On World Mental Health Day, we speak to community members in Kachin State, Myanmar, about the critical role of mental health and psychosocial support in harm reduction and HIV prevention and treatment among people who inject drugs.
Ja Kai* vividly remembers the day that everything changed.
As a nurse working for a community-based organization in rural Kachin State, Myanmar (Burma), she is respected in her community for her care and diligence. When Myanmar spiraled into violence and economic collapse following the 2021 coup, the stress of frequent fighting near her village and financial problems pushed her husband into injection drug use. In Myanmar, limited access to needles and syringes and stigma against drug users means that needle-sharing is widespread. When he started to feel unwell, he visited a local clinic where he had an HIV test. The result came back positive.
“The counselors suggested that [I come in] for an HIV test as I could be infected as well,” explains Ja Kai. “I was very shocked at first and refused to go. Finally, I mustered the courage to get tested. I remember thinking to myself, if I turn out to be positive too, I am leaving this world, or at least I am going away where no one knows me. I eventually got tested, and when the counselor returned with the results, my world crumbled. The memories are still so vivid when I think about that day.”
Ja Kai returned home, helpless and depressed. Her husband and children were worried about her health. When she returned to the clinic for her follow-up appointment, she encountered understanding and supportive staff. “They comforted me [and showed me] that there is always a solution. They made no judgments. It was so comforting to be in a judgment-free environment.”
Ja Kai discussed her anxiety and mental pressure with the clinic counselor and learned to focus on the positive. She decided to enroll on antiretroviral treatment provided through the clinic. “I still have difficulties opening up about my status to my friends. But I am working on it, and I think I am getting closer to a healthy body and a peaceful mind.”
The Asian Harm Reduction Network (AHRN) runs the clinic treating Ja Kai. AHRN is one of the partners in USAID’s HIV/TB Agency, Information and Services (AIS) Activity led by Community Partners International (CPI). The AIS Activity aims to achieve HIV epidemic control by ensuring that 95 percent of people living with HIV in Myanmar are aware of their status, 95 percent of those identified as positive are on antiretroviral treatment (ART), and 95 percent of those on treatment are virally suppressed. It also aims to achieve a Myanmar free from Tuberculosis (TB) by reaching every person with TB, curing those needing treatment, and preventing the spread of disease and new infections. The AIS Activity prioritizes service delivery to areas and populations with the highest HIV and TB prevalence.
As Myanmar’s crisis has intensified, the AIS Activity is providing certified psychological first aid training to partners to help people who inject drugs and people living with HIV cope with mental health challenges.
Psychological first aid uses three pillars: Look, Listen and Link. It aims to identify alarming signals of mental distress and can be provided during mobile outreach activities alongside other health services such as TB and HIV prevention. Trainees learn to detect safety risks, urgent basic needs, and distress signals; approach beneficiaries to offer support and ask about their needs; help address those basic needs and access services; provide information and link beneficiaries to social support services. Although certified staff are not allowed to provide counseling, they can refer cases to medical facilities.
AIS partner Metta is providing psychological first aid with harm reduction and prevention services to people who inject drugs (PWID) in Kachin State. Kachin State is home to the largest concentration of PWIDs in Myanmar. Through their mobile team, they can reach clients in remote, hard-to-reach locations. Stigma and discrimination against PWID impact their clients’ mental health and create barriers to harm reduction.
Seng Tu, a Metta outreach worker who provides HIV prevention services and antiretroviral treatment counseling in Kachin State, received certified training in psychological first aid provided by the AIS Activity. “Before receiving training, I had difficulty helping clients with mental health problems,” he explains. “I didn’t know how to respond to their concerns or provide the support they needed. I lacked confidence. But now I can better address this challenge.”
“One day, the family of one of our clients came to the clinic,” recounts Seng Tu. “They said that he was verbally and physically abusive. They were worried that he would hurt himself. The client had stopped adhering to ART, and his health had quickly deteriorated. I asked him about his problems and feelings with the family's permission. He admitted to spiraling down due to drugs. After discussing with the clinic team, we referred him for professional mental health support. A few months on, he no longer shows aggressive or harmful behavior and has returned to ART treatment.”
The experiences of AIS Activity partners and clients around Myanmar underline the critical importance of integrating mental health and psychosocial services and psychological first aid into harm reduction and HIV prevention and treatment among people who inject drugs.
*All names have been changed to protect privacy.
The USAID HIV/TB Agency, Information and Services (AIS) Activity aims to achieve HIV epidemic control by ensuring 95 percent of people living with HIV in Burma are aware of their status, 95 percent of those identified as positive are on antiretroviral treatment, and 95 percent of those on treatment are virally suppressed. It also aims to achieve a Burma free from TB by reaching every person with TB, curing those in need of treatment, and preventing the spread of disease and new infections. It is funded by PEPFAR and the Global Accelerator to End TB through USAID.