In March 2011, Myanmar’s 50-year old military junta officially ended the world’s longest-running military dictatorship and opened the nation’s previously impermeable borders to international economic and political groups—from Coca-Cola® to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In November 2015, as Nobel Peace laureate and democracy advocate Aung San Suu Kyi’s political party was swept into power by the country’s first free and fair national election in half a century, an amfAR-funded implementation science study to improve HIV testing and treatment among the country’s gay men, other men who have sex with men (MSM), and transgender individuals (collectively, GMT) got underway.
“Myanmar was inaccessible to global research prior to 2011, so this study will shed light on what obstacles there are to linkages to HIV treatment and care among GMT,” says Sandra Hsu Hnin Mon, who is originally from Myanmar and is a student investigator at the Johns Hopkins Bloomberg School of Public Health, one of several institutions collaborating on the project.
In a 2000 World Health Organization (WHO) ranking of world health systems, Myanmar came in second to last, ahead of only Sierra Leone. But in 2013, the government began increasing health spending and reforming its dilapidated healthcare system, including its HIV response. This, combined with an influx of funding from PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other international donors, means that antiretroviral treatment (ART) is now becoming available in the country; however, only 40% of Burmese people living with HIV are currently receiving it—a dangerously low rate of access caused in part by extremely poor HIV awareness and testing uptake. According to the country’s 2015 Global AIDS Response Progress Report, only 48% of MSM have ever been tested for HIV.
“As the government changed, they increased the budget for health and HIV and allowed civil society to participate in the national response,” says Dr. Soe Naing, executive director of International HIV/AIDS Alliance Myanmar. “Now patients can get treatment, but the problem is we have to find out who the patients who need treatment are.”
Same-sex sexual activity is illegal in Myanmar, and while prosecutions under the law, known as Section 377, are rare and many GMT individuals in urban areas live openly, stigma and discrimination remain rampant, preventing many community members from accessing HIV testing and care at government clinics. In the amfAR-funded study, the Alliance and John Hopkins are working in collaboration with the Myanmar Ministry of Health, the University of Public Health of Myanmar, and two community-based organizations—the Myanmar MSM Network and the Myanmar Youth Star Network—to reach marginalized and “hidden” populations by using new and innovative HIV testing and treatment technologies.
These include home-based HIV self-testing, point-of-care CD4 testing—which can determine a patient’s treatment eligibility in minutes, without requiring them to return to the clinic for results—and having peer navigators familiar with the health system help those who test positive access GMT-friendly healthcare and adhere to treatment.
“These innovations are very new to Myanmar,” says Kuang Htet Thu, research coordinator at the Alliance, which provides both testing and treatment. “Previously, we lost patients to follow-up while waiting to get their CD4 test results, and self-testing with OraQuick® will be a great solution [to address low testing rates] because confidentiality is key to privacy and dignity.”
The study includes two arms: participants receiving the newer interventions and those receiving more traditional methods of testing and care at GMT-friendly clinics. This design will allow the team to generate definitive data regarding the effectiveness of these strategies—data that can then be used to advocate for scaling up interventions throughout Myanmar and in other resource-limited settings.
“We will use this research to make recommendations to the government for it to implement in its future programs,” says Dr. Myo Thant, a regional officer of the Ministry of Health’s National AIDS Program, who will serve as a lead researcher on the project.
Despite the progress, many challenges to improving the national response to HIV remain, including the persistence of Section 377, doubts that the healthcare infrastructure can effectively absorb the influx of international HIV funding, and questions about how much power the military is willing to hand over to the newly elected government. But in Yangon, in the aftermath of the election, the talk was of hope and change. “Compared with the old days, things are really improving,” says Dr. Naing. “And we are still in the process of fighting.”
Source – amfAR