Assessing the magnitude of the HIV/AIDS epidemic in Burma

OBJECTIVES: Estimates of the HIV/AIDS burden in Burma (Myanmar) are uncertain. Using data from the 1999 national HIV sentinel surveillance and available population data, we generated estimates of Burma's HIV burden in 1999. METHODOLOGY: The 1999 sentinel surveillance included women attending antenatal clinics, male military recruits, blood donors, injecting drug users, patients of sexually transmitted disease clinics, and sex workers. We used data for women attending antenatal clinics and male recruits aged 20-29 years to estimate HIV prevalence among women and men, respectively. Data points were merged to give five regional estimates of prevalence for men and women. Census figures were used to obtain national population estimates of the numbers of Burmese living with HIV infection, along with confidence intervals (CIs). RESULTS: HIV prevalence varied by region, with the lowest rates in the West, intermediate rates in the central region, and highest rates in the North, East, and South. The highest rates were in the East (Shan State), with female prevalence of 3.0% (95% CI, 1.9-4.5). The total number of infected women nationwide was 218,300 (95% CI, 159,400-277,100), and that of men was 468,700 (95% CI, 343,300-594,200). We estimated HIV prevalence of at least 3.46% (95% CI, 2.72-4.19) among adults aged 15-44 years; 5700 infants were born with HIV infection in 1999. DISCUSSION: Burma has a generalized epidemic of HIV-1 in reproductive age adults. We estimated that there were 687,000 (95% CI, 541,100-832,900) Burmese adults living with HIV infection in 1999, or about one of every 29 adult citizens. This estimate is higher than the UNAIDS estimate for the same year of 530,000 adults and children living with AIDS, or a population prevalence of about one in 50 adults. HIV prevention and care programs are urgently needed in Burma.