Strengthening Community HIV/AIDS Responses (FHAM)Please note that this is a closed, archived program. September 2003 - May 2005
Pact initiated the Strengthening Community Responses to HIV/AIDS project in 2003 targeting 363 rural villages in central Myanmar's Dry Zone having a total population in excess of 400,000. The first year of project activities was funded through the Fund for HIV/AIDS in Myanmar, a consortium of donors for which UNAIDS acts as the secretariat. Upon completion of this support in July 2004 the project activities have been absorbed into the Partnership for Primary Health Care Services project. Statistics about HIV prevalence in our work areas are limited. In one of our townships, blood donor screening shows 0.5% prevalence. However, blood donors may not be a realistic proxy indicator for the general population as a large percentage of donors are monks, presumed to be free of infection. In another of our townships, blood screening yielded 8.4% prevalence and "suspect group" testing yielded 34% prevalence. Our community mobilization experiences in these villages has led us to appreciate the nature of the threat that migration places on those migrating and on their spouses. In the Dry Zone villages where we work, over 59% of the population is either landless (44%), or has less than 3 acres (15%). Poverty here makes migration an economic necessity. Our own detailed survey indicated that 25% of all households (almost 69,000) in our project villages are affected by migration. When extrapolated to cover the whole of the dry zone, it is estimated that migration affects 4,500,000 people. Within Myanmar's rural village context, strong normative pressures yield a social setting in which attitudes about sexual relations are very conservative. Evidence suggests that within rural villages there is little extramarital sex and it is not unusual for women to remain celebate until marriage. However, when removed from this social setting and placed within the harsh and often oppressive conditions faced by migrating laborers, the reinforcing social norms for conservative sexual behavior are removed, leaving workers vulnerable to the threat of HIV. Within the Greater Mekong region, Myanmar migrant workers are vulnerable, either as clients of sex workers, from engaging in commercial sex themselves, or from injecting drug use. They are a major conduit of HIV into the wider population. The conservative sexual environment in rural villages also makes youth vulnerable, with young males seeking their early sexual experiences from sex workers in urban centres, where HIV prevalence can exceed 25% among sex workers. The sexual conservatism in rural villages also supports the presence of deep-seated stigma around HIV/AIDS.
Pact's approachPact believes that HIV/AIDS knowledge in itself in not sufficient to stem the tide of the epidemic. Our approach mixes education with community action planning and supports the creation of enabling environments in which stigma is reduced and resources are available to mitigate the impact of HIV/AIDS. Pact promotes open dialogue and helps to ensure that communities are capable of undertaking these important activities within a setting where normative influence can create an enabling environment for risk reduction. Elements of our approach include:
Interim results
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SE Asian countries, because of their relatively low rates of HIV/AIDS prevalence, are considered to be in the "prevention stage" in their response to the HIV/AIDS pandemic. In Myanmar UNAIDS data published in 2002 reveals that the national HIV/AIDS prevalence has passed the 2% cap with rates of over 60% among injecting drug users (IDU), 38% among commercial sex workers (CSW) and 12% among male patients with sexually transmitted infection (STI). The current level of knowledge of the epidemic and its growth patterns within the populations is still limited and few actions to raise awareness and promote safe practices among the population have been implemented.