A reproductive health needs assessment in Myanmar

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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. 70
A Reproductive Health Needs Assessment in Myanmar The STD Teams and MMA should become more involved in primary prevention efforts to promote a broader awareness of the risk of STDs and HIV and the ways to reduce transmission, especially through the promotion of early and prompt treatment of STDs and condom use. Reports of the occurrence of iatrogenic infection due to lapses in infection control procedures were reported to be rare by most health providers. Both clients and providers emphasized the need to use disposable needles for injection, however the client must purchase a clean needle themselves and, consequently, it is probable that some reuse of needles occurs. It was not clear that all health facilities have adequate equipment for high level disinfection and sterilization of instruments. There is a need to strengthen infection control procedures within medical care services as a means to prevent iatrogenic infection. Management of symptomatic infections - The vast majority of people indicated that first line treatment for symptoms potentially related to STDs was self-medication with antibiotics purchased through drug shops. A variety of traditional medicines or practices were also commonly reported. The net effect of these behaviours is to delay appropriate therapy and prolong the period that the person is potentially able to further transmit the infection. The inappropriate use of antibiotics may also play a significant role is causing vaginal yeast infections among women. Health education materials should discourage the self-treatment of illness symptoms potentially related to STDs and delays due to use of ineffective indigenous medicines. Such materials should stress the need to seek health services promptly from a welltrained provider and encourage the appropriate use of antibiotics, including complete adherence to prescribed therapy. During the course of the assessment the team interviewed a broad range of people who provide treatment for symptoms potentially related to STDs, including public sector providers at all levels, GPs, and drug shop dispensers. The variation in current therapeutic practices was striking. Many providers are prescribing or selling the wrong drugs sometimes in the wrong dose and for the wrong period of time. It was very common for clients to receive two and sometime three antibiotics where one would have sufficed, adding significantly to the cost of therapy and increasing the risk on the emergence of antimicrobial resistance. Finally, many providers were using drugs for certain illness that may no longer be effective because of antimicrobial resistance (i.e. the use of penicillin to treat gonorrhoea). There is an urgent need to develop and disseminate standardized guidelines for the case management of men and women with STD and other RTI symptoms. These guidelines should be disseminated widely for use by private GPs, staff working within government health facilities, and drug shop dispensers. In addition to national guidelines that seek to rationalize the provision of antibiotic treatment for RTI syndromes, there is a need to train providers in other aspects of RTI case management. At present, treatment focuses narrowly and the provision of antibiotics and little attention is paid to the issues of primary prevention counselling, condom promotion, and partner notification and treatment. Also, some women mistakenly believe that all vaginal discharge symptoms are the result of STDs, when in fact endogenous infections are probably 71
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A reproductive health needs assessment in Myanmar

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