1 December
EVERY year, World AIDS Day is celebrated on December 1. It is the moment of the year for all the people in the world to disseminate information about the status of the HIV epidemic, to unite in the fight against HIV and to show support for people living with HIV.This year’s theme for World AIDS Day is "Communities make the difference" and aims to recognize the essential role that communities have played and continue to play in the AIDS response at the international, national and local levels.
HIV Epidemic Situation in Myanmar
Myanmar currently has the 4th highest number of People living with HIV(PLHIVs) in WHO-SEAR after India, Indonesia & Thailand. In 2018, Myanmar has an estimated 237,000 people living with HIV, representing 0.57% prevalence in general pop. Concentrated epidemic among key populations primarily occurring among People who Inject Drugs( PWID); Men who have sex with men (MSM)/ Transgender(TG); and Female Sex Worker (FSW) and their clients.
All countries in the region are struggling very hard to contain their HIV epidemics. It has been a successful endeavour and Myanmar is not an exception. The overall HIV epidemic in Myanmar is estimated to be declining slowly at the national level. The prevalence of HIV among adults 15 years and older seems to have stabilized at 0.57 % in 2018, and there has been a significant decline in AIDS-related deaths, 35% over the last five years.
However, the HIV Epidemic at sub-national level is quite different from region to region. The sub-national estimates show that Yangon, Kachin, Shan (N) and Sagaing HIV epidemics are not declining as the national one. At national level, all modes of transmission are important, but at sub-national level there are some key modes of transmission driving the epidemic.75% of new infections occurs in Kachin, Shan- North, Yangon, Mandalay and Sagaing.
A major global public health issue
According to WHO’s 2019 World AIDS Day Fact sheet, there were approximately 37.9 million people living with HIV at the end of 2018. As a result of concerted international efforts to respond to HIV, coverage of services has been steadily increasing. In 2018, 62% of adults and 54% of children living with HIV in low- and middle-income countries were receiving lifelong antiretroviral therapy (ART). A great majority (82%) of pregnant and breastfeeding women living with HIV also received ART, which not only protects their health, but also ensures prevention of HIV transmission to their newborns. Due to gaps in HIV services, 770000 people died from HIV-related causes in 2018 and 1.7 million people were newly infected.
HIV can be diagnosed through rapid diagnostic tests that can provide same-day results. This greatly facilitates diagnosis and linkage with treatment and care. There is no cure for HIV infection. However, effective antiretroviral drugs (ARVs) can control the virus and help prevent onward transmission to other people. Between 2000 and 2018, new HIV infections fell by 37% and HIV-related deaths fell by 45%, with 13.6 million lives saved due to ART. This achievement was the result of great efforts by national HIV programmes supported by civil society and international development partners.
HIV remains to be a major global public health problem, having claimed more than 32 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives.
Myanmar’s Response to HIV
Myanmar is one of the countries in Southeast Asia region hardest hit by HIV epidemic since last three decades ago. The national response against HIV/AIDS has been implementing in concerted efforts with all implementing partners including community-based organizations and positive groups since the early phase of the epidemic.
The national efforts are systematically accelerated by the medium and long term National Strategic Plans (NSP) for HIV/ AIDS which have been developed with the full engagement of all stakeholders, multi-disciplines and multisectoral. Under the government leadership, Myanmar’s current third HIV NSP (2016-2020) envisioned the political declaration on ending HIV from public health threat by 2030 where the global fast track 90-90-90 test, treat and retain targets are adopted as built-in strategic milestones assessing the progress of national responses. Its framework describes the current dynamics of the HIV epidemic and articulates a strategy to optimize investments through a fast track approach with the vision of ending HIV from public health threat.
The NSP is the strategic guide for the country’s response to HIV at national, state/regional and local levels. The plan has highly focused, cost-efficient strategies to ensure that the right interventions are implemented in the right places for the right people. Prevention, Care and Treatment Continuum model was being developed to ensure the availability of essential package for health service for HIV in all townships, either through direct service provision or through referral to nearby townships. Health system strengthening, private sector engagement and community mobilization are necessary elements to ensure the availability and the quality of the continuum of HIV services.
With effective behavior change communications and preventive programme, the incidence of HIV infection is significantly reduced, 24% over the same five years period. A number of routine activities such as HIV sentinel sero-surveillance survey, assessment of early warning indicators for HIV Drug Resistance including Cohort assessments of people on ART, the periodic integrated HIV Bio-Behaviour Surveillance Survey among Key Population etc. continually taking place.
In term of funding contribution approximately 20% of all National AIDS spending is from domestic public, 50 % from GFATM and remaining 30% from other international donors including US-PEPFAR, Access to Health fund and other development partners. Myanmar is one of the few countries among middle- and low-income countries that is paying already for 80% of all the Antiretroviral medicines with full commitment of government contribution. Sustaining Government contribution to HIV response will be central for ensuring successful acquisition of external funding. In order to reach the targets of the Sustainable Development Goals, the streamlining and integrating multiple service delivery models by both public and NGOs and integrating HIV through the universal health coverage approach is critical.
Lessons learned: Challenges
When Myanmar’s current third HIV NSP (2016-2020) comes to the implementation, the following challenges remain for our country.
-TB/HIV prevention coverage gaps: Insufficient capacity to effectively implement TB/HIV prevention including Latent TB Infection (LTBI) treatment; The progress is much more modest in LTBI treatment among newly enrolled PLHIV in public sectors
-Gaps in linkage to care: Dropoff in cascade from testing to treatment and delayed treatment- seeking behaviours, perception, social norms.
-Community & peer support are critical and help a person to pre prepare and make the decision to start therapy; overcoming the barriers and optimizing our current strategies is essential for improving TB/HIV Management
-Rapid ART transition from private to public sector; Burden on public sector The Way forward
Realizing the current critical challenges and to achieve the aspirational goals, the following priority actions to be undertaken have also been identified.
• Develop next circle of National Strategic Plan for HIV (NSP-IV) (2021-25)
• Sustaining Government contribution to HIV and TB response is crucial for ensuring successful acquisition of external funding
• Streamlining and integrating multiple service delivery models by both public and NGOs; and integrating HIV through the universal health coverage approach
• Integrated ‘co-location’ approach to expansion of services for co-infections such as TB, HCV, HBV and co-morbidities
• Greater effort to address stigma and discrimination in the community and within health services across every level
• Human resource shortage is a continuing unsolved challenge; Piloting to mitigate by using innovating way such as social contracting and community mobilization; Empower community-based organizations (CBO), self-help groups and volunteers to involve more in TB/HIV services
• To initiate Tasking Shifting whenever feasible; Expanded partnerships with Ethnic Health Organizations (EHO) and private sector
Communities make the difference
World AIDS Day 2019 will offer an opportunity to translate our commitments into action, to ensure the role of communities for HIV and health progress are both celebrated and accelerated. WHO recommends that expanding the role of communitie and community-based health care will help countries meet global HIV and UHC targets. Therefore greater mobilization of communities is needed to explore the challenges that stop communities delivering services, including restrictions on registration and an absence of social contracting modalities. The strong advocacy role played by communities is required more than ever to ensure that AIDS continues on the political agenda, that human rights are respected, and that decision-makers and implementers are undertaken accountable. Communities can provide to the AIDS response in many different ways. Their leadership and advocacy ensure that the response remains relevant and grounded, keeping people at the centre and leaving no one behind.
Communities include peer educators, networks of people living with or affected by HIV, such as gay men and other men who have sex with men, people who inject drugs and sex workers, women and young people, counsellors, community health workers, doorto- door service providers, civil society organizations and grassroots activists.
The framework of the new National Strategic Plan and with the strong foundation and support of all partners, we hope to contribute Myanmar’s vision of universal health coverage, the achievement of Sustainable Development Goals and make great strides to eliminate HIV as a public health threat by 2030.
Reference:
1. Draft Progress Report 2019, National AIDS Program, DOPH, MOHS, 2019
2. HIV/AIDS Fact Sheet 2019, WHO, 2019
3. Global HIV & AIDS Statistics- 2019 fact sheet, UNAIDS, 2019
4. National Strategic Plan on HIV and AIDS, Myanmar(2016-2020), DOPH, MOHS,2016
5. Progress Report on HIV, Viral Hepatitis and STIs 2019, WHO, July 2019
By Dr Aung Tun & Dr Htun Nyunt Oo (Ministry of Health and Sports)
