I have been unable to find any scientific evidence that "decentralisation has a track-record for reducing discrimination" as UNAIDS is said to have said.

The article does not mention one reason that people are loathe to seek care in the public sector. They are treated badly by doctors and nurses there.

But care must be decentralised to the public sector.

Jamie

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HIV patients apprehensive about new treatment plans
Shwe Yee Saw Myint
Myanmar Times
26 March 2015

HIV-positive patients are concerned for the future quality of their medical options as the government takes control of HIV care and aims to largely decentralise treatment to the township level by next year.

The plan is meant to make treatment more accessible, but HIV-positive patients told The Myanmar Times their concerns range from the public health sectors’ hygiene and the quality of drugs to potential extortion and poor quality of care.

“Government hospitals do not have enough staff and they haven’t been trained very well to understand how to provide treatment confidentially. HIV patients will not have full services anymore and will face discrimination,” said U Myo That Aung, chair of the Myanmar HIV-positive group.

Currently, anti-retroviral therapy (ART), which prevents transmission of HIV and slows the progression of the virus, is available only at specialised facilities. Most of the 139 ART treatment centres are located in Mandalay and Yangon, or in high-risk areas in Kachin and Shan states. To get the dispensaries, patients often must overcome expensive and lengthy travel barriers, a large factor behind why nearly half of the estimated 240,000 people living with HIV in Myanmar do not have access to treatment.

To expand HIV care provisions, the Ministry of Health began a decentralisation strategy in 2013, and plans to cover 140 townships by the end of 2015.

“I know most people do not want to come to the public hospitals for ART drugs, but they have to think long term. NGOs will not keep supporting ART if they finish their project,” said Dr Htun Nyunt Oo, assistant director of the National HIV/AIDs Program at the Ministry of Health.

The government has pledged to provide free treatment to around half of the country’s patients affected by HIV by 2016.

As the public facilities take over treatment, NGOs will refocus on finding new HIV patients and initiating treatment, according to Dr Htun Nyunt Oo.

UNAIDS, which is supporting the government strategy, said both NGOs and government health workers are well aware of patients’ privacy concerns, but added that decentralisation has a track-record for reducing discrimination and improving treatment rates in other countries.

“Some people do not wish to access treatment in their local area because of discrimination in the community so will be allowed to access it in another locality close to where they live,” said Eamonn Murphy, country director for UNAIDS.

But an HIV-positive resident of Mawlamyine who volunteers at a private clinic – and asked not to be named for privacy reasons – said public sector facilities are so badly equipped and funded that they have done more harm than good.

“Now we have the problem of second-line [drug-resistant] cases because government hospitals’ counselling services are not good. Counsellors see many patients in a day and cannot speak with patients for very long, so people leave not knowing how to take the drugs properly or regularly,” she said.

“For many reasons, most HIV patients do not wish to go to the public hospitals. They accept to get treatment there only when they have no money and no other choice.”

http://www.mmtimes.com/index.php/national-news/13747-hiv-patients-apprehensive-about-new-treatment-plans.html