YANGON - Htay Htay Thwe is one of the lucky ones. True, she is infected with HIV, her husband died last year, she has tuberculosis, chronic abdominal pains, no job and a seven-year-old daughter to support. PHOTO: Lynn Maung

But Htay Htay Thwe is receiving life-saving medicine, setting her apart from most people living with HIV in Myanmar, for whom the virus guarantees a slow, painful death.

The 41-year-old widow sits straight-backed on a plastic stool as she waits for her monthly visit with the doctor at a small, concrete-floored clinic in Myanmar's main city Yangon. Four months ago, she was accepted on a community-based HIV/AIDS programme and now receives anti-retroviral treatment (ART) for free.

"Before I got on the programme, I could not afford this medicine, or any other medicine," said Htay Htay Thwe, painfully thin after months of illness.

"I was very sick. I was sure I would die like my husband."

An estimated 240,000 people in military-ruled Myanmar are infected with the HIV virus that causes AIDS. That comes nowhere close to the numbers infected in parts of Africa, but it is the yawning gap between those who need treatment and those who receive it that marks out Myanmar's HIV/AIDS tragedy.

Of the 75,000 people in need of anti-retroviral treatment, just one fifth actually get it. The remainder are dying, or waiting to die.

The priorities of Myanmar's ruling generals lie elsewhere. The government spends nearly half of its budget on defence, but just 0.3 percent of GDP on healthcare. Of that, only a tiny amount goes towards spending on HIV/AIDS.

"People are dying needlessly because there just isn't enough money," said Peter Paul de Groote, the head of Medecins Sans Frontieres-Holland in Myanmar, by far the biggest provider of anti-retroviral drugs in the country.

"The government and the international community urgently need to scale up ART provision," he added.

International donors, too, have been slow to respond. Reluctant to commit funds to a country ruled by military dictatorship since 1962, donors give less per head to Myanmar than any other poor country in the world.

In 2007, Myanmar received only US$4 per person in aid, compared to $47 in Cambodia and $68 in Laos, according to the Organisation for Economic Cooperation and Development (OECD).

"It's difficult to understand," de Groote told Alertnet. "We have 60,000 people here who are going to die. There shouldn't be a political element to the decision to save them. It's a simple humanitarian imperative."

DONORS REASSESS APPROACH

Some donors are reassessing their approach to Myanmar, acknowledging that years of sanctions have failed to bring political change. And aid workers say the relief operation launched after last year's Cyclone Nargis showed that aid could be delivered effectively and independently in Myanmar.

A key donor in the health sector, The Global Fund To Fight AIDS, Tuberculosis and Malaria, pulled out of the country in 2005 but earlier this month approved a new $158 million grant to fund HIV/AIDS treatment in Myanmar over five years.

That is significant new money for those struggling to combat the epidemic. Smaller NGOs and grassroots groups in Myanmar say they are preparing to expand their HIV work as soon as more money becomes available.

One such group, Private Partnerships for Public Health (PPPH), has created a model bringing together community organisations, doctors and public hospitals to provide care for people living with HIV - including testing, counselling, medical treatment and home visits.

"We are drawing on capacity that already exists -- our role is to create partnerships so that more people living with HIV/AIDS can access the care they need," said Dr Tazeem Bhatia Theuss, advisor to the programme which is funded by the UK-based International HIV/AIDS Alliance.

"There isn't nearly enough money, but we see this as a sustainable model and we are ready to scale up if the money comes in."

The programme targets the very poor - patients like Htay Htay Thwe, who is now too weak to work, but used to sell charcoal on the side of the street.

For her, like the majority of people in Myanmar, the $30 to $40 per month that anti-retroviral drugs cost is beyond her means.

Back at the simple, wooden house she shares with her mother, sisters, brother, daughter as well as five other children, Htay Htay Thwe explains that before she was accepted on the ART programme, she assumed she would die.

"I did not expect help. We are poor, we cannot buy medicine. People like us are usually left to die by ourselves," she said.

"So I feel lucky. Now maybe I will live to see my daughter grow up."

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