20 years of assistance to people living with HIV in Myanmar

Myanmar, the poorest country in Southeast Asia, suffers from a severe lack of investment in its healthcare sector. The combination of lack of service delivery and funding, increased production of drugs as well as the general socio-economic situation has exacerbated the country's health gaps. These factors also explain the high prevalence of HIV infections, which often go undetected for prolonged periods. According to the World Health Organization (WHO), Myanmar is among the 14 global high burden countries (HBC) on HIV.

In Dawei, a coastal town situated in the Tanintharyi region in the southern part of the country, the concurrent challenges of HIV/AIDS and tuberculosis is affecting thousands of individuals, particularly in vulnerable communities.

Since 2004, MSF has been delivering comprehensive HIV care in Dawei, including outreach initiatives aimed at preventing infection among marginalized and high-risk groups such as migrant workers, fishers and people who inject drugs. Despite the political instability affecting Myanmar, our activities have persisted over the years.

After two decades, of HIV work in Dawei, MSF is be transitioning its entire HIV patient cohort to the National AIDS Programme (NAP), reallocating its resources to support this program. Nevertheless, many of the challenges resulting from the collapse of the public healthcare system in 2021, which delayed the handover, still remain. It is a moment to reflect in pictures on twenty years of MSF's dedicated involvement in the fight against HIV in the region.

Caring for patients and tackling stigma

Dawei is a good example of the importance of MSF's commitment towards HIV patients in Myanmar. In 2004, the organisation decided to launch an intervention in response to the dual epidemic of HIV and tuberculosis, mainly affecting marginalized and vulnerable communities. Faced with the state's limited health capacities, MSF's action rapidly expanded.

Over the years, the Dawei project supported people living with HIV in many ways, from testing, treatment to peer-to-peer support about how to manage the disease and handle the stigmatisation that many patients feel.  

Reaching rural communities

During its twenty years of work with people living with HIV in Dawei, MSF has continuously played an important role, adapting both to changing environments and to the needs of patients. MSF also significantly invested in reaching rural communities far from health centers, emphasizing prevention and, where necessary, providing adequate care.

In 2014, for the first time in Myanmar, patients began receiving oral treatment for Cytomegalovirus retinitis (CMVR), a neglected opportunistic disease linked to HIV/AIDS causing blindness. Previously the only treatment option available in Myanmar was painful once-weekly injections directly into the eye.

Once someone is diagnosed with the disease, viral load monitoring - measuring the levels of HIV virus in the blood - is essential to measure whether treatment is working. While annual viral load tests are standard in wealthy countries, access in countries like Myanmar still lags far behind.

There is no cure for HIV, although life-long treatment using combinations of drugs known as antiretrovirals (ARVs) helps manage the virus and enables people to live longer, healthier lives if taken regularly.

Fighting HIV in the midst of a pandemic

In 2020, just like the rest of the world, the project had to deal with the Covid-19 pandemic, leading to huge disruptions in treatment for people under care. Travel restrictions hit HIV patients in Dawei hard, as most people live in rural areas and a large number on islands along the coastline.  

Ma Mi Mi remembers how “COVID-19 happened, and the ships did not run anymore, and I could not come back [to the clinic]. I couldn’t take my medicine for about three months.”

Coping with HIV in everyday life

From the outset, health education and peer counseling have been fundamental to MSF's treatment program in Dawei in order to provide patients a better understanding of the disease so they can cope more effectively with it. Teams have worked closely with the community to encourage testing and treatment of the disease, making a significant contribution to reducing the stigma associated with HIV.

For Gay Gay, who is living with HIV and who has been receiving treatment from MSF in Dawei for many years, the availability of clinics has always been one of the most difficult things to manage.  

“When first found out about this disease, I had to deal with a lot of difficulties since there were no clinics or hospitals to go to and receive any treatment. Receiving proper medical care was challenging before, but all of that has changed now because of the availability of more clinics and hospitals providing testing and treatment. It’s easier to go to the clinics and receive treatment now.

The perception of people living with HIV has changed in Myanmar. [Even so] there are a range of challenges living life as an HIV-positive person. Some struggle to make a proper living or livelihood due to their family situations while also taking into consideration transportation when going to clinics.”

A handover delayed by two years of instability

In January 2021, MSF began transferring patients into the NAP for treatment. Two months later, Myanmar faced political upheaval when the military replaced the elected government. The transfer out was put on hold and MSF began to register new patients in our Dawei HIV programme for the first time since 2019.

In 2023, MSF resumed the handover of HIV patients to the NAP which is once again able to provide ART. In Dawei, all patients completed their transfer by the end of 2023. This marks a huge step in the right direction and the hope is that with the NAP functioning, patients will not have to travel so far to reach a clinic, making adherence to treatment far easier.  

Moving towards a different commitment to people living with HIV

The population in Dawei is made up of many migrants who work away for long periods of time, like Ko Maung Myint*, who works on a deep-sea fishing operation in Kawthaung; “In the past, I could get six months’ worth of medicine at a time so that I could work five months away and come back here for one month.”

Without enough medication, patients may have to return to clinic sites again and again. Furthermore, movement in many parts of Tanintharyi and in the rest of the country is currently very difficult and dangerous. Healthcare workers and facilities have consistently been targeted in Myanmar.

Without unimpeded supply lines for everyone, including the public system, and without the mobilization of all the medical resources available in and around Dawei, people on HIV treatment will continue to be affected by a lack of regular medication.

However, MSF teams remain committed, and from 2024, will work in a Support Model alongside NAP. MSF welcomes the chance to continue supporting the National Aid Programme clinics to ensure quality of care for HIV patients in Myanmar.