Maintaining Momentum in Myanmar’s Response to AIDS

Ma Thandar Lin helps her son with homework. / UNAIDS

Guest Column by Eamonn Murphy, UNAIDS Myanmar Country Director, published in The Irrawaddy on 1 December 2016

On World AIDS Day, the spotlight will be on Myanmar—a model for other developing nations of how to implement strategies to end the AIDS epidemic as a public health threat by 2030.

Myanmar is one of 35 countries that account for 90 percent of new HIV infections globally each year.  Since 2010, new infections in the country have fallen by 24 percent, and AIDS-related deaths have decreased by 40 percent.

Behind these numbers are women like Thandar Lin who are not letting their HIV-positive status get in the way of living a vibrant and productive life. This mother of three HIV-negative children runs a community group that generates income through handicraft projects.

The country’s effort to scale up treatment is phenomenal. This includes significant efforts to eliminate new infections among children. The Prevention of the Mother-To-Child Transmission (PMTCT) program involves providing antiretroviral therapy (ART) to HIV-positive pregnant women to reduce the risk of passing on the virus to their babies. Seventy-seven percent of pregnant women living with HIV are now accessing treatment.

Thandar Lin’s happiness is heartwarming. Her youngest son is full of energy. She savors his hugs and early morning kisses and she dreams of his future.

In the last three years, Myanmar has nearly tripled antiretroviral therapy (ART) among people living with HIV. An estimated 115,000 people enjoy healthier and longer lives as they now access ART. Many have also been empowered to work and contribute to society as independent citizens.

How has Myanmar managed to put more than half of its citizens living with HIV on treatment programs, when the average for Asia and the Pacific hovers at 41 percent?

We often assume it is all about money. And yes, Myanmar has received financial assistance from external sources. But the country’s successful HIV program cannot be chalked up merely to generous donors. The government has shown bold and engaged leadership, and it has had the vision and commitment to make change—and make it fast. This, in turn, has been implemented by dedicated healthcare workers in the government and partner organizations.

In 2013, Myanmar started to decentralize HIV services, which were previously been limited to a handful of hospitals in large cities. Now, programs providing prevention and treatment are available in 140 townships across the country, even in remote rural areas.

Moving treatment closer to patients is an innovation that has paid great dividends. It is easier for people living with HIV to lead productive lives if they do not have to make long and frequent journeys to urban hospitals, as they have had to do in the past. This has also generated savings for families who no longer have to pay for costly transportation and lodging.

These are outstanding accomplishments. But of course, a number of challenges remain.

Getting more people treatment is a challenge itself, since it adds the not-unsubstantial cost of having to maintain a lifetime supply of medicine for patients. Thousands of people have yet to access treatment, but once they do, they will need a steady supply of medicine.

This places a huge burden on government resources. However, the health sector is becoming more efficient by task shifting and training nurses to perform jobs—such as routine treatment management—that at one time were the exclusive domain of doctors.

Myanmar is also stepping up to the plate and sharing responsibility. The last four years have seen an eight-fold increase in resources for HIV from the Ministry of Health and Sports. In 2016, it budgeted US$16 million dollars for its HIV program.

Another big hurdle is confronting the stigma and discrimination that prevent people living with HIV from seeking services. If people delay finding out their HIV status, for instance, they cannot access treatment in a timely manner. People who start treatment late are more likely to have complications, which could dramatically shorten their life expectancy.

The government is tackling stigma and discrimination by building strong partnerships with community groups that represent key populations, including sex workers, men who have sex with men, transgender people, drug users, and migrants. These groups work with hospitals to provide peer counseling and reach out to key populations.  It is this partnership approach that the government has cultivated with civil society, international organizations, and people living with HIV that has been crucial to the stunning results Myanmar has achieved so far.

More efforts are required to ramp up prevention services to reduce new infections, which will in turn reduce personal and economic costs to individuals, families, and communities. However, funding for this work is declining, which is a cause for major concern.

Despite ongoing challenges, Myanmar’s progress in its fight against HIV has been extraordinary. And in showing that this work must be a movement—not a moment—it will hopefully pave a path for how to help people with HIV live out fulfilled and productive lives they deserve.