Abstracts of papers on HIV and drug use in Myanmar / Burma at the international harm reduction conference

Here are the abstracts of three important papers being presented this week in Vancouver at the 17th International Conference on the Reduction of Drug Related Harm. If the authors would be so kind as to send their papers to [him] the moderator will attach or post them.


Title of Paper:       Discovering Drug Use Among Commercial Sex Workers (CSWs): Experiences of Medecins du Monde in Kachin, North Myanmar
Written By:       Françoise Sivignon
Stobdan Kalon
Béatrice Stambul
Presented By:       Stobdan Kalon
Béatrice Stambul

Issue: MDM has 2 project sites in Kachin focussing on CSWs and IDUs respectively. Linkages between the 2 target populations became more and more evident giving rise to a need to introduce harm reduction for CSWs. To assess the extent of problem this study was initiated. In-depth interviews using KAP questionnaires triangulated with records from STI/HIV clinic/laboratory to assess prevalence of HIV was done.

An analysis of the outcomes from these questionnaires and clinic records will be presented at the conference. The study would give an insight into the severity of this problem and help in addressing the issue appropriately.

Description: Myanmar is affected by one of the worst HIV epidemics due to injecting drug use. High opium production, unique socio-economic factors makes the country even more vulnerable to the epidemic. Links between sex work and drug use has been documented in other contexts buy no study has been done in Myanmar.

Sex work like drug use is a highly clandestine in the country but flourishes to drive the spread of HIV in this country. CSWs that are IDUs or vice-versa are a double high risk category. In Myanmar there was a total lack of HIV prevention and harm reduction initiatives till MDM started in 1996. This study will be an eye opener for this double risk population for which there is no intervention and help to address the problem with an evidence base.

Methodology: 50 CSWs had individual in-depth interviews using Behavioural Surveillance Survey (BSS) questionnaires and clinical examination with rapid testing for HIV as per MDM protocols. The patients were explained about the study and written consents were taken.


Title of Paper:       Pioneering Harm Reduction In a Difficult Operating Environment' Outcomes and Lessons Learned From MDM's Decade Long Experience In Myanmar
Written By:       Stobdan Kalon
Béatrice Stambul
Françoise Sivignon
Presented By:       Stobdan Kalon

Introduction: With 90% HIV prevalence among IDUs Myanmar had one of the worst-hit IDU related HIV epidemics in the world. And to make matters worse there was a total non-existence of services to address the issue. In response to this unmet need Médecins du Monde (MdM), pioneered harm reduction interventions in the Kachin state in 1996 through a comprehensive strategy.

Methodology: A comparison of the key statistics of the period at the early and present stages of the project was made to track the progress made.

Discussions: The outcome of the program has been satisfactory with outreach visits increased from 1,198 in 2003 to 1,356 by 1st half of 2005. Needle distributed from 135,729 in 2003 to 130,826 by 1st half of 2005. IDUs getting health education increased from 55 in 2003 to 216 by 1st half of 2005. Clinic attendance increased from 472 in 2003 to 356 by 1st half of 2005, and PLWHAs attendance from 40 in 2003 to 297 by 1st half of 2005. Finally Harm Reduction being officially adopted by the MOH was a big outcome of advocacy initiatives.

Lessons Learned and Conclusions: Through the experience of MdM in Kachin for nearly a decade, one can conclude that in a difficult operating environment, it is possible to implement an intervention as sensitive as harm reduction. Sensitive advocacy with the key stakeholders for local involvement and sustainability has to be a priority. It is best promoted through a comprehensive strategy where sensitive components can be bundled into a package of services with more acceptable components. Multi-sectoral collaboration especially with police has been a corner-stone for creating an enabling environment.

Foundation built by years of work should be capitalized upon and harm reduction interventions should be scaled up without further delay as the spread of HIV/AIDS due to injecting drug use can be explosive.


Title of Paper:       Primary Care Health Services and Harm Reduction in Myanmar
Written By:       Bobby Limbu
Presented By:       Bobby Limbu

Background: The high rate of abscess cases and other such infections related with injecting drug use is being reported to some Effective Approaches Projects (EAPs) currently overseen by the Asia Regional HIV/AIDS Project, in Myanmar. Training has been specially designed on primary care health services with the consultation of clients, field workers and medical personnel. Provision of training in five Effective Approach Project sites enhances the skills of outreach workers in the field of basic primary care health services. They are provided by doctors, nurses, Myanmar Red Cross staff and STD team leaders in respective sites.

Method: Training contents designed to address abscess management, minor infections and effects of different drugs. Some technical knowledge and skills like sterilization, universal precautions, first aid, mouth to mouth resuscitation, home based care and disposal methodology is also delivered through this training. Five days extensive training also included observation tour to Central Supply Department (CSD) and incinerator in local hospital and STD clinic and some organization providing home based care.

Results: Primary care health service training targeting injecting drug users, effectively reinforces skills for abscess management and increases the number and quality of education sessions on safer injecting. The number of abscess cases subsided after the provision of primary care health education in drop in centers and frequent education on preventive skills. Demand for these services is ever increasing.

Conclusions: Inclusion of primary care health services within harm reduction programs, proved to be successful in terms of increasing relevance of the EAPs to their clients. Outreach workers have gained practical skills of benefit to clients as well as the community.

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