A reproductive health needs assessment in Myanmar

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A Reproductive Health Needs Assessment in Myanmar Data from the National STD Control Programme The National STD Prevention and Control Programme was established in 1951 and operates under the auspices of the Department of Health (Disease Control). Currently, 36 STD control teams work in 25 of Myanmar’s 320 townships. The Teams work to reduce the transmission of STDs and HIV, diagnose and treat cases of STDs, and monitor, record, and report STD regional trends to the Central STD team in Yangon. They are also encouraged to promote and provide condoms and engage in outreach prevention activities, particularly with target groups such as commercial sex workers and youth. The are also responsible for implementing the serological and behavioural sentinel surveillance programme described above. The Central STD Team in Yangon compiles data from the field and publishes annual statistics regarding STDs in Myanmar. The most recent available report, for 1996, indicates, for example, that 3.8 per cent of screened primapara pregnant women were VDRL positive, 2.3 per cent of blood donors, 16.8 per cent of male STD clinic clients and 25.4 per cent of female STD clinic clients. Information regarding the incidence of other STDs is generally presented numerically, rather than as a percentage of screened clients. As a result, comparisons need to be made across townships or time. For instance, incidence rates for gonorrhoea and chancroid seem to have fallen since the mid-1980s and both discharge and ulcerative STDs are recorded at much higher rates in the urban centres of Yangon and Mandalay than they are for any of the other townships (Ministry of Health 1997b). The temporal trend presented in the 1996 Annual Report confirmed a 1995 retrospective incidence study that investigated the number of STD cases reported by the AIDS/STD control teams since 1985 (Ministry of Health 1997b). In the most recent years, new cases of syphilis measured among pregnant women as an “indicator group” decreased from 5.2 per cent of women screened in 1993 to 4 per cent in 1995. The data gathered by the STD control teams, however, do not give a reliable indication of STD prevalence throughout Myanmar as they only reflect infection rates of clients seeking treatment at public STD facilities. The township level STD Control Teams are also centrally involved in the UNICEF-sponsored project “Prevention and Control of HIV/ AIDS in Myanmar through Promotion of Reproductive Health.” In an effort to strengthen the teams’ capacity for diagnosis and treatment of STDs, the programme has given team leaders refresher training on STD care and management, and involved them in improving STD services offered by private medical practitioners. The project is also working to develop and strengthen the Central STD Team’s data management system. COMMUNITY KNOWLEDGE AND PERCEPTIONS Knowledge of STDs and AIDS and their prevention The recently completed FRHS included a number of questions concerning women’s knowledge of STDs and AIDS and strategies for prevention. These data, summarised in Table 14, show a number of important patterns. Knowledge of STDs, AIDS and HIV prevention strategies is clearly better in urban areas, where women presumably have better access to media and health education initiatives. There is also a strong association between awareness of AIDS and educational attainment (MOIP 1998a). Knowledge of AIDS was 42
A Reproductive Health Needs Assessment in Myanmar consistently greater than that concerning STDs; a finding that was corroborated by discussions conducted in the community as part of our field assessment. Table 14. Knowledge of AIDS and Prevention Strategies % of ever-married % of ever-married % of ever married women who have women who have heard women who know how heard about STDs about AIDS to prevent AIDS Residence Urban 86 96 78 Rural 71 77 43 Education No schooling 55 60 27 1-4 77 85 48 5-8 87 96 70 9-10 95 99 88 University 98 99 97 Total 75 82 51 Source: Ministry of Immigration and Population (1998) Fertility and Reproductive Health Survey (preliminary results) Table 15 summarises the knowledge regarding specific means to prevent HIV transmission among the 82 per cent of women who knew one or more method of preventing infection. It is worth noting that, even among women, the most commonly reported means of preventing AIDS was “avoid sex with a prostitute.” As described below, many people interviewed by the assessment team strongly associated AIDS with commercial sex and, simultaneously, felt themselves to not be at significant risk. Table 15. Knowledge of ways to prevent HIV transmission Prevention strategy % of ever-married women Use condom during sex 5.4 Have only one sex partner 27.8 Avoid sex with prostitute 35.3 Avoid sex with homosexuals 6.5 Avoid kissing 1.4 Avoid blood transfusion 16.0 Avoid injections 24.8 Avoid IV injection of narcotic drugs 8.5 Avoid tattooning, acupuncture, other skin piercing 2.7 Other 0.5 Note: Does not to 100 per cent because of multiple responses Source: Ministry of Immigration and Population (1998) Fertility and Reproductive Health Survey (preliminary results) Such attitudes were found to be widespread in a number of recent studies. The results from a 1994 study of 6000 interviewed participants, fewer than 50 per cent of participants believed that AIDS could happen to people like themselves, or that they would ever become infected in their lifetime. Similarly, an open-ended question soliciting spontaneous responses about means of HIV transmission was most frequently answered with “having sex with a 43
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ANNEX I Summary of Reproductive Hea
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Agency UNHCR Programme Local Reinte
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ANNEX III Summary Reproductive Heal
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Assuming that: (1) TFR in 1990 was
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A reproductive health needs assessment in Myanmar

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