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."