them regain their confidence and strength is really rewarding. From a professional point of view, as a medical advisor, I’ve gained an overall perspective that I didn’t have before when I was a doctor in a clinic.

On a personal level, it’s been a real learning process. I’m a naturally patient person and, here, I feel as though I’ve found my cousins. The people are calm and never complain. They just get on with it and I like that philosophy.