World AIDS Day 2018

World AIDS Day observes on the 1st December each year.It is an occasion for all the people in the world to unite in the fight against HIV, to show support for people living with HIV, and to mourn those who have died from a AIDS-related illness. 2018 will be making its 30th anniversary of World AIDS Day on 1 December. This year’s theme for World AIDS Day is “Know your status”.

Global HIV & AIDS Statictics

In 2017, 36.9 million [31.1 million–43.9 million] people globally were living with HIV and 21.7 million million people were accessing anti-retroviral therapy.1.8 million people became newly infected with HIV and 940 000 people died from AIDS-related illnesses. Every week, around 7000 young women aged 15–24 years become infected with HIV.The risk of acquiring HIV is 27 times higher among men who have sex with men; 23 times higher among people who inject drugs; 13 times higher for female sex workers; 12 times higher for transgender women. TB remains the leading cause of death among people living with HIV and TB accounts for around one in three AIDS-related deaths. In 2016, 10.4 million people developed TB disease and 1.2 million were living with HIV. People living with HIV with no TB symptoms need TB preventative therapy, which lessens the risk of developing TB and reduces TB/HIV death rates by around 40%.

Epidemiological context of HIV in Myanmar

The HIV epidemic in Myanmar began with the identification of the first HIV infected case in 1988, and the almost three decades old HIV epidemic is concentrated among population subgroups with high-risk behavior. These population subgroups include Female Sex Worker (FSW), Men who have sex with Men (MSM), People Who Inject Drug (PWID), and sexual partners of these sub-group populations. Myanmar is one of the few countries in the world where the incidence rate of HIV infection among adult 15 to 49 years old has decreased by more than fifty per cent over the last decade (Ending AIDS, global AIDS update, UNAIDS, 2017).

According to estimation and projection exercise employing the AIDS Epidemic Modelling, the new HIV infections among people aged 15 and above reached the peak at around 28,000 in the year 2000 which was declined to 12,500 in 2015 and further declined to 11,000 in 2017. The risk groups including Key affected populations (KAPs) shared more than seventy per cent of annual new infections in 2017.

However, the HIV Epidemic at sub-national level is quite different from region to region. At national level, all modes of transmission are important, but at sub-national level there are some key modes of transmission driving the epidemic: Kachin State, Shan (N) State and Sagaing Region have an Injecting Drug Use (IDU) driven HIV epidemic whereas Yangon and Mandalay regions have Men that Have Sex with Men (MSM) and heterosexual driven (FSW and clients) epidemic.

Progress in National Responses to HIV

The national response against HIV/AIDS has been implementing in concerted efforts with all implementing partners including WHO, UN organizations, NGOs and community based organizations, and positive groups since the early phase of the epidemic.

The efforts are guided by the medium (5-year) and long term National Strategic Plans (NSP) for HIV/AIDS which have been developed based on the information from program evaluations, surveillance surveys, operational researches and other studies and with the full engagement of stakeholders.

Myanmar’s current National Strategic Plan on HIV and AIDS (2016-20) envisioned the political declaration on ending HIV as public health problem by 2030 where the fast track 90-90-90 prevention, testing and treatment targets are adopted as built in strategic milestones assessing the progress of national responses.

The National Strategic Plans are usually used as a guideline that ensuring concerted efforts of all stakeholders. The current cycle of NSP has based on five main strategic directions aiming for providing holistic and continuum of services while moving towards the goal of “reducing HIV transmission and HIV related morbidity, mortality, disability, & social and economic impact”

Reducing new HIV infection and Improving health outcomes for all people living with HIV in Myanmar

The significant reduction in the number of new infection in the past decade revealed the positive impact of prevention services. Of the estimated 66,000 FSW (NAP, 2017), the proportion reached with prevention program was 63% in 2017. In 2011, 37% of the estimated 252,000 MSM (NAP, 2017) was reached by prevention services in 2017. The number of PWID was estimated to be 83,000 (NAP, IBBS PWID 2015). 72% of PWID accessed harm reduction services in 2017 while the number receiving MMT was increased from 10,290 at the end of 2015 to 13,441 by the end of 2017. In addition, the number of needle syringes distributed a PWID per annum have been increased to 324 in 2017.

Services for improving health outcomes for people living with HIV have been increasing reach in term of both geographic and population coverage. Coverage of antiretroviral therapy (ART) has doubled from 55% in 2015 to 66% (146,826 of estimated 223,000 PLHIV) on ART by 2017.

In addition, the treatment and care services have been made available to more and more townships by expanding the ART centers and establishing decentralize ART services up to sub township level. By the end of 2017, the treatment and care services are available in 227 townships through 127 ART centers and 174 decentralized sites. In addition, ART services are increasingly available and accessible for those in prisons. In collaboration with National TB control program, 96% of PLHIV enrolled in care received TB screening in 2016 which increased from 95% in 2013.

Regarding Progress in Strengthening integration of community and health systems and promoting a human right based approach, innovative services delivery modalities that help integration of community based services and ensure continuum of services from prevention, testing, to enrollment into care was formalized and started rolling out in townships with high priority townships as defined in NSP III. There are ongoing activities for strengthening procurement and logistics management, and laboratory information system in recent years. Review and revision of HIV related laws/policies including the new HIV laws, the amendment of the Prostitution act and are also in progress.

Regarding Progress in Strengthening strategic information and research to guide service delivery, management and policy, a programmatic exercise for key populations that helps not only with providing better picture of program needs but also improve capacity of local stakeholders for better coordination and optimized resources allocation was conducted in 46 highest burden townships in 2016 and in additional 28 townships in 2017. Details HIV Epidemic picture are available for Yangon, Mandalay, Kachin, Shan (North) and Sagaing.

Regarding Progress in Promoting accountable leadership for the delivery of results and financing a sustainable response, under the leadership of Myanmar Health Sector Coordinating Mechanism (M-HSCC), the HIV Technical Strategic Group (HIV-TSG) has being fully functioning ensuring the cooperative responses from all implementing partners, drawing technical inputs from UN agencies and development partners, and acquisitive funding opportunities from government and development partners.

The way forward

Myanmar has already announced to join “the Global HIV Prevention Coalition” during the 71st World Health Assembly on May 22,2018, in Geneva, Switzerland.Union Minister for Health and Sports Dr Myint Htwe mentioned that Myanmar is creating an enabling environment for providing continuous efforts for removing legal, stigmatizing factors and financial barriers to help achieve “AIDS FREE MYANMAR”

Although Myanmar has limited resources in both Central NAP and State/Regional AIDS/STD teams the following activities are planned as priorities among others in the coming years.

√ Strengthen prevention of new infections ensuring the holistic continuum of services for all key population and achieving the elimination of mother to child transmission of HIV in Myanmar by 2025.

Devising innovative service delivery models that tailored to the local epidemic and need

Improve the accessibility of lab services for all and strengthen the lab information system that ensure the results are linked and used to improve individual patient management

To holistically provide HIV health services to target communities and populations by way of providing medical facilities, equipments, strengthening capacity of health workers at national level, State or Regional and townships, improved access to community outreach among target populations and encourage HIV infected person to approach those facilities and workers.

Know your status

HIV testing is extremely important for expanding treatment and making sure that all people living with HIV can lead healthy and productive lives.It is also essential to achieving NAP targets and enabling people to make choices about HIV prevention so they can protect themselves and their love ones.

Globally, 75% of all people living with HIV knew their HIV status in 2017. In Myanmar, an increasing trend can be seen in term of HIV testing coverage among key populations. The testing coverage increased from 42% in 2015 to 60% in 2017 for FSW; from 13% in 2015 to 33% in 2017 for MSM; and from 33% in 2015 to 43% in 2017 for PWID. In addition, efforts have been made to reach the partners of key populations. There has been increase in number of partners being reached with HIV prevention services and HIV tests. .

Myanmar has fully followed the Global Goal of Ending Paediatric HIV infection by 2020 and prolonging mother life. Establishing a community based service delivery modality is a priority recommendation to reach the Global PMCT Goal effectively and sustainably (WHO,2013). In late 2013, Myanmar started its first step of community based movement with the introduction of decentralized HIV testing where the primary care providers are allowed to perform screening test for all pregnant women seeking Antenatal Care.

This community based testing strategy brought a significant improvement in the number of pregnant women received HIV test and test result (309,677 pregnant women knew HIV status in 2013 and it was increased to 848,557 in 2017).

Although improvements have been seen in term of providing HIV testing and treatment for positive pregnant women living with HIV, limited improvement has been observed in the area of providing follow up care and diagnostic services for exposed infants. Only 28% of the exposed infants received HIV testing within 2 months of age (early infant diagnosis) in 2017.

Regarding HIV testing, some barriers such as Stigma, discrimination and access to confidential HIV testing still persist.

World AIDS Day 2018 theme emboldens everyone to know their HIV Status.

You can join us in the fight this World AIDS Day in promoting awareness about the importance of knowing one’s status and asking for the removal of all barriers to accessing HIV testing.

Reference:

1. Draft Progress Report 2018, National AIDS Program, DOPH, MOHS, 2018

2. Global HIV & AIDS Statistics-2018 fact sheet, UNAIDS, 2018

3. National Strategic Plan on HIV and AIDS, Myanmar(2016-2020), DOPH, MOHS,2016

4. World AIDS Day 2018 Message of UNAIDS Executive Director, UNAIDS,2018

5. World AIDS Day 2018-Feature Story, UNAIDS, 2018

By Dr Aung Tun, Dr Htun Nyunt Oo
Ref; The Global New Light of Myanmar