Gaysia (31 page)

‘If you're a customer, you might pay me 10,000. And then you'll say, “And if you
don't
use a condom, I will give you an extra 10,000 kyats.” How can I decide? I would take the money,
because this short-term problem is more important.'

It was a common attitude in Myanmar. Existence was so hand to mouth that the idea of later getting sick and dying wasn't even worth thinking about. You literally couldn't
afford
to think about it.

If it hadn't been for PSI, Kyaw Swe would still have been out there, often having unprotected sex. Statistically speaking, if he'd kept on working the streets, it was likely that he would have contracted HIV by now.

Myths about HIV were prevalent in Myanmar. The most pervasive belief was that if someone had HIV, you would be able to
see
evidence of it. The logic was messy but understandable: if someone was incubating a deadly virus, then surely that person would look as though they were dying. They would look weak and bony, and have lesions that oozed pus. In most people's minds HIV looked like, well, AIDS.

These beliefs were held even by more-educated Burmese. Zin Min Htet was thirty-two years old and an engineer with a PhD. He was smart, had held a government engineering post for years and had even been accepted into international postgraduate courses. When I met him in Yangon, he was dressed like a businessman on casual Friday, wearing an ironed, pink-collared shirt and smelling of cologne.

Zin Min Htet was also HIV-positive. Originally, we'd been scheduled to talk about his work for Myanmar's International HIV/AIDS Alliance, but during a walk to a hotel bar, Zin Min Htet told me the story of how he'd gotten HIV from a long-term boyfriend. The boyfriend had since gone off to work in
Singapore, and Zin Min Htet had no way of contacting him. Zin Min Htet wasn't sure if the boyfriend knew he was HIV-positive.

‘I didn't suspect him,' he said, ‘because he looked very handsome and strong.'

‘Macho, you mean?'

He nodded.

‘And you didn't think anyone like that could get HIV?' I said.

He shook his head. ‘I wrongly stereotyped that HIV cannot exist in a person who is handsome. This is my misconception.'

Zin Min Htet was
abone
like his boyfriend – versatile and masculine-presenting. They both assumed HIV exclusively affected
apwint
, transgender or feminine men. These were the men usually targeted for HIV tests by NGOs, which came back to sex roles:
apwint
were always on the receiving end of anal sex. Zin Min Htet said he'd learned how HIV was spread only after becoming HIV-positive himself – far too late.

Zin Min Htet grew up in the northernmost part of the Yangon region, in a township called Mingaladon, but moved to the city to attend university. Afterwards, he got a job with Myanmar's Ministry of Science and Technology, regularly transferring from city to city. When he was offered the opportunity to study in Germany and India, he had a mandatory health check, including blood test, standard policy for anyone intending to leave the country. Zin Min Htet was posted in Mandalay at the time and didn't think there would be anything wrong with the results.

But he
had
been getting weird fevers on and off, with increasing frequency. He thought it was just his immune system playing up. When he went back to Yangon's National Health Laboratory to get the test results, they told him he was HIV-positive.
The doctor gave him the results unceremoniously – without counselling, referrals or words of comfort – then let him go. His doctor did say one thing, though. Because he knew Zin Min Htet worked for the ministry, he told him very clearly: ‘Don't talk about your blood test results to the government.'

Perhaps it was the shock of the results, or just a coincidence in timing, but his fever took hold properly soon after his diagnosis. Zin Min Htet's lymph nodes swelled up, his body temperature spiked and constant diarrhoea left him badly dehydrated. He was away from home and on his own in a Yangon hostel. He called in sick from work, closed the doors to his dorm room and stayed in bed for a week.

At the end of that week, one of Zin Min Htet's friends came to visit, worried about his health. Knowing he looked ravaged, Zin Min Htet told his friend he was HIV-positive. His friend didn't flinch, and said his sister worked at Médecins Sans Frontières Holland.

Staff at MSF Holland's
Thazin
clinic diagnosed Zin Min Htet as also having tuberculosis, a disease that commonly affects Burmese people with HIV. It's known as an opportunistic infection, because it's easy to infect an HIV-weakened body. For the first few weeks, Zin Min Htet was on powerful anti-TB drugs. In the meantime, his CD4 count – the gauge of his immune system's strength – was plummeting, but he would have to wait another four months to go on ARTs, since they couldn't overlap with TB medications.

As Zin Min Htet recovered from TB, he tried sorting out the logistics of his job. His government post was in Mandalay, an overnight bus ride from Yangon, but he'd need to stay in Yangon to commit himself to his forthcoming ART regime. If he slipped off the strict ART schedule, he would have to start it again.
There were far fewer ART supplies in Mandalay than in Yangon, and no guarantees he would receive his required dosage.

Zin Min Htet's work supervisor was the rector of Yangon University, someone with connections and power, so he took a gamble. He told her he was HIV-positive and asked her whether he could work in Yangon. Troubled, she urged him to disclose his status to the minister responsible for his job. She hoped that the ministry would be able to issue him with an official transfer.

Zin Min Htet sat down and wrote the letter, ignoring his doctor's advice never to tell the government that he was HIV-positive. For the next eight months, he stayed in Yangon on a temporary transfer, started ART treatments and worked as a university lecturer while he completed his PhD. He recovered from the TB, and despite the initial side effects of the ARTs, his health returned.

Then Zin Min Htet's professor received a phone call from the minister himself. Zin Min Htet's file had come to his personal attention, and he demanded that Zin Min Htet take long-term sick leave from his ministry job. Zin Min Htet could be reaccepted into his ministry role, the minister said, but only once his blood tests came back HIV-negative. Everyone knew that was impossible. The message was blunt:
Don't come back
. Knowing this part of his life was over, Zin Min Htet folded and resigned.

Zin Min Htet caught the bus back home to Mingaladon. His parents, two younger brothers and one sister still lived together in relative poverty, and the family relied on Zin Min Htet's income to survive. It was impossible to explain why he'd lost his job without also disclosing his HIV status. He braced himself and told them the news.

‘Their reaction was good,' he said. ‘They take care of me. But they don't want me to be MSM.'

I laughed. ‘So they're okay with you having HIV, but they're not okay with you being an MSM.'

He laughed too. ‘Yes,' he said.

Timing was on his side, though. Zin Min Htet looked healthy, and the ART treatment meant his risk of developing AIDS or another opportunistic infection had greatly receded. He was sure he could get another job.

‘What would have happened if you hadn't been able to transfer to Yangon in the first place?' I asked.

‘I think I was dead!' He laughed, trailed off, then stopped altogether. ‘Dead by now,' he said, sombrely.

In his new role working for the International HIV/AIDS Alliance, Zin Min Htet was acutely aware that thousands of people in Myanmar needed ARTs. Some were on waiting lists for the medication – a life-or-death wait – while others didn't even know they needed it. Zin Min Htet would live, but he knew many others would die, especially if they lived outside the city centre.

I caught a flight to Mandalay, where I'd been told the availability of ARTs was far worse than in Yangon. It was in Mandalay that I met Than Win. Even though Than Win's birth certificate said she was a 22-year-old man, she was
apwint
and looked more like a fifteen-year-old girl. She was wide-eyed as a calf and kept her wavy, bob-length hair in metal clips like a children's book character.

Than Win lived in a town whose name roughly translated to ‘Mandalay New Town', a ninety-minute bus trip from Mandalay, although it could take much longer since ‘buses' in this region
were covered utility trucks, which carted produce and sometimes livestock, as well as human passengers. Mandalay New Town wasn't too different from Mandalay itself: wide streets, lots of motorcycles and exposed holes in cement drains covered by wooden slats, with poorer people bathing in the public ablution stations on street corners. The summers were scorching; the rainy seasons muggy and plagued with mosquitoes.

Despite her youth and beauty, Than Win had the gnarled frame of an elderly woman. Her skin was patchy and dry. The fingernails of one hand were painted a purply pink, but the polish was flaking off. She found it difficult to maintain eye contact, saying she felt ashamed of what she was telling me. She had big eyes full of trauma, like a Disney-cartoon fawn that had accidentally wandered into a horror film.

Until recently, Than Win had been a full-time sex worker, working seven nights a week. She'd left school after fourth standard, and you needed to finish tenth standard to qualify for a semi-decent job. During the day, Than Win helped out her family in the cramped home they shared: Than Win, her grandmother, two parents, four brothers and Than Win's husband – nine people in one house. Living in such close confines was difficult on a practical level, and her relationship with her family was already tense. They knew what Than Win did for work at night and hated it.

‘Don't do that!' her family would say. ‘It's not good for your health!'

Than Win's family hated her construction-worker husband even more. He would accompany Than Win to score her clients and ensure she got home safely. When Than Win and her husband returned home after a long night's work, they would often find her family had locked them out. They got used to sleeping
in the detached room outside.

After a few years, the family's objections quietened down. They realised they couldn't stop Than Win by locking her out. Plus, they were getting money from Than Win, and money was the one thing you couldn't argue with in this country. When business was good, Than Win earned 10,000 kyats in a night (thirteen US dollars), which exceeded the salaries of some professionals in downtown Mandalay.

Her family was right about her health, though. Two years earlier, Than Win had discovered genital warts on her anus, which made her wonder what other horrors were lurking undetected inside her body. Blood tests at Marie Stopes International came back positive for HIV. Than Win was stunned.

She spent days crying her guts out, and her lack of appetite meant she rapidly lost weight. When I asked Than Win whether she knew how she'd caught HIV, she bowed her head.

‘I'm pretty sure I got HIV from unprotected anal sex,' she said.

She was one of the many sex workers who knew it was risky not to use a condom, but whose clients often refused to wear one. When your client said no, you weren't in a strong position to convince them otherwise.

‘I had to obey,' Than Win said quietly.

When I asked her how often she had unprotected sex with clients, she looked past me.