Outgoing UNAIDS Country Director: ‘Structural Barriers are Preventing People From Getting Tested and Treated’
By Rik Glauert 26 June 2017
Mr. Eamonn Murphy is about to take up the position of regional director for the Asia Pacific Joint United Nations Program on HIV/AIDS (UNAIDS) after holding the position of country director in Myanmar twice: between 2002 and 2004, and most recently since 2012. He has presided over an office that has seen new HIV infections in the country fall by 24 percent since 2010, and AIDS-related deaths decrease by 40 percent.
Last month, Mr. Murphy welcomed the government’s third five-year national strategic plan on the issue, and praised the injection of extra funding from the current administration. The Irrawaddy’s Rik Glauert sat down with Mr. Murphy to learn more about his insights into and his experiences of fighting the HIV epidemic in Myanmar.
What are you most proud of from your time in Myanmar?
The work of UNAIDS is to help others to do their work. You won’t see photos of me in the newspaper treating people. We don’t make the change alone; we support others who are trying to create change. The fact that the community groups are leading, with the Parliament, in the drafting of legislation on the new HIV law in Myanmar, is a real success for me. We are supporting them, technically, but we are behind. It has been truly nationally owned. That for me is the satisfaction of working in the UN in this particular organization.
The HIV and AIDS treatment program scale up has been very much led by the government. The new policies and decentralization have meant more people are being treated than ever before. Civil society continues to grow and be empowered—we have done training with groups of men who have sex with men (MSM) and sex workers’ groups. There has been so much positive change in the last five years, and it has been a privilege to be here and support national leadership. It is Myanmar people leading, not a lot of foreigners telling people what to do.
What unique challenges have you observed concerning the fight against HIV/AIDS in this country?
Every epidemic is different because the country has unique cultural, social, political characteristics that impact it. HIV prevalence among injecting drug users, principally heroin, is high in Myanmar—nationally it is 28.5 percent. But there are pockets, particularly in towns in Kachin and northern Shan states, where it is as high as 50 percent. Drug use in these areas is the ‘center of the onion’—you’ve got issues like conflict, cross-border trade in jade, timber, and drugs, a whole range of economic and social factors surrounding it.
Culturally conservative groups can reject modern health interventions, from both a values and a political basis—they see methadone and needle exchange programs as impositions from the central government. Geography is also a major challenge: if people have to travel to get to methadone they will continue to buy heroin at the local market where it is cheaper and easier to come by.
HIV prevalence among MSM is also very high—up to between 22 and 27 percent in the urban centers of Mandalay and Yangon. The lack of any law reform in Myanmar for decades is also holding things back. Lawmakers currently have a discrimination protection law for people living with HIV, and if they can also address Section 377 of the penal code that criminalizes “unnatural sex,” that will help a lot to reduce fear and will reduce new infections. The Suppression of Prostitution Act is also up for revision, which could improve help available to sex workers.
There’s a lot of stigma and discrimination against HIV positive people in Myanmar, which needs to change. If you’re a taxi driver in Yangon, why do you need to have a HIV test? I’m unaware of anyone getting HIV from riding in a taxi. Critical structural barriers are preventing people from getting tested and treated.
What changes have you seen throughout the course of your time in Myanmar?
The first time I was here [in 2002], HIV/AIDS was highly politicized. In the eyes of the government, any journalist walking through the door was looking to criticize the country, and HIV/AIDS was used as a way to do that. The government didn’t like the data coming out—there was a whole range of estimates of infections, from the government, from us, from outside. HIV/AIDS was picked on, compared to other health issues, to criticize in hopes to bring about democratic change. That didn’t help us respond to the epidemic—the government went into lockdown and the overall HIV/AIDS numbers were held back. The then health minister Dr. Kyaw Myint was very brave. He set out to establish a fund for HIV treatment and prevention and gained international financial support. He was happy to engage with people and establish formal structures.
In 2012 there was big shift when power moved from the military junta to the Union Solidarity and Development Party. It was really exciting to work with colleagues in the Ministry of Health when I came back—many of them knew what they wanted to change, even though the ability to make that change was hard, but the motives were there and the energy was so strong.
Dr. Pe Thet Khin [health minister from 2011-14] invited a number of different partners and NGOs and was working to establish universal health coverage. He had a very public health approach and was responsible for bringing back medicines into the health systems in 2013.
Things have not changed that fast, of course, and things slowed down over the 2015 election period. With the new National League for Democracy-led government we have seen more openness to decisions, but the bureaucracies are slow to change. The current health minister Dr. Myint Htwe has a very public health approach and has introduced a very progressive new national health plan that HIV will be part of. He is the one driving the change in treatment provision. Devolving decision-making to the states and regions is going to be critical for his vision. It is going to take a while for people to find the confidence in his plans, though.
How has international funding informed the way Myanmar tackles HIV/AIDS?
Myanmar has never been awash with development assistance in the way that some other countries in the region have been, because of international sanctions. And, since 2011-12, health funding has actually been in decline. The budget for HIV, tuberculosis and malaria has not grown; it has shrunk and it is now covering more things. It is understandable that development money is going to the economy and capacity building in the workforce, but the need to fight HIV is still great.
The new government has increased the provision of treatment with new policies and more government money. The new minister has trebled what was put in before to US$15 million as the Global Fund [to Fight AIDS, Tuberculosis and Malaria] flatlines. The costings behind the new strategic plan are clever. A World Bank tool and an AIDS epidemic modeling tool were used to optimize the spending. That’s why models of service are changing.
[This change] is out of necessity but it is also out of good logic. The future of public health depends on more domestic resources. But, unfortunately, prevention will lose out in the middle of that, that’s where development partners can help. You can’t treat yourself out of a HIV epidemic. I encourage development partners to really look at investment in health and HIV and the whole range of social services.
What’s next for you?
I’ll be regional director for Asia Pacific. For UNAIDS, that region is all the way from Pakistan and Afghanistan to the Pacific islands. It includes China and India—a lot of people. We may not have the large-scale epidemics of Africa, but we have serious numbers at risk or infected and major human rights issues. The challenges are going to be great, but I love a challenge. It’s not just about the disease itself, it’s about the context. The rights of the individuals, their access to rights and services. Of the biggest challenges will be rights issues, because of the concentrated nature of the epidemics. It is marginalized people that are most affected.
I’m excited about it, as I will also be able to get back to Myanmar. I would like to refer to the successes of Myanmar too, for other countries to look at. They can ask: “How did Myanmar scale up treatment with limited resources available?” A lot of it is about commitment. I think there is a lot to be learned from Myanmar. Health reform is a real positive thing here.