Stigma Against HIV on Agenda as Burma Joins Regional Conference

By Samantha Michaels 18 November 2013

RANGOON — Government health officials from Burma will travel to Thailand this week for a major regional conference focused on fighting the spread of HIV.

More than 50 Burmese delegates—including dozens of civil society leaders and health professionals, along with several lawmakers and officials from the Ministry of Health—are expected to attend the Bangkok-based 11th International Congress on AIDS in Asia and the Pacific. The five-day conference opened on Monday and will draw over 3,000 delegates from across the region to share lessons from their national outreach programs and devise strategies for raising more awareness on prevention of sexually transmitted infections.

Another goal is to reach out to key affected populations, including men who have sex with men, drug users and sex workers, according to Dr. Ni Ni Khaing, who will attend the event as the national program officer on HIV for the UN Population Fund (UNFPA) in Burma.

“In Myanmar [Burma], HIV/AIDS is still considered a taboo subject and as a result of the stigma attached to the disease, many delay or even avoid getting tested, or they receive treatment when it is too late,” she told The Irrawaddy.

Burmese laws that criminalize the behaviors of some of these at-risk populations often keep people away from health facilities where HIV detection and treatment is possible.

“For the most at-risk populations, including sex workers and intravenous drug users, if you stigmatize them, HIV transmission can be increased,” says Kyi Minn, another Burmese delegate representing World Vision, an international humanitarian organization. “This is the main reason I am interested in attending the conference.”

Nearly 5 million people in Asia were infected with HIV in 2012, according to UNAIDS. In Burma, about 200,000 people are HIV-positive, and at the end of last year only about 40 percent of those who required antiretroviral therapy (ART) were receiving it, according to medical humanitarian organization Médecins Sans Frontières, the first and biggest provider of ART in the country.

Beyond legal reform, one strategy to reduce stigma is to increase tolerance among faith-based communities, Kyi Minn says, adding that World Vision conducts workshops in Burma to teach religious leaders about the challenges faced by HIV-positive people. “We ask people living with HIV to come and give their personal perspectives about their experience,” he says.

Nearly two in 10 people living with HIV in Burma reported being verbally insulted as a result of their HIV status, while one in 10 reported physical assault, according to surveys by UNAIDS.

Major annual religious festivals could also provide an opportunity to raise awareness about safe sex practices, says Dr. Phone Myint Win, the Burma country representative for the Burnet Institute, a health-focused humanitarian organization, and a former medical officer at public hospitals under Burma’s Ministry of Health.

“Men who report having both male and female sexual partners are hidden in nature and have low access to health care services,” he says. “Festivals where they usually come should be used as a site for future prevention programs. Peer-to-peer education strategies should be adapted to reach non-identifying MSM [men who have sex with men] to increase health literacy and promote behavior change.”

Less than one in three men who have sex with men were tested for HIV in South Asia and Southeast Asia over a one-year period, UNAIDS reported in 2012. Burma was one of several countries, including Nepal, Thailand and Vietnam, that reported high coverage of condom use among surveyed MSM populations, at more than 75 percent.

Although Burma’s transition from military rule has led to a slight increase in national funding for health care while allowing more access for medical humanitarian organizations, it has also caused new challenges, says Soe Naing, chairman of the International HIV/AIDS Alliance in Burma.

“Myanmar is opening up, so the Internet has become much easier to access and many people, especially young MSM, can date on the Internet and chat to each other,” he says. “And then they tend to start having sex at an earlier age, before 16.”

“Some transgender people are also forced to have sex,” he adds, calling for better child protection laws.

Poor health infrastructure in rural areas is also worrisome, according to the Burma national association of the YMCA, which is also sending a delegate to Bangkok and offers counseling to HIV patients in Kachin State, where prevalence of the disease is high due to the large number of migrant workers, drug use and sex trafficking.

“We also support their children in education and we have handicrafts training for women who have been affected by HIV,” says the group’s general secretary, Maung Maung Win, adding that the services are also offered in Rangoon and Irrawaddy Division.

Asked whether there was enough cooperation regionally to fight the disease, Kyi Minn of World Vision said the Association of Southeast Asian Nations (Asean), a regional body that includes Burma, agreed to allow migrant workers to access health services in their host countries.

“Myanmar migrant workers with HIV in Thailand should be able to get ART in Thailand. The employer should pay for health insurance. Under this kind of scheme, they should be able to get ART treatment from the Thai government,” he says. “But I’m not sure if this is really accessible—migrants may not be able to access treatment because some are undocumented.”

Some 2.5 million Burmese migrant workers live in Thailand—about half of whom are estimated to be undocumented—and health care professionals say many lack information about safe sex practices.

The Asia-Pacific director for the International Labor Organization, however, says Thailand has done a relatively good job of offering health services for migrants.

“Of course there are some areas that need some improvement, but that’s a model,” Yoshiteru Uramoto reportedly told the media team for the HIV conference in Bangkok. “But with other countries concerned in Asia, I think there’s a lot of room for improvement.

“Not just skilled labor, but unskilled, undocumented, irregular migrants—often they are in the shadow of national registration. … So they face all sorts of problems.”

Throughout the Asia Pacific, progress in fighting HIV infections varies. The rate of new infections fell by more than 25 percent in Burma, Cambodia, India, Malaysia, Nepal, Papua New Guinea and Thailand between 2001 and 2011, according to UNAIDS. The rate increased by more than 25 percent in Bangladesh, Indonesia, the Philippines and Sri Lanka.

The International Congress on AIDS in Asia and the Pacific, organized by UNAIDS as well as the AIDS Society of Asia and the Pacific (ASAP), is known as the largest forum on HIV in the region. Approximately 22 countries in Asia and the Pacific, as well as Europe, the Americas and Africa are expected to be represented.

Among the Burmese delegates will be Ko Ko Naing, assistant director of the National AIDS Program in Naypyidaw, along with Aung Thurein, a medical officer at the National AIDS Program and a public health specialist from the Ministry of Health. Burmese officials from international organizations, including the World Health Organization and UNAIDS, will also be in attendance.