A reproductive health needs assessment in Myanmar

A Reproductive Health Needs Assessment in Myanmar
Experience from other countries suggests that targeted interventions for groups at highest risk
of HIV infection are especially important in the early stages of the epidemic. In the course of
our interviews several groups were identified consistently as facing a higher risk of infection.
These included sex workers, men who travel away from home frequently (who are seen as
being more likely to visit sex workers), male youth (who often initiate sexual activity with
sex workers), and both men and women who migrate to Thailand for work.
Targeted primary prevention interventions, such as peer education programmes for high
risk groups (including sex workers and their clients) should be developed and evaluated.
These programmes should stress personal vulnerability to infection and include skills
training for negotiation and condom use.
While knowledge of HIV/AIDS and the modes of transmission was high, some inaccurately
believe they can acquire HIV through touching, etc., resulting in unnecessary fear and
stigmatization of persons living with HIV/AIDS. Many individuals also had only superficial
knowledge concerning STDs and condom use. When asked how to prevent HIV, most men
and women simply said “avoid prostitutes”. As with birth spacing, the lack of health
education materials in languages other than Myanmar was also a barrier to accurate
knowledge among some populations.
Improved health education materials are needed regarding HIV/AIDS and other STDs,
including materials in a range of languages that emphasize the role of STDs in
augmenting the transmission of HIV and provide accurate information about techniques
for using a condom.
A review of sentinel surveillance data suggests that HIV presents a serious public health
problem in Myanmar, particularly along the eastern border areas. While there is considerable
variability, STDs are also felt to be a common problem as well. With the exception of the
eastern Shan State and the Thanintharyi Division, the number of reported AIDS cases
remains low and there is a generally poor perception of personal vulnerability to infection on
the part of most community members. Familiarity with condoms remains very low, despite
the fact that widespread condom use is one of the few means of preventing further spread of
the HIV epidemic.
There is a need to expand condom promotion efforts. This will require a special effort to
reach men with both information and high quality commodities. Achieving and
sustaining higher levels of condom use will, in turn, demand improving logistical and
supply systems and strengthening social marketing programmes.
At present the national network of STD teams focus primarily on the treatment of
symptomatic individuals, the training of other health staff who may encounter patients with
STD symptoms, and limited syphilis screening and surveillance activities. Given the
expertise of these teams, they have a potential to become more involved in primary
prevention activities, such as counselling training, condom promotion, and awareness raising.
Similarly, local branches of the Myanmar Medical Association (MMA) have also focused
primarily on the training of GPs concerning the management of symptomatic STDs.
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