AHRN MYANMAR

From 2003 up until 2006, AHRN Myanmar recieved financial support from the Fund for HIV/AIDS in Myanmar. From 2005 to 2006, the Global Fund also provided support for AHRN activities in the country. More recently, AHRN signed an MoU with the Three Diseases Fund (3DF). In Myanmar, AHRN has a total workforce of 43 staff, counting 11 in Yangon, 6 in Kone Nyaung, and 26 in Lashio (Northern Shan State).

I. Three Diseases Fund (3D Fund)

II. Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis (GFATM)

III. Fund for HIV/AIDS in Myanmar (FHAM)

AHRN Myanmar

The country office AHRN Myanmar was set up in July 2003. In 2006, AHRN Myanmar was funded by the Fund for HIV/AIDS in Myanmar (FHAM) through UNAIDS/UNDP and the Global Fund for Aids, Tuberculosis and Malaria (6 months phase-out). AHRN is operational in Myanmar under a MoU with the Central Committee of Drug Abuse Control (CCDAC), Ministry of Home Affairs. Preparations for a MoU with the Ministry of Health started in 2006 and should be finalized beginning 2007.

During its third year of operations in Myanmar (2006), AHRN focused on advocacy, capacity building, as well as service delivery.

I. Three Diseases Fund (3D Fund)

Background
Following a review of Fund for HIV/AIDS in Myanmar (FHAM) in 2005, the cessation of funding from FHAM in late 2006, and the withdrawal of the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis (GFATM) from Myanmar, some concerned donors have expressed the desire to substitute FHAM and GFATM with a single pooled funding mechanism which can address the three diseases – HIV/AIDS, tuberculosis and malaria –called the Three Diseases Fund (3D Fund).

The goal or overall objective of 3D Fund is to reduce the burden these three diseases in Myanmar. The 3D Fund’s purpose is to resource a programme of activities to reduce transmission and enhance provision of treatment and care to meet the needs of people affected or vulnerable to HIV/AIDS, TB and malaria.

National strategies for the three diseases were developed and expect to achieve the following for each disease respectively:

1. To reduce transmission and enhance provision of treatment and care for people living with and affected by HIV/AIDS;

2. To reduce the morbidity, mortality and transmission of TB while simultaneously preventing the further emergence of drug resistant forms of TB;

3. To reduce malaria morbidity by at least 50% by 2010.

Activities

With the support of 3D Fund, AHRN’s current DIC/OPO in Lashio and Kone Nyaung is being supported with plans to expand drug user coverage by setting up new service delivery sites. New sites will be located first in Laukkai in Northern Shan State while an additional three other proposed sites are located in Sagaing Division, close to the Manipur border (Kalay, Tamu, Monywa), where preliminary data indicates that no specific services are available for drug users.

This activity seeks to further develop and expand comprehensive services for (injecting) drug users and their partners and families, through advocacy, capacity building, outreach, DICs, primary health care (PHC) and extensive referrals, in line with the National Strategic Plan.

Immediate objectives:

• To set up and sustain a local enabling environment for implementing drug services;
• To strengthen the capacity of national staff working in programmes and peer educators;
• To improve HIV awareness, knowledge and attitudes within the drug user communities;
• To improve access to services for drug users;
• To improve the prevention of transmission of HIV through reduced use of contaminated injecting equipment;
• To improve the prevention of sexual transmission of HIV among (I)DUs and their sexual partners.
• For more information about the 3D Fund, visit their website at www.3dfund.org.

One of the major challenges in harm reduction services is police crack-drowns and arrests of drug users. It affects the continuation of outreach and prevention activities once clients are arrested and sent to prison. Read more on Harm reduction services in Mandongpar Kokang prison

II. Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis (GFATM)

Although the GFATM support was terminated in Myanmar, AHRN was a sub-recipient during its existence in the country. AHRN’s key achievements and output summary under GFATM:

1. Number of trainings: A total of 16 trainings (target reached) were organised for a total of 319 participants (target overreached). For the details including dates, topics and participating agencies, please see the Summary.

2. Number of Rapid Assessment Response (RAR) conducted: Two RAR were conducted and finalised in Northern Shan State (Lashio and Laukkai). One RAR intended for Sagaing Division could not be performed because of issues relating to authorisations. Key findings were disseminated at three different workshops. 23 (of the 25 targeted) RAR researchers were trained.

3. 25,000 safety boxes were procured: 8,000 safety boxes for discarded injection equipment will be disseminated by AHRN to partners working with injecting drug users. This process is still ongoing.

III. Fund for HIV/AIDS in Myanmar (FHAM)

Background
The Fund for HIV/AIDS in Myanmar (FHAM) was established in January 2003 to support amongst others the implementation of an Operational Plan for effective interventions aimed at reducing HIV transmission among injecting drug users, under the Joint Programme for HIV/AIDS in Myanmar (2003-2006). AHRN-Myanmar carried out activities under three of this Programme’s guiding components:

· Component #2 – Reduce individual risks of HIV among Injecting Drug Users, their sexual partners and their families;

· Component #3 – Increase awareness of HIV/AIDS among the general population, particularly young people; and

· Component #5 – Strengthening essential elements of enabling environments for an effective expanded and national response.

Activities
With FHAM support, AHRN Myanmar was able to organise, facilitate and participate in several workshops (on outreach, harm reduction, HIV/AIDS, drug treatment, primary prevention as well as prison health), study tours (to Pakistan, Australia, India and Hong Kong), meetings (including high-level advocacy meetings and consultations), as well produce multiple documents (including a baseline survey report in Northern Shan State, translation of key policy documents, IEC and BCC materials addressed to drug users). Additionally, with FHAM’s support, AHRN Myanmar team members were able to attend key international events like the International Congress on AIDS in Asia and the Pacific and the International Conference on the Reduction of Drug Related Harm. Finally, the AHRN Myanmar team organised a national art competition on the topic of drug use and HIV.

Under FHAM, AHRN also implemented comprehensive services for drug users, partners and families in two sites – Lashio & Kone Nyaung – in Northern Shan State. These drop-in centres / outreach project offices (DIC/OPO) deliver the following activities:

• Outreach with needle and syringe exchange programme (NSEP), ward level advocacy to promote outreach and NSEP; outreach to the designated wards; establishing and maintaining contacts with clients; identification of outreach contact points and contact persons; distribution of needles and syringes with other disinfection supplies; conducting ward-specific health education sessions; conduct antiretroviral treatment preparedness addressing adherence issues and education on management of opportunistic infections and other related care and treatment for people living with HIV; and referrals.

• DIC based medical interventions such as primary health care; abscess management; symptomatic treatment of drug use behaviour; prophylaxis and treatment of opportunistic infections (including STIs, TB and other diseases); referrals to general (hospital level treatment) and special health (detoxification, rehabilitation, ART, TB etc.) care facilities; follow-up to support individual treatment plans (including substitution therapy); VCT to establish diagnosis linked with STI-HIV Team and DIC case management;
• DIC based case management including assistance in making individual treatment plans; case management linked with the medical interventions and outreach work; in-depth individual and family counselling sessions on HIV and associated drug use issues; referrals and follow-ups linked with medical interventions; regular meetings with methadone maintenance therapy (MMT) clients; and staff counselling (i.e. personal problems, burn-outs, stress, anger management etc.).
• DIC based support activities including social development activities such as income generation; neighborhood meetings to raise awareness on DIC/ OPO; health education / general awareness sessions for community; and film shows on drug use and HIV.
• Health education sessions linked with different units (such as outreach, medical, case management).
• Social support activities including client and staff interaction; DIC based NSEP (i.e. fixed site); low threshold social care and tea/coffee shop; and indoor/outdoor recreational facilities;
• Support to self-help group of drug users through regular meetings; quarterly newsletter; and monthly members’ dinner at DIC/OPO.

The Black Sheep Self Help Group of Drug Users was formed with support from AHRN Myanmar. The first Black Sheep quarterly newsletter was published in May 2007 and provided opportunities for drug users to share their feelings, experiences and opinions with readers.

The objectives of Black Sheep Self Help Group are:

Ø To develop job opportunities, generate income and become independent through sustainable employment;

Ø To include and recognise the drug users as part of the workforce of the Union of Myanmar;

Ø To prove that the drug users can be productive members of society and enjoy quality lifestyle like other citizens;

Ø To reduce the stigma and discrimination associated with drug use and to re-integrate the users back to the society;

Ø To set up and sustain a local enabling environment for developing employment opportunities for drug users.

Over 2,000 drug users have currently been reached and received services through those interventions.

Key outcome

Projects deployed and implemented under FHAM allowed AHRN to position itself strategically in the country’s response to HIV and drug use and maintain drug users as a priority target group on the policy agenda. Indeed, AHRN Myanmar representatives were nominated to several decision making and technical support bodies such as the IDU-HIV Workgroup (AHRN co-chair) under FHAM; member of the Technical Working Group (TWG), of the advisory body to FHAM and one of three international NGO representatives in the Expanded Theme Group on HIV/AIDS.

Visit UNAIDS website for more details on the response and challneges in Myanmar.
The AHRN Country Office in Myanmar was set up in July 2003 and became operational in August 2003 with a team of two expatriates and a Myanmar national. It operates through a MoU with the Central Committee of Drug Abuse Control (CCDAC), Ministry of Home Affairs, Union of Myanmar.

For more information on programmes, projects and policies in Myanmar, download the AHRN Country Profile - Myanmar: Service delivery, capacity building, and training in policy, advocacy and harm reduction 2005 (308Kb).

Contact:

Mr. Willy De Maere – Country Coordinator
AHRN - Myanmar Country Office - willy@idu.org.mm.
Tel: +951 593154, 507089
Fax: +951 507089