Myanmar has the second-highest HIV prevalence in Southeast Asia at 0.7% of the population and is one of 35 countries that, together, account for 90% of new infections worldwide.
Countries in the Asia-Pacific region like Thailand, Australia and more recently, Vietnam, New Zealand, China and Indonesia have been able to stem the spread of HIV using PrEP (pre-exposure prophylaxis), a relatively new preventative measure taken in advance of exposure to HIV. Although PrEP was included in Myanmar’s National Strategic Plan developed by the National HIV/AIDS Program, as of 2019, it had not yet been included in any programming.
Enter PSI Myanmar’s Targeted Outreach Program (TOP) for HIV and sexually transmitted infections, which was founded 17 years ago to serve clients with HIV, especially members of vulnerable populations. It uses a comprehensive model that addresses the health and well-being of populations that are at risk of infection, making them an ideal candidate to implement a PrEP program in Myanmar. TOP is the largest community-led program in the country; by 2019, it had reached more than 25,000 female sex workers (FSWs) as well as 42,370 men who have sex with men (MSM) and had performed nearly 67,000 HIV tests for most-at-risk populations.
Using its sustained research and experience on infection trends in Myanmar, TOP developed a proposal for Myanmar’s first PrEP program, prioritized for MSM. The proposal was developed collectively with the USAID HIV/AIDS Flagship (UHF) Project and Myanmar’s National AIDS Program. Research has suggested that there may be unsatisfactory condom behaviors and use among MSM, which results in a higher rate of infection than any other key population. The HIV epidemic disproportionately affects specific key populations, including MSM, transgender people, female sex workers and people who inject drugs. 65% of these populations reside in five states and regions of Myanmar. TOP’s 13 key population service centers are strategically placed in 48 high burden townships to serve the most vulnerable and at-risk communities with an extensive range of free clinical services, including counseling, testing, and treatment for sexually transmitted infections, HIV, TB and other opportunistic infections, as well as reproductive health services.
Myanmar’s First PrEP Program
The TOP center at Yangon was selected this year to implement one of three pilot PrEP programs in Myanmar, along with Medical Action Myanmar and National AIDS Programme Latha, with visionary funding from UHF. The inauguration of the first PrEP clinics marks a major milestone for HIV prevention in Myanmar.
Using an HIV combination prevention method, the new PrEP programs will contribute to scaling up HIV prevention, first for MSM and transgender persons and soon after for people who inject drugs. At TOP, the pilot project commits to providing PrEP services free of charge (transitioning later in the project to a co-pay model to continue providing these services at a subsidized price), leveraging its existing clients to reach some of the highest-burden populations in Yangon.
The new program is already seeing results: one of TOP’s clients, Mg Shar Lar Lar, has been taking PrEP to prevent HIV transmission from his partner. “I learned about PrEP two months ago on the TOP Facebook page. I was so excited that I could prevent HIV by taking [this medication],” Mg Shar Lar Lar explained.
“Last week I enrolled in the PrEP program and am taking it regularly. I feel very happy and much more confident than before.”
What’s next for the PrEP program?
TOP plans to expand the PrEP program by using data to decide which communities are most in need of HIV treatment, focusing especially on MSM in high-density regions. At first, the program will provide PrEP services free of charge, and will then transition to a co-pay model to provide services at a subsidized price, ensuring the program’s sustainability and scale-up across Myanmar.
A big win for the TOP program has been its engagement with clients using both digital and program-based interventions to create demand—the program has already helped 23 individuals at our TOP clinics, some of whom have sought PrEP in the past, demonstrating consumer demand for the treatment.
Although USAID’s funding makes PrEP delivery possible to prioritized key populations, there is still a recognizable unmet need for TOP’s services outside of these populations. Expanding PrEP services across all key populations will require increased donor funding from a range of sources, to ensure the investment required to meet increased demand generation of PrEP in Myanmar. TOP aspires to deliver its PrEP services not only to prioritized communities but increasingly all key populations across Myanmar as well.
Banner image courtesy of PSI Myanmar