Has it really been ten years since harm reduction began in Kachin? How many lives have been lost? It is good to see HR finally taking off …
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10 years of harm reduction in Myanmar- setting up a best practice in difficult operating environment TUPE0562
S.S. Kalon1, F. Sivignon1, B. Stambul21Medecins du Monde, France, Paris, France, 2Medecins du Monde, France, Marseille, France
Issues: Myanmar is experiencing one of the worst HIV epidemics among Injecting drug users (IDUs) in the world with about more than 90% HIV prevalence in 1990s. The country is 2nd highest producer of heroin in the world, has a poor health system and politically very isolated. Due to total non-existence of response to HIV among IDUs, Medecins du Monde (MdM) -France started operations in 1996 in one of the hotbeds of HIV in Myanmar- Kachin where HIV prevalence was about 95% in IDUs that time. Due to the sensitive context it has been a very demanding program. With a total denial and minimal participation on part of the locals initially to a country wide coordinated response with active participation of local partners recently, the program has been able to do some ground breaking work in Myanmar.
Description: MdM started with a HIV prevention program for general population then stepped up to a comprensive Drop-in-centre based HIV prevention cum care program. Gradually a full range of activities like Counseling and testing for HIV, psycho-social support, prison care and medical care for IDUs and PLWHAs. Methadone substitution program in collaboration with local hospital starts this Febraury and followed by ART for IDUs stabilised on methadone. After 10 years coverage has increased from 50 to 3000, Needle sharing dropped from 50-60% to 9% and HIV prevalence to 37%.
Lessons learned: In order to impliment a HIV program for IDUs which is controversial in any context one has to adopt a comprehensive approach with advocacy and diplomacy as a priority to create an maintain an enabling environment.
Recommendations: HIV in IDUs being an epidemiologically explosive and extremely deserving for care from a humanitarian aspect therfore needs urgent response. Local involvement for acceptibility and sustainability is essential and for difficult operating enviroments advocacy has to be a top priority.
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Advocacy on harm reduction concept to different targeted groups in Myanmar CDE0002
D.K.O. Zin, D.W.W. SheinCARE Myanmar, Health, Yangon, Myanmar
Issues: Of the 52.4 million populations, Myanmar is estimated to have approximately 339,000 people currently living with HIV infection and a generalized epidemic. Injecting drug use is one of the main causes of HIV transmission in Myanmar. Reduction in harmful consequences of injecting drug use is a new concept that needs to be widely accepted and implemented in the country.
Description: In Myanmar, CARE has been implementing Harm Reduction interventions under the Global Fund project since 2005. CARE developed five Information packages for advocacy, targeting the general population, youth, pwe troupes (traditional theatrical troupes), and police and prison personals through establishment of resource networking with target groups including drug users and influential artists. Using information package, CARE has trained police officers of 80 townships out of 324 townships in Myanmar for the first year as voluntary trainers. Rolling out trainings on harm reduction among police and family members were conducted by the police trainers involving IDUs and sex workers when they come across during their duties. Community received harm reduction advocacy through traditional theatrical performances based on CARE developed harm reduction education scripts. As rural communities become fond of these performances, 18 famous pwe troupes will continue to use these scripts at least for a decade in open season of 6 months a year in the whole Myanmar.
Lessons learned: Though harm reduction is a lawfully, culturally sensitive new concept in Myanmar, repeated and extensive advocacy to different target groups has contributed to gradual acceptance of the concept particularly by the law enforced personals and youth.
Recommendations: While harm reduction through advocacy approach is operating in Myanmar, it will build towards stronger coordination, broader capacity building and policy change conducive to effective harm reduction response against the HIV epidemic. To make it happen long-term, funding availability for Myanmar becomes a crucial role.
