The [him] moderator has received a copy of the concise version of the new Myanmar National Strategic Plan and Operational Plan on HIV/AIDS 2011 - 2015.

The only other copy of the plan he had previously looked at was the draft complete plan. The attached document appears to a shorter version with text directly cut and pasted from the complete plan. The complete plan is too long. One wonders why it was written like this in the first place. Has anyone but the author read all one hundred and forty pages of the complete plan?

The [him] moderator has two major issues about the evidence that informed the development of the plan.

1) The complete plan says "In this document the usage of the term ‘men who have sex with men’ will include transgender. At this stage all prevention programmes for men who have sex with men include transgender as well. All self help groups are open to both men who have sex with men and transgender. Myanmar language distinguishes at least six sub-groups of men who have sex with men and transgender. The boundaries between groups appear sometimes blurred and more research is needed to improve the understanding of the local context."

Five years after formal recognition of men who have sex with men as a key population at higher risk in the country, it is not good enough to simply say that more research needs to be done. Why hasn't it been done and where are the plans for this research in the new plan? There aren't any.

Simply adding transgendered people to the population of men who have sex with men is not evidence-informed. There is no published evidence of HIV infection among transgendered people. Transgendered people are not men who have sex with men and lumping them together with men who have sex with men denies them autonomy. It puts them under the hegemony of the 'MSM community'.

But the concise plan doesn't even have the word transgendered in it. Transgendered people are excluded from it.

2) The sexual partners of the three classical key populations appears to have been added as an afterthought. Or perhaps at the political bidding of  'intimate partner' lobbyists. Where is the evidence that the noncommercial partners of women sex workers, their clients, and their clients' other partners are at risk and where is the evidence-informed programming? Where is the evidence that the wives of bisexual men who have sex with men are at risk and where is the evidence-informed programming? Where is the evidence that the sexual partners of injecting drug users are at risk from sexual transmission and where is the evidence-informed programming?

This appears to the [him] moderator to be a nonstrategic example of loss of focus and 'MARP creep' in which people who have little in common are added to the list of risk populations. This pads programmes and increases their costs.

But there is a group of people who are at risk of HIV acquisition for which there is an evidence-informed intervention: the seronegative partners in couples in which one member is seropositive and both partners know about the partner's infection.

The author of the plan seems to be confused about testing as prevention:

The plan says "HIV counselling and testing play a fundamental role both in treatment and in prevention and are the necessary entry point for the continuum of care. A minority of those practicing high risk behaviours and likely to have been exposed to HIV have access to counselling and testing. Even in PMCT, where voluntary counselling and testing is routinely offered, many women and their sexual partners do not take the test for fear of stigma and discrimination. Scaling-up HIV testing, therefore, should include improved protection from discrimination as well as access to prevention (e.g. BCC, condoms, co-trimoxazole, PMCT) and treatment (e.g. ART)."

The [him] moderator is a bit tired of stating this point over and over. HIV counselling and testing play only a minor role, if any, in the prevention of HIV transmission. VCT never has been a highly effective method to prevent HIV infections. This has been shown in studies. Couples VCT is the only kind that has been shown to work, decreasing HIV acquisition in the negative partner in discordant couples. VCT is just an entry point to care. 'Treatment as prevention' notwithstanding.

The [him] moderator could go on about the deficiencies of the plan. He is interested in hearing from others what they think of it. And now is the time to get down to implementing it. The clock is ticking.

[him] moderator