HEROIN PUTS BURMA IN CRISIS OVER AIDS

RANGOON, Burma -- At sidewalk tea stalls where Burmese men socialize over
cups of fragrant black tea, proprietors in some towns have added a lucrative
sideline -- heroin -- and use the same syringe to inject as many as 40
customers.

The surreptitious practice, described by several Western diplomats and
doctors, illustrates how Burma, the world's foremost exporter of opium, has
developed its own domestic heroin habit, with potentially disastrous
consequences.

So many young Burmese are injecting heroin that some medical experts say
Burma, also known as Myanmar, has the world's highest rate of HIV infection
and AIDS contracted from dirty needles. By 1994, the Global Program on AIDS
of the World Health Organization reported, 74 percent of drug addicts in
Rangoon (also known as Yangon), 84 percent in Mandalay and 91 percent in
Myitkyina, in the north, had HIV, the virus that causes AIDS.

This compares with about one-third of New York City's 150,000 to 200,000
intravenous drug users who are HIV-positive, according to Donald Des
Jarlais, research director for the Chemical Dependency Institute at Beth
Israel Medical Center in New York.

The Burmese government has reported registering only 60,000 addicts, with as
few as 17,000 infected with AIDS. Foreign medical researchers put the total
number of addicts closer to 500,000, and estimate that several hundred
thousand heroin injectors have become HIV-positive.

Another study, financed by the United Nations Drug Control Program, a terse
abstract of which was released by the Burmese Health Ministry, found drug
abuse prevalent in 1.7 percent to 25 percent of the population studied in
three dozen Burmese townships. With 88 percent to 99 percent of drug abusers
identified as male, the study implied that up to half of the men in some
townships could be addicted.

Both studies are cited in a new book, "War in the Blood: Sex, Politics and
AIDS in Southeast Asia," by Dr. Chris Beyrer, an American epidemiologist who
has worked in the region and interviewed health workers, addicts and people
with AIDS.

"It's going to be one of those situations where people will say, 'How could
the world not have known, because hundreds of thousands of people have died
there?"' he said in a telephone interview from his office at Johns Hopkins
School of Hygiene and Public Health in Baltimore.

Burma offers a harrowing example of drug-producing or transit countries that
find their own people growing addicted to heroin or cocaine intended for
foreign markets.

The military government's own AIDS statistics have been suspect since 1996,
when it wooed foreign tourists with a "Visit Myanmar" campaign that
portrayed the country as a vacation paradise.

Beyrer said he knew of Burmese researchers who were punished for being too
candid about the country's AIDS problem. Beyrer also said the military
junta's credibility was so suspect that even if they told the truth, many
Burmese might not believe them.

Although for years older hill people smoked opium to relax or as a treatment
for illnesses like malaria, it is younger, lowland Burmese who are injecting
opium's refined derivative, heroin.

Dr. Ba Thaung, director of the Drug Dependence Research and Treatment Unit
in Rangoon, said that heroin was widely available, inexpensive and
devastatingly pure. "Before, we had very few social problems, but now we
have a lot of problems connected to drug use," he said.

Dr. Gyaw Htet Doe, a psychiatrist in the research unit of the Rangoon drug
treatment center, estimated that 62 percent to 65 percent of younger heroin
patients are HIV-positive. "As a doctor at the Ministry of Health, I have to
be concerned because there is no cure for this," he said. "It will kill or
harm a lot of young people in our country."

Other medical specialists made available by the government confirm the
problem. "The majority of intravenous drug users are HIV-positive," said Dr.
Martin Joseph, a consulting psychiatrist at the general hospital in Lashio,
a town in northeastern Burma. "We estimate about 80 percent."

The epicenter of Burma's AIDS pandemic is Hpakan, a jade-mining town
northwest of Myitkyina, where heroin injection is said to be rampant and
clean needles a rarity. When seasonal rains halt the digging in Hpakan's
open-pit jade mines, thousands of migrant miners return home, carrying the
HIV virus back to their wives.

The relatively late arrival of AIDS in Burma has contributed to widespread
ignorance about the disease. By 1988, only a single case of AIDS, brought
back by a dying sailor, had been diagnosed. By 1989, doctors were
discovering hundreds more Burmese infected.

Yet as late as 1995, a survey of 714 Burmese prison inmates found that only
11 percent knew that HIV could be contracted by injecting drugs. Dr. Than
Zaw, medical superintendent of the Lashio general hospital, said that
patients there "may have heard of AIDS but they don't know how it's
contracted." "All they know is when they have AIDS, there is no cure," he
continued.

The government has opened 30 drug-treatment centers since 1975. But many
heroin users stay away, because detoxification means undergoing agonizing
withdrawal with little more than modest doses of tincture of opium and
meditation lessons from Buddhist monks.

"Sometimes when they learn they are HIV-positive, they leave treatment,"
Than Zaw said. "They don't want their families or other people to know,
because they are looked down on."

Copyright 1998 The New York Times Company