Decentralizing HIV testing and ART services in Myanmar

In Kanchin State, a remote part of northern Myanmar, 24 year-old U Dee Se has used heroin since the age of 18. Like many other people who inject drugs (PWIDs) in the area, throughout his drug use, he shared needles with friends, but was unconcerned about potentially contracting HIV. “My body was asking for the drug, I could not think about the disease,” he said. “Maybe this is the way I got HIV.” After developing symptoms including diarrhea, fever, and weakness, he decided to get tested for HIV, but he couldn’t travel far for testing and was not sure where to get tested.

However, not far from his home at his village’s church, U Dee Se and his pregnant wife were able to access a mobile HIV testing service operated by Substance Abuse Research Association (SARA). SARA, a local non-governmental organization operating with CHAI support, works to set up mobile HIV testing for PWIDs and to provide harm reduction activities for this vulnerable group. Together with CHAI, SARA integrates HIV testing services and mobile HIV testing activities for the community in the Namati sub township area. After being tested at the SARA mobile clinic, both U Dee Se and his wife tested HIV-positive and were referred to Myitkyina General Hospital’s ART Center to initiate treatment and counseling. They are among the estimated 212,000 people with HIV in Myanmar; prevalence among drug users in Kachin State is the highest in the country, with over 35 percent among PWIDs compared with other key population groups.

“Being diagnosed with HIV is hard to accept, but I already expected that I might have HIV,” said U Dee Se. “SARA said that I don’t have to die since there is a way to treat with ART.” His wife delivered a baby girl at the hospital in January 2016. The baby was given Neviripine syrup as recommended by the National AIDS Control Program to prevent mother-to-child transmission of HIV and was tested for HIV with a DNA PCR test, as part of a Government-sponsored early infant diagnosis program supported by CHAI, when she was two months old. In June the result was returned as negative. The couple is now waiting to conduct a second EID test after their daughter has stopped breastfeeding.

CHAI has worked in Myanmar as a partner of the Ministry of Health and Sport and others since 2013; work in Kachin State is serving as a demonstration model for decentralizing HIV testing and ART services in Myanmar. The state suffers from a lack of adequate services due not only to its remote location, but also civil unrest. In rural areas of the country like Kachin State, a higher proportion of PWIDs are HIV-positive compared to PWIDs in urban areas, indicating that services are particularly needed here. To that end, CHAI has been providing technical support to the National AIDS Control Program to plan and conduct ART counseling and training for the local medical and policy communities to educate them on how to test and counsel both the general HIV-positive population and specifically the HIV-positive PWID population. Since July 2014, nearly 1,500 PWIDs from remote areas of the state have been are tested for HIV via drop-in center and mobile testing services. Among them 132 HIV-positive PWIDs and family members were initiated for ART services, including U Dee Se and his wife.

“My CD4 count was 62 when I start taking ART. Today my six-month CD4 result shows 204,” said U Dee Se. His wife’s CD4 count increased from 272 at initiation to 556 after six months. “My baby’s result is waiting but I expect the negative result since we followed the instruction of medical doctor and nurses. We are praying to God the baby is not infected with HIV.”

Now on treatment and with their health improving, the couple is now active in peer groups for people living with HIV. They dream of opening a small shop in their village and supporting their daughter. U Dee Se is working with to spread the messages of testing and clean needle use to his friends who are still using heroin.

CHAI’s support for this work in Kachin State is generously funded by the Elton John AIDS Foundation.