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16 Oct 2014 | Family planning
Our team in Myanmar’s work with men who have sex with men, sex workers and young people, shows that adapting and innovating services is key to reaching the most stigmatised and at-risk groups for HIV infection.
Every August, tens of thousands gather in Taung Pyone in central Myanmar for the famous nat pwe spirit festival, where spirit brothers are reputed to grant wealth and good fortune.
Nat pwe is also known for drawing one of Myanmar’s most stigmatised and at-risk groups for HIV infection, men who have sex with men (MSM). This group has the second highest HIV prevalence in Myanmar (7.8 per cent versus 0.6 per cent for the general population) due to the highly restrictive legal environment and deep-seated stigma and secrecy.
This festival’s openness towards MSM is unusual in culturally conservative Myanmar. Ma Zar Chi Htwe, Global Fund Consortium Project Manager at Marie Stopes International Myanmar (MSI Myanmar) explains:
“The festival is a safe space for them. No one can stigmatise or discriminate against them there. That’s why it is so important to use the opportunity to provide the HIV/AIDS education and services they need.”
As in the past several years, MSI Myanmar set up a booth along the road into Taung Pyone. Trained MSM peer educators talked to festival-goers about safe sex, distributed condoms, and made referrals for voluntary counselling, testing, diagnosis and treatment of sexually transmitted infections. Over the course of the festival, 90,000 condoms were handed out and 1,000 MSM were reached with health education sessions.
What made the activities especially effective were the joined up efforts between two of MSI Myanmar’s projects – the Global Fund Consortium Project and Link Up Project – and the leadership of the Myanmar National AIDS Programme and the Department of Health in implementing national strategies that identify MSM, as well as sex workers and young people, as strategic priorities for HIV prevention.
“Reaching at-risk and key affected populations means going outside our clinic walls. We shouldn’t wait for these people to come to us,” said Link Up Project Manager Dr Ne Tun Zaw. “We have to go to them.”
For the Link Up Project, this has meant recruiting peer educators from the target groups and partnering with community-based organisations. To reach young people, youth peer educators also go to universities and pagoda festivals.
Educators have also extended their working hours into the evening, when they are more likely to be able to reach their peers, and established youth-friendly corners at MSI Myanmar centres.
Reaching out to sex workers, nearly 10 per cent of who are HIV positive, has presented some of the greatest challenges to these projects. Commercial sex workers face criminal prosecution and extreme stigma, and have fewer safe spaces to find support.
Ma Zar Chi Htwe relates that at a recent sex worker forum, attendees told her sometimes they are too ashamed to go to a clinic, even if they are free of charge. “They can’t bear the eyes of others on them,” she added.
To overcome these barriers, MSI Myanmar outreach workers visit brothels, massage parlors, and karaoke bars to provide HIV/AIDS education, distribute condoms, and make referrals.
They get to know the women and the brothel owners. Sometimes they accompany sex workers to the clinic; other times the mobile family planning services stop near to brothels.
Most importantly, Ma Zar Chi Htwe says, is that everyone employs client-centred care to “empathise and sympathise with these women. That’s their life. It’s normal to them, and we should treat them as normal.”
Dr. Moe Moe Aung, MSI Myanmar’s Director of Programmes, says these projects have helped drive a more holistic integration of HIV/AIDS and sexual and reproductive health activities.
Now outreach workers include HIV/AIDS prevention messages in community health education sessions, and voluntary counselling and testing, and diagnosis and treatment of sexually transmitted infections are available. Similarly, with support from the Link Up Project, sexual and reproductive health services, like family planning, are being provided in HIV-focused activities.
The numbers speak for themselves. In the Global Fund Consortium Project’s first two years almost three million condoms were distributed, there were 6,600 voluntary counselling and testing services and 3,500 STI services were given to sex workers and MSMs. In the last three months the Link Up Project has reached 1,200 young people with integrated sexual and reproductive health and HIV services.
The projects keep adapting and innovating too. As Global Fund Consortium Project Officer Dr. Phyo Wai Minn points out, more and more festival-goers are carrying mobile phones so the projects are looking towards mobile apps and social media to complement their other outreach strategies.
“Myanmar has always had spirit festivals. Now we will also have smartphones. That’s the future of information and links to services for our clients that we are looking towards.”
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