For people living with HIV (PLHIV) in Myanmar (Burma), the February 2021 coup and ensuing turmoil are endangering the health services they rely on for survival. We speak to community health workers supported by the USAID HIV/TB Agency, Information and Services (AIS) Activity providing a lifeline to PLHIV during this crisis.
The crisis unfolding in Myanmar is affecting PLHIV in several ways. As the health system struggles to sustain services, they risk delays in HIV diagnosis and interruptions in HIV treatment. These can be devastating for PLHIV with weakened immune systems, leaving them vulnerable to opportunistic infections.
The USAID HIV/TB AIS Activity, led by Community Partners International, is supporting organization partners in Kachin State, Shan State, Sagaing Region, Yangon Region, and Mandalay Region in Myanmar to provide HIV prevention and treatment services to approximately 80,000 people in key populations at the highest risk of HIV infection. Key populations include people who inject drugs (PWID), men who have sex with men (MSM), female sex workers (FSW), and transgender persons.
These key populations bear a significant burden of Myanmar’s HIV epidemic. Data from 2019 reveal that 19% of PWID, 8.8% of MSM, and 8.3% percent of FSW tested for HIV were positive. That compares to an estimated HIV prevalence of 0.8% in the general Myanmar population aged between 15 and 49.
Adapting rapidly in the first months of the coup, AIS partners were able to avert catastrophic HIV service interruptions and mitigate the impact on clients. Telehealth practices and social media use adopted during the COVID-19 pandemic provided crucial channels of communication with clients when travel and face-to-face interactions became more difficult. AIS partners actively followed up with clients through phone, messaging apps, and social media to encourage them to attend HIV testing appointments, support linkage and adherence to antiretroviral therapy (ART), provide counseling, and connect them to medical care as needed.
The outcome of these rapid adaptations is that, for many AIS partners, service coverage has now returned to pre-coup levels. This is a tribute to the resilience and resourcefulness of these community-based care networks serving PLHIV during the most challenging situations. Here are some of the individuals supported by the USAID HIV/TB AIS Activity sustaining these critical services:
Ma Nu Sant
Ma Nu Sant is a counselor with AIS partner, the Asian Harm Reduction Network (AHRN), in Kachin State. For the past eight years, Ma Nu Sant has been counseling clients ahead of HIV and TB tests, enrolling them in methadone treatment or antiretroviral therapy, and providing mental health support.
As Kachin State is home to the largest concentration of people who inject drugs (PWID) in Myanmar, Ma Nu Sant became a counselor to alleviate the plight of the PWID in her community. Every month, she counsels around 90 people.
“I love talking with people and hearing about their challenges and difficulties,” she shares. “Since HIV requires long-term treatment, people who live with HIV can suffer mentally and physically. That’s why I want to improve their lives.”
Ma Nu Sant works hard to earn the trust of her patients. She particularly enjoys guiding them through tough decisions. “I remember a client who used drugs and was discriminated against by his family and community for having HIV and TB. I was able to comfort him and get him to start the necessary treatment. He now has a better social life with his family”.
Ban Htoi is a field assistant with AIS partner, the Kachin Backpack Health Worker Team (KBPHWT), in Kachin State.
As a member of KBPHWT’s mobile outreach team, Ban Htoi travels to remote areas to provide health education and testing services. Every month, she delivers about 20 health education sessions in different parts of Kachin State.
“I want to deliver a message to the young people so they can enjoy a safe and happy life free from HIV,” she shares. “That is why I work in HIV service provision.” She says she can make the most significant difference with people who inject drugs, a key population group at higher risk of HIV transmission.
Aung Nu Pan
Aung Nu Pan is an outreach worker with AIS partner, the Asian Harm Reduction Network (AHRN), in Kachin State. She is often the first person new clients meet when enrolling in medical treatment and starting their journey toward recovery.
She visits key populations to provide HIV prevention, distribute condoms and share knowledge about her clinic’s services. When she identifies someone needing help, she directs them to the clinic for follow-up tests and counseling.
“Many people have never thought of getting tested,” she reveals. “Once I convince them to test for HIV, many turn out HIV positive. We are then here to provide them with treatment.”
When she is not traveling, Aung Nu Pan works at an AHRN drop-in-center providing tailored services to women at higher risk of HIV transmission. “Some people are still afraid of HIV like I used to be before I learned about it. Now I know that, with the right care and information, we can change people’s minds and lives.”
Shin Thant is a bit of a celebrity in her community. As a project officer with AIS partner Lan Pya Kyel, this influencer has been working to obtain equal rights for LGBTQ+ people for more than eight years. Today, she manages an outreach team visiting key populations to provide HIV prevention and linkage to care services.
Her team visits locations where key populations gather to share information about preventing and treating HIV and invites them for HIV testing. She assists those who tested HIV positive to enroll in ART and provides pre-exposure prophylaxis (PrEP) for eligible clients who test HIV negative.
Shin Thant cares deeply for her clients and cultivates trusting relationships with them. It is through trust that she can make progress.
“I remember a client who came to the clinic with a weak immune system due to TB,” she shares. “She was very weak, so I provided rice to her and her family. After six months [of clinical care], she is now much healthier. We were all happy to see her regain good health!”
Naing Htun Oo
Naing Htun Oo is an online coordinator with AIS partner Lan Pya Kyel. He leverages social media and online resources to encourage members of key populations to seek HIV testing and treatment. Through the COVID-19 pandemic and the coup, social media has become a crucial channel for communicating with key populations.
Naing Htun Oo creates social media campaigns and manages confidential messaging platforms that bring 200 people each month to the organization’s clinic for HIV prevention and treatment services. He is keenly aware of the most effective strategies to reach and engage key populations facing widespread stigma and discrimination.
“Online users always hide their behaviors, and they are quite afraid to let people know their sexual orientation,” he reveals. “Whenever we share healthcare education online, we don’t need to meet in person, but we discuss and solve the health problems they face online. Then we can advise them to get an HIV test.”
Daw Khaung Naw
Daw Khaung Naw is an ART counselor with AIS partner, the Myanmar Positive Group (MPG), in Kachin State. For the past five years, she has counseled ART patients to support them and ensure they receive and take their ART medication.
Each month, Daw Khaung Naw meets with up to 150 PLHIV to follow up on their treatment and provide counseling and health education. She also provides financial support to cover their travel and hospitalization expenses.
“I chose to work for this organization because it cares for and represents people who live with HIV,” she explains. “I love to help [them]. I once met a client who was reluctant to accept medical treatment for religious reasons. I met with him and after a while I was able to convince him to enrol in ART without offending his religious views. It felt good.”
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.