Discrimination and Fear Hamper HIV Eradication in Myanmar

By Rik Glauert 3 November 2017

YANGON — While Myanmar has been celebrating triumphs in controlling its HIV epidemic, the country is facing a new challenge with infection rates among the gay community in major cities among the highest in Asia.

Myanmar’s number of deaths due to the virus have halved in just six years. State Counselor Daw Aung San Suu Kyi touted HIV as an area of “greatest progress” since her government took power last year in her diplomatic address in September.

But as international donors withdraw funding in the wake of the country’s perceived development, the government warned that its HIV program was facing a funding shortfall of US$150 million by 2020—a third of what it says is needed to battle the disease.

The head of UN’s HIV program in Myanmar, Oussama Tawil, said the country could “lose some of the momentum it has gained over the last five years, if current investments decline and other funds are not mobilized.”

With urban centers including Yangon and Mandalay having Asia’s highest rate of gay and bisexual men and transgender women infected with the virus—27 and 22 percent respectively in in 2015—some worry that the funding shortage would further exasperate what experts have described as the latest battle ground in tackling the epidemic.

The percentage of Myanmar’s new infections coming from this community nearly doubled to 13 percent in 2015 from five percent in 2000, making it one of the three populations most at risk to HIV, following people who inject drugs and sex workers.

Health experts said pervasive discrimination against homosexual, bisexual, or transgender people in Myanmar is preventing people from seeking medical help to prevent and treat HIV and Aids.

Intercourse between people of the same sex is illegal in Myanmar with the penal code punishing “carnal intercourse against the order of nature” with up to 14 years in prison.

Living in Fear

After a young man was diagnosed with HIV in 2009, he says he felt like committing suicide.

The 29-year-old from Kyaukme in Shan State who referred to himself as Ko Kyaw Kyaw was forced to quit his job at the restaurant he worked at as the company screened employees for HIV.

Destitute, Ko Kyaw Kyaw could not turn to his family for support—he feared they would neither accept that he had had sex with a man nor that he was HIV positive.

“There was just no one to take care of me,” he told The Irrawaddy.

According to Ko Hla Myat, director of one of Myanmar’s largest lesbian, gay, bisexual, and transgender (LGBT) associations Colors Rainbow, the group is misunderstood by the public and face daily humiliation.

“The majority of Myanmar’s population don’t see them as humans with equal rights, so they experience lack of respect in all aspects of life—at school, at work, in public health, housing, and even within their families,” he told The Irrawaddy.

A 29-year-old man from Shan State felt desperate after finding out his HIV status. (Photo: Htet Tun Naing / The Irrawaddy)

This pervasive discrimination deters individuals at-risk of HIV infection from seeking prevention and treatment services at public hospitals for fear of humiliation or mistreatment.

Like many of the gay or transgender people living with HIV the Irrawaddy spoke to, Ko Kyaw Kyaw avoided government clinics and instead sought help through an INGO when he became worried about his HIV status.

He said friends told him about humiliation at the hands of health professionals, and that some doctors and nurses were known to reprimand patients and tell them HIV infection was punishment for their “lifestyle.”

For UNAID’s Oussama Tawil, eliminating stigma and discrimination is of utmost importance for Myanmar to hit country targets in bringing the epidemic under control.

“There is a need to continue to raise awareness among law enforcers, health and social-care providers to recognize and uphold rights of men who have sex with men, transgender and others as highlighted in the national plan on AIDS.” he told The Irrawaddy.

Safe Spaces

Instead of public hospitals and government agencies, it is non-governmental and community- based organizations that provide prevention services for people like Ko Kyaw Kyaw. That includes providing information on safe-sex, handing out condoms, and encouraging HIV testing, and health facilities that provide treatment without discrimination.

But many users of LGBT-friendly health centers—such as Aye Nyein Myittar and Population Services International—told The Irrawaddy they feel uneasy over the future of these critical services as global funding dwindles and the government and INGOs struggle to keep up with the costs.

At the centers, counselors work to inform communities about the risks of HIV, the importance of testing and help patients deal with diagnosis and starting treatment—even accompanying them to public hospitals if necessary.

A counselling session at Population Services International’s center in Yangon. (Photo: Htet Tun Naing)

Outreach workers at the centers travel to areas of the city frequented by LGBT, hold group sessions, offer pre- and post-HIV test counselling and have recently began reaching out to people through Facebook, Viber, B-talk and mobile applications popular with gay and bisexual men—quadrupling the number of of gay and bisexual men getting tested for HIV and the number testing HIV-positive in just six months.

U Chit Ko Ko, a 60-year old retired natkadaw—a spirit medium that dresses in female attire—was one of the first people in Myanmar to speak out about being HIV positive and openly gay when he found out he had the virus in 2002.

He supported people in the community to get tested before setting up Lotus—one of the first groups to reach out to those at risk.

After working with hundreds of people over more than a decade, he said discrimination and stigma in Myanmar were still preventing vulnerable people from receiving the services they needed.

“Awareness is needed to fight discrimination,” he told The Irrawaddy. “Without talking about LGBT and HIV, you can’t eliminate the disease.”