Humanitarian help can't wait for politics

Donors to Burma face a dilemma. The country's AIDS and humanitarian crisis demands immediate attention. One in 50 adults is estimated to be infected with HIV, poverty is worsening and education standards are falling, reducing people's economic opportunities and ability to care for themselves.

But many of those providing aid fear that re-engagement, even in the form of limited humanitarian aid, could boost Burma's military government.

On the other hand, strategies of coercive diplomacy and economic isolation are failing. There are also no indications that existing aid programs have any significant political costs.

The prevailing mood in Burma is one of despair. While the population endures rising poverty and illness, many donors focus on the country's political fate and particularly that of the National League for Democracy and its leader, Daw Aung San Suu Kyi.

To put pressure on the military regime after the crackdown in 1988, the West suspended new loans and aid programs and applied restrictions on trade and investments. In principle, these sanctions have excluded humanitarian assistance. In reality, such aid has been cut dramatically as well.

Political talks between the ruling State Peace and Development Council and the league have gone on for more than a year with little visible headway. The human costs of Burma's deprivation cannot wait until some indefinite democratic future.

All parties - the European Union, the United Nations, nongovernmental organizations, donor governments, the Burmese military regime and the league - need to think carefully about current aid restrictions.

The spread of AIDS is deeply worrying. It could cripple economic and political prospects for many years to come. Burma is close to the point where the critical mass of infection gets so great that the epidemic becomes widely prevalent in the general population. This makes it much harder and more expensive to address even if behavior among drug users and sex workers improves. The epidemic is fueled by population mobility, poverty and frustration, all of which breed risky sexual behavior and drug taking. Thailand and Cambodia have shown that concerted, nationwide intervention at this stage can succeed in controlling the epidemic.

Two guiding principles have been established in successful prevention and care campaigns: Be pragmatic, and work on a large scale. To do both in Burma, aid organizations, UN agencies and NGOs will have to make a substantial change in the way they work.

Donors should be less cautious and more innovative in their approach to aid. Many aid organizations on the ground have the knowledge and commitment to pursue a progressive agenda but are constrained by the conservatism of donors.

There are signs that at least some important factions within the Burmese government are willing to take a pragmatic approach to the AIDS epidemic

Burma needs far more resources if it is to mount an effective response to AIDS. The response must surpass the capacity of existing nongovernmental organizations. This means, in short, working with the government and through government institutions.

The good news is that the most relevant of these institutions, the public health infrastructure, is in the hands of competent professionals who have demonstrated willingness to work hard to deliver services to at-risk groups. They have established good working relations with NGOs and international organizations, although they have often been obliged to fly below the radar of their political bosses to do so. It should be possible to capitalize on these informal relationships and find creative ways to fund AIDS-related programs in Burma.

It is by no means certain that attempts to work with the government to avoid a health disaster will succeed. What is certain is that the country cannot stem the tide without immediate, substantial and sustained financial and technical support. The AIDS crisis cannot be put on a back burner until the political situation improves or a more amenable regime is in power.