Myanmar sex online website
For example, in Waingmaw in Kachin State, HIV prevalence among people who inject drugs was particularly high at 47% during 2014.10 Distribution of drugs from this region also has contributed to new HIV infections developing in more remote areas of the country, providing additional challenges to expanding the coverage of harm reduction and HIV services.11 Currently, less than 50% of people who inject drugs report regular testing for HIV and less than a quarter of those asked in 2016 reported consistent condom use.12 Moreover, under 86% of people who inject drugs report using sterile injection equipment for their last injection.13 HIV prevalence (6.4%) among gay men and other men who have sex with men (sometimes referred to as MSM) has continued to remain a concern in Myanmar, with rates particularly high in many cities and urban areas such as Yangon (26.6%).14 This the highest recorded rate of prevalence for this group in the Southeast Asia region, even higher than Bangkok, Thailand (24.4% ).
Myanmar’s latest National Strategy Plan recognises that these rates are alarming and should present an immediate call to scale up targeted services in high burden geographical locations.15 There appears to be an increased risk of HIV infection within the most sexually active age group (25-49 year olds) where prevalence of HIV is significantly higher than average.
As a result, the country has witnessed the number of AIDS-related deaths fall by an estimated 52% as ART coverage has expanded in the last six years.47 Nevertheless, despite improvements in treatment access, Myanmar is still a high burden country with limited availability of viral load testing and HIV drug resistance testing for monitoring patients who are on first-line as well as second-line ART.48 Case study: Long-term outcomes of second-line ART in Myanmar Second line ART has been available in Myanmar since 2008, however there has been no published data about the outcomes of patients on second line treatment until recently.
A 2017 study followed a cohort of 824 adults and adolescents across seven years in which time 11% of patients died and the overall incidence rate of unfavourable outcomes of those who moved on to second-line treatments was 7.9%.
In 2015, 3,923 HIV-positive pregnant women received ART to reduce the risk of mother-to-child transmission, but only 39% of these were put on lifelong treatment (Option B ) as recommended by the WHO, with the rest only put on treatment while pregnant and breastfeeding.42 In 2015, overall ART coverage among pregnant women living with HIV to prevent mother-to-child transmission was estimated to be 77%.43 Routine monitoring continues to be an area of weakness - as it is across most testing, prevention and treatment services in Myanmar.
Out of the 2,169 exposed infants only 801 were given an HIV test within two months of birth.44 Myanmar’s National Strategic Plan suggests that there is a critical need for better collaboration between health services to integrate early infant diagnosis into post-birth care in order to establish a fully comprehensive PMTCT cascade.45 According to UNAIDS, 130,000 (55%) of all people living with HIV in Myanmar currently have access to antiretroviral treatment (ART).46 It is worth noting that this figure has more than doubled (from 24%) in 2012 (NSP), and has brought the country up to speed with the treatment rate of people living with HIV in the rest of the Southeast Asia region (41%).
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Comparatively, patients with higher baseline CD4 counts, those who had taken first-line ART at a private clinic or received ART at decentralised cites all seemed to have a lower risk of unfavourable outcomes.
As such, there have been strong arguments for a transition from private and NGO-run services to public sector delivery with the hopes of making treatment more readily available to vulnerable groups across the country.50 Total health expenditure in Myanmar (2-2.4% of its GDP) is among the lowest in the Southeast Asia and Western Pacific regions, which goes some way to explaining the country’s current state of HIV incidence.51 An analysis of countries from different regions, and with different epidemic patterns, found that Myanmar was among the countries where funding of effective and focused primary HIV prevention was insufficient.52 In 2015, the country committed US$ 11 million in domestic funding towards HIV programmes while relying on an additional US$ 71.8 million from international donors.53 Further findings from the National AIDS Spending Assessment (NASA) indicate that while more than 20 donors provide additional financial support for healthcare in Myanmar, only a few are committed to funding HIV-specific programmes.
Of these, the Global Fund currently provides around half of the existing funding towards such programmes (investing a total of US$ 266 million to date since 2009).54 Sex work in Myanmar is currently illegal.
Nevertheless, in 2014, the IOM data project did find that 18% of people identifying as migrants in Mon and Kayin states were HIV positive - although it is difficult to assess if the point of infection happened within country.27 However, it is broadly assumed that migrants might face residency and social restrictions that limit their access to HIV programming services, as well as other general forms of healthcare.28 Since 2014, HIV awareness campaigns specifically targeting large migrant populations have been created to address this issue.29 The current National Strategy Plan for HIV also proposes developing specific packages for people near transit points in addition to cross-border referral mechanisms and agreements to strengthen access to health services in destination countries.30 Across the country the rate of HIV testing for the general population was last recorded at 11.3% in 2007, with specific testing rates varying among key affected population groups.31 However, in 2014 the estimated testing coverage for key affected populations specifically was still far from optimal with only 34% accessing testing services.32 Unfortunately, there has been no new behavioural data on HIV testing among the general population since 2007.
As such, there is an urgent need for strengthening the involvement of community networks in the planning and monitoring of testing services.33 Myanmar’s most recent National Strategic Plan, launched in 2016, aims to promote early HIV testing and counselling in line with WHO recommendations, and to close the testing gap by prioritising townships with a high epidemic burden and by centralising the provision of HIV counselling and testing to become a local public health sector concern.34 Research consistently shows that harm reduction programmes - such as needle and syringe exchange programmes and opioid substitution therapy – are the most effective ways of reducing the spread of HIV among people who inject drugs.35 However, because the scale of drug use in Myanmar is particularly extensive, existing harm reduction services are currently failing to meet the escalating demand by people who inject drugs.36 For example, in response to a 2014 study which estimated that the reported re-use of needles varied from 16% in Mandalay to 63% in other areas, there were 18 million sterile needles and syringes distributed free of charge during the next year.37 Despite these efforts, it was still found that the coverage of additional needles was not enough.
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Based on typical injecting practices involving 2-3 daily injections, around 60-90 million would be needed.