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close this bookEffective Approaches for the Prevention of HIV/Aids in Woman (PAHO, WHO; 1995; 62 pages)
View the documentExecutive summary
View the document1. Introduction
View the document2. Opening of the meeting
Open this folder and view contents3. Women and HIV/AIDS
Open this folder and view contents4. Effective approaches to prevention of HIV/AIDS in women
Open this folder and view contents5. Experiences from other fields: implications for HIV/AIDS prevention
close this folder6. Future directions: national policies and large-scale programmes
View the documentNational programme for training urban and rural women on STD/HIV and health in Myanmar
View the documentIncome generation and reduction of women entering sex work in Thailand
View the documentMan/Hombre/Homme: meeting male reproductive health care needs in Colombia
View the documentFuture directions: policies and large-scale programmes - Conclusions
View the document7. Overall conclusions
View the documentAppendix 1 - Agenda
View the documentAppendix 2 - List of participants
View the documentAppendix 3 - List of background papers
View the documentAppendix 4 - Selected reading list
 

National programme for training urban and rural women on STD/HIV and health in Myanmar

Presented by Dr Nyo Nyo, Myanmar Maternal and Child Welfare Association

HIV/AIDS infection is on the rise in Myanmar with a potentially disastrous impact on the lives of families and youth. Although by June 1994 only 334 AIDS cases had been reported and fewer than 8500 HIV-positive cases confirmed, studies reveal that young people working as fishermen, truck drivers, traders, day labourers and miners, as well as young women who are their wives and partners, are particularly at risk. Available data indicate that HIV/AIDS is beginning to affect the general population, including mothers and children. In one border town in Shan State, the sentinel surveillance system has revealed that as many as 6.0 to 10.6% of pregnant women who are registered at a public maternal and child health centre are HIV-positive.

In response to the new threat that HIV/AIDS poses, the Myanmar government, through the National AIDS Programme (NAP), formulated a national strategy for the prevention of HIV, and a medium-term plan (3 years) for its implementation. In this context, an initiative on reproductive health and HIV/AIDS was launched in late 1993. It called for collaboration between the Ministry of Health, NGOs (the Myanmar Maternal and Child Welfare Association - MMWCA, the Myanmar Red Cross Society - MRCS, and the Myanmar Medical Association - MMA), and UNICEF (Table 4). Partners play complementary roles with defined tasks. Overlap is avoided by the development of plans by each organization or institution, which are then consolidated into one plan. The focus of this undertaking is to prevent and control STD/HIV infection in young people and women by providing information and helping them to develop personal skills that will enable them to follow through on decisions to avoid being infected with STDs, including HIV, and to space births; by strengthening public and private STD services for early diagnosis and effective treatment in settings that are accessible and user-friendly for youth and women; and by creating a holistic health environment for women at public maternal and child health centres by offering STD, birth spacing and counselling services in one place.

Table 4

Myanmar-UNICEF HIV/AIDS project - township level services

SERVICE

MANAGING MEMBER

TARGET GROUP

STD CLINIC

MOH (Township Hosp)

men, commercial sex workers

MCH SERVICE

MOH (some MMCWA support)

women

PRIVATE PRACTITIONERS

MMA

middle income men & women

STD (treatment and counselling)

MMA

youth, women

COMMUNITY EDUCATION

MOH, MRCS, MMCWA, MMA

all

 

MOH - Ministry of Health
MMCWA - Myanmar Maternal and Child Welfare Association
MMA - Myanmar Medical Association

 

MRCS - Myanmar Red Cross Society

The MMCWA, the programme’s leading organization, is an NGO with a mandate to promote nationwide maternal and child welfare activities at township and village level, with the objective of reducing maternal and child mortality. In operation for 40 years, the MMCWA functions in 293 of 320 townships, with 685 branch associations. The role this NGO plays is particularly important in view of the fact that the capacity for reaching young women with information and services through the formal sector is limited (e.g. birth spacing programmes exist in only 31 out of the 320 townships in Myanmar). In its national programme for training urban and rural women on STD/HIV and health, the MMCWA seeks to enhance organizational, clinical, training and communication skills at the township level. A total of 25 townships have been identified as project sites - 15 of them are now implementing activities, and there are plans to extend the programme to all 25 townships by the end of 1995.

In all project townships, the local chapters of the MMCWA and MRCS organize training for youth and women in decision-making, communication, and negotiation skills. The training addresses existing social norms regarding sexuality, the practice of safe sex gender relations, and HIV/AIDS discrimination issues. To increase condom availability which has been poor in the past, a condom social marketing strategy has been developed in collaboration with UNFPA. The government now distributes condoms through STD clinics, drug treatment centres and selected family planning centres.

This programme is relatively new, and has not yet been evaluated. A mid-term programme review is planned for 15 townships at the end of 1995, after one or two years of implementation. The public STD and maternal and child health clinics in 6 townships have been strengthened through improved laboratory facilities, increased supplies (e.g. diagnostic kits, STD drugs, condoms) and staff training. Two hundred and fifty general practitioners in 6 townships have been trained in syndromic STD case management and counselling on STD/HIV prevention. Using the training manual on reproductive health and HIV/AIDS that was developed for the programme, 320 urban youths and 320 urban women have so far been trained to be ‘core trainers’.

Lessons learned

• A partnership between a variety of NGOs, the government, and UN agencies on reproductive health and STD/HIV can be successfully formed as part of a broad strategy to prevent HIV transmission in a country where the infection is increasingly affecting the general population.

• A rational policy with broad objectives can be developed, and individual agencies and NGOs can prepare plans that are coordinated to avoid overlap and duplication, and ensure that a broad strategy is translated into action.

• For each major policy component (e.g. preventing infection with HIV), a programme with stated goals and objectives can be formulated (e.g. strengthening public and private STD services for early diagnosis and effective case management), and specific activities and interventions defined (eg, training of youth and women by two NGOs, and introducing a condom social marketing programme).

• National-level women’s NGOs with local affiliates can be powerful allies and implementors of national policies to prevent HIV/AIDS. They offer the advantages of having existing infrastructures, an established presence in communities and the trust of community members, the possibility of replication and expansion of successful interventions, and through women - access to men and youth (e.g. teaching husbands and children what they have learned).

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