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The burden of HPV-related cancers in different regions worldwide varies according to several factors. This study aims to measure inequality in the risk of incidence of HPV-related cancers in term of geographical risk patterns in northern Thailand using a population-based cancer registry data. Trends in age-standardized HPV-related cancer incidence were calculated for the 2008-2017 time period. The Besag-York-Molli'e model was used to explore the spatial distribution of the relative risk (RR) of HPV-related cancers at the district level. A higher RR reflects a larger disparity. The geographical risk pattern of the diseases in two periods, 2008-2012 and 2013-2017 were described and compared. From 2008 to 2017, the incidence of oropharyngeal and anal cancers showed a slightly increased trend in males but remained stable in females, the incidence of vulvar, vaginal and penile cancers were stable while the incidence of cervical cancer decreased. The RR range was closer to 1 in the second period compared to the first period. This suggests a decrease in the disparities of incidence of cervical cancer. However, in some areas near the Thai-Myanmar border, the RR values remained high. The incidence rate of most HPV-related cancers remained low and stable over the study period in northern Thailand. For the most common HPV-related malignancy, cervical cancer, the incidence rate steadily decreased but with marked geographic disparities, possibly reflecting health inequity especially in the border areas.

Northern Thailand has a high burden HIV epidemic among MSM and TG. Oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine has demonstrated efficacy in preventing HIV among MSM and TG in Chiang Mai, Thailand. Determinants of PrEP acceptability are needed to gauge the potential uptake of this prevention strategy. From January to February 2012, 238 MSM and TG participants, who self-reported as HIV-uninfected or of unknown status, completed a self-administered survey on hand-held computers. Participants were recruited by venue-day-time sampling and asked to rate their likelihood of using oral PrEP for HIV prevention with an efficacy of 50%. PrEP acceptability was defined as being \"very likely\" to use PrEP. Odds ratios and 95% CIs were calculated to identify correlates of acceptability. 131 MSM and 107 TG responded, with mean ages of 23.7 and 21.8, respectively. 24% of MSM engaged primarily in receptive anal sex vs. 74% of TG. 21% of MSM and 44% of TG reported regular medication use. Prior awareness of PrEP was high at 66% among both MSM and TG respondents. 41% of MSM and 37% of TG were \"very likely\" to use PrEP. Among MSM, factors associated with PrEP acceptability included a prior history of STIs (AOR 4.6; 95%CIs 1.7-12.6), previous HIV testing (AOR 2.4 95%CIs 1.1-5.3), regularly planned sex (AOR 2.8 95%CIs 1.1-7.2), and infrequent sex (AOR 2.9 95%CIs 1.3-6.3). Among TG, factors associated with acceptability included prior awareness of PrEP (AOR 3.3; 95%CIs 1.2-9.0) and having private insurance (AOR 5.0; 95%CIs 1.3-19.0). MSM and TG in Northern Thailand are distinct groups in terms of sexual behaviors, patterns of medication use, and correlates of PrEP acceptability. Efforts to maximize PrEP uptake should include expanded HIV testing services and the provision of financial subsidies to reduce the cost of PrEP.

Neglected diseases remain one of the largest causes of disease and mortality. In addition to the difficulties in provision of appropriate drugs for specific diseases, many other factors contribute to the prevalence of such diseases and the difficulties in reducing their burden. We address the role that poor governance and politically motivated oppression have on the epidemiology of neglected diseases. We give case examples including filariasis in eastern Burma and vector-borne diseases (Chagas' disease, leishmaniasis, and yellow fever) in Colombia, we show the links between systematic human rights violations and the effects of infectious disease on health. We also discuss the role of researchers in advocating for and researching within oppressed populations.

Beyrer and colleagues discuss infectious disease threats in Burma and suggest policy options for responding to them.

Neglected diseases remain one of the largest causes of disease and mortality. In addition to the difficulties in provision of appropriate drugs for specific diseases, many other factors contribute to the prevalence of such diseases and the difficulties in reducing their burden. We address the role that poor governance and politically motivated oppression have on the epidemiology of neglected diseases. We give case examples including filariasis in eastern Burma and vector-borne diseases (Chagas disease, leishmaniasis, and yellow fever) in Colombia, we show the links between systematic human rights violations and the effects of infectious disease on health. We also discuss the role of researchers in advocating for and researching within oppressed populations. [PUBLICATION ABSTRACT]

We investigated human rights concerns related to migration, living and working conditions, and access to HIV/AIDS services and reproductive health services for Burmese women in Thailand. Vulnerability to HIV/AIDS for Burmese women stemmed from abuses they experienced: gender and ethnic discrimination, including violence; unsafe migration and trafficking; labor and sexual exploitation; and denial of health care. Despite having bound itself to human rights laws, the Thai government is failing to fulfill its obligations to Burmese women, with particularly devastating impacts for their well-being, including the risk of HIV/AIDS. Moreover, as our documentation shows, this failure to incorporate human rights concerns into its national response to the epidemic virtually guarantees that HIV/AIDS will continue to be a problem in Thailand. /// Nous avons examiné les problèmes des droits de l'homme en relation avec la migration, les conditions de vie et de travail et l'accès aux services de santé relatifs au VIH/SIDA et à ceux de la reproduction des femmes birmanes en Thaïlande. La vulnérabilité des femmes birmanes au VIH/SIDA provient des abus dont elles sont victimes: discrimination sexuelle et ethnique, y compris violence; migration à haut risque et trafic de personnes; exploitation sexuelle et au travail; refus de soins médicaux. Malgré son accord avec les lois sur les droits de l'homme, le gouvernement de la Thaïlande manque à ces obligations envers les femmes birmanes, avec des conséquences dévastatrices sur leur bien-être, y compris le risque du VIH/SIDA. De plus, notre documentation montre que cet échec d'incorporer les problèmes des droits de l'homme à sa réponse nationale à l'épidémie garantit que le VIH/SIDA continuera d'être un problème en Thaïlande. /// Investigamos temas en cuanto a derechos humanos relacionadas con migración, condiciones de vida y laborales así como acceso a servicios para personas con infección de VIH/SIDA y los servicios para la salud reproductiva para mujeres birmanas en Tailandia. La vulnerabilidad a infección por VIH/SIDA para mujeres birmanas se derivó de los abusos que experimentaron: discriminación de género y étnica, incluso violencia; migración y tráfico inseguros; explotación laboral y sexual, y negación de cuidado de la salud. A pesar de haberse sometido a las leyes de los derechos humanos, el gobierno tailandés no está cumpliendo con sus obligaciones con las mujeres birmanas, con repercusiones en particular devastadoras para su bienestar, incluso el riesgo de infección por VIH/SIDA. Más aún, como lo muestra nuestra documentación, este fracaso para incorporar temas respecto a derechos humanos en su respuesta nacional a la epidemia virtualmente asegura que la infección por VIH/SIDA seguirá siendo un problema en Tailandia.

Introduction Cyclone Nargis hit Burma on May 2, 2008, killing over 138,000 and affecting at least 2.4 million people. The Burmese military junta, the State Peace and Development Council (SPDC), initially blocked international aid to storm victims, forcing community-based organizations such as the Emergency Assistance Teams-Burma (EAT) to fill the void, helping with cyclone relief and long-term reconstruction. Recognizing the need for independent monitoring of the human rights situation in cyclone-affected areas, particularly given censorship over storm relief coverage, EAT initiated such documentation efforts. Methods A human rights investigation was conducted to document selected human rights abuses that had initially been reported to volunteers providing relief services in cyclone affected areas. Using participatory research methods and qualitative, semi-structured interviews, EAT volunteers collected 103 testimonies from August 2008 to June 2009; 42 from relief workers and 61 from storm survivors. Results One year after the storm, basic necessities such as food, potable water, and shelter remained insufficient for many, a situation exacerbated by lack of support to help rebuild livelihoods and worsening household debt. This precluded many survivors from being able to access healthcare services, which were inadequate even before Cyclone Nargis. Aid efforts continued to be met with government restrictions and harassment, and relief workers continued to face threats and fear of arrest. Abuses, including land confiscation and misappropriation of aid, were reported during reconstruction, and tight government control over communication and information exchange continued. Conclusions Basic needs of many cyclone survivors in the Irrawaddy Delta remained unmet over a year following Cyclone Nargis. Official impediments to delivery of aid to storm survivors continued, including human rights abrogations experienced by civilians during reconstruction efforts. Such issues remain unaddressed in official assessments conducted in partnership with the SPDC. Private, community-based relief organizations like EAT are well positioned and able to independently assess human rights conditions in response to complex humanitarian emergencies such as Cyclone Nargis; efforts of this nature must be encouraged, particularly in settings where human rights abuses have been documented and censorship is widespread.

Background:Case reports of human rights violations have focused on individuals’ experiences. Population-based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma.Objective:We describe the association between mortality and morbidity and the household-level experience of human rights violations among internally displaced persons in eastern Burma.Methods:Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months.Results:Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one-third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations.Conclusions:Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population-level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere.

Documents how decades of repressive rule, civil war, and poor governance in Burma have contributed to the spread of HIV/AIDS, tuberculosis, malaria, and other infectious diseases.