A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
assessment team was also told that, as prostitution is highly criminalized and the venues for
commercial sex restricted, often several men would spend an evening with a single sex
worker in a secluded location. In these situations it would be rare for the sex worker to use
condoms for every sexual encounter and, hence, the risk of disease transmission is very high.
Many respondents also mentioned that men go to work in Thailand and bring back STDs and,
particularly HIV, which they have acquired from prostitutes. There is a very strong
association made between STDs, AIDS, pimps, and prostitutes. As a consequence, few
people see this as a problem that directly affects their own lives. While women generally do
recognize that they can acquire STDs from their husbands, most feel that their own personal
risk is low because their husband “does not visit prostitutes” or “does not work in Thailand.”
The strong association between STDs and commercial sex creates one of the greatest barriers
to more widespread condom use, as condoms are seen primarily as a means of preventing
infections associated with sex workers. Indeed, in some locales the mere possession of a
condom by a man is seen as an intention to visit sex workers and, for women, having a
condom may be used to corroborate an accusation that she is a sex worker herself.
The team found that in most large villages people knew that condoms could prevent STD
transmission and were sometimes also aware of places where condoms could be purchased.
Some even reported that condoms are available at the brothels. Most individuals mentioned
that the price is 20 kyats apiece whereas the shops reported selling them for 5 kyats. Thus,
while the use of condoms for STD prevention is generally known, condoms are rarely used.
This reflects both the stigma associated with condoms (described above), as well as their cost
and limited availability.
Attitudes toward condom use were significantly different in Tachileik, where proximity to
Thailand and the Thai national AIDS prevention campaign, as well as a large population of
persons living with AIDS, may have contributed to greater awareness of the widespread
nature of HIV and the need to prevent infection. This is probably related to the fluid border
between Tachileik and Mae Sai and the fact that many Shan can understand the Thai
language. It was also reported that much of the commercial sex purchased by men from
Myanmar residing in Tachileik actually takes place in Thailand. Consequently, the effects of
Thailand’s “100 per cent condom use” policy — which has been aggressively implemented in
Chiang Rai and other northern Thai Provinces — would have reached these men.
As noted previously, awareness of HIV/AIDS is generally higher than other STDs. Many
people have heard-about HIV/AIDS from television, billboards, pamphlets, and radio songs
and most know that it is a serious, incurable, and fatal disease. There is also a general belief
that the incidence of HIV/AIDS is on the rise. This was often attributed to the “risky sexual
behaviours of young people.” Their knowledge of HIV/AIDS is quite superficial, however.
Although most know about the principle modes of transmission, few are able to distinguish
between HIV and AIDS or able to say how long it takes before a person with HIV infection
will develop AIDS. Most people who reported a personal experience with persons living
with HIV/AIDS referred to knowing someone who had gone to work in Thailand and came
back suffering from AIDS. These individuals were reported to have become very thin with
high fever. They later became listless and died. The rather uniform nature of these
descriptions may reflect an incomplete understanding of the multiple presentations of HIV
disease. Deaths from HIV/AIDS were most commonly reported to be among returning
migrant workers.
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