Responding to the seriousness of the HIV/AIDS epidemic in Myanmar, UNICEF and the Myanmar Government cooperate in a program of multisectoral HIV/AIDS activities, focussing on vulnerable groups in the Chinese and Thai border regions but with potential to benefit the whole country.

Children in Yangon enjoy a treat

The new UNICEF-supported prevention of mother-to-child transmission (PMCT) project aims to reach 25 townships by the end of 2005. Special efforts are being made to boost care and support for affected children and families. UNICEF has the largest country program and widest reach of the UN agencies operating in Myanmar.

Lifeskills in School: SHAPE

Building on an unprecedented partnership between Myanmar's health and education sectors, School-based Healthy Living and HIV/AIDS Prevention Education, or SHAPE, has brought Lifeskills-based HIV/AIDS/STI education to over 1.2 million Myanmar schoolchildren in over 9,000 schools, placing it among the front ranks of Lifeskills projects in East Asia and the Pacific.

SHAPE is popular with both children and teachers

SHAPE's "spiral curriculum" combines age-appropriate information about HIV/AIDS and healthy living with Lifeskills and peer education components for children aged 7-15. And SHAPE's potential goes far beyond the school gates. It is designed for children to bring what they learn to their families, and to involve parents, teachers and communities in community activities. SHAPE township committees oversee activities in and out of school (UNICEF has supplied bicycles to make their job easier). UNICEF is also supporting development of a training package for parent-teacher associations on how to promote SHAPE activities in the community.

UNICEF has been closely involved in SHAPE since the outset, from advocacy to curriculum development to training teachers and education officials. SHAPE has been integrated into the national curriculum, and implementation is steadily growing towards national scale.

Lifeskills Out of School

Another very successful program has been the Lifeskills-based HIV/AIDS/STI training for women and youth provided by the Myanmar Maternal and Child Welfare Association and the Myanmar Red Cross Society. The Myanmar Red Cross Society has been implementing a community-level peer-education project for youth since 1994.

Running parallel with this has been a similar program with the Myanmar Maternal and Child Welfare Association aimed at women of reproductive age. Along with its immediate benefits in terms of prevention, the project has been very popular with women, and particularly married women, as it provides them for the first time with a forum for informal discussion of marital issues. UNICEF already supports these activities in 19 townships, and is supporting implementation in more townships hand in hand with the expanding prevention of mother-to-child transmission project.

MRCS youth training on HIV/AIDS

More information on: The Myanmar Red Cross Society project.

100 Frequently Asked Questions

"100 Frequently Asked Questions and Answers about HIV/AIDS" is a Myanmar-language UNICEF publication that answers people's real concerns about HIV/AIDS. It deals with the ABC of prevention and care, but also tackles more down-to-earth practical issues – for example how to treat the body of someone who has died of AIDS – as well as more complex moral questions.

"100 Frequently Asked Questions" has its origins in UNICEF-supported HIV/AIDS education sessions, during which facilitators noted down the questions most frequently asked by women and youth. Originally intended as extra reading material in SHAPE schools and as a basic resource for UNICEF partners, demand for the book has been much wider. Since its publication in December 1999, 50,000 copies have been printed, and requests for copies keep coming in.

In 2001, sections of "100 Frequently Asked Questions" are regularly being published in English and Myanmar-language newspapers – a welcome sign that the epidemic and UNICEF support to the national response are being taken seriously.

A Clearer Picture

HIV/AIDS programming for vulnerable groups in Myanmar has been constrained by a shortage of reliable information on people's HIV/AIDS-related knowledge and behaviour. Between 1999 and 2001, UNICEF and the Population Council's Horizons Project supported a set of landmark studies in Lashio (Shan State) and in communities around Yangon. The studies looked at risk behaviours and reproductive health issues among out of school youth, HIV/AIDS education materials for ethnic minorities, and the counselling needs of people with HIV/AIDS and their families. UNICEF will continue to support individual surveys as well as capacity building and technical assistance to national counterparts, in partnership with the Population Council and Family Health International.

Reproductive Health

UNICEF supplies 36 public STD clinics in 27 high-prevalence townships with a range of STI tests and treatments, making it the biggest contributor to public-sector STI prevention in Myanmar. Public clinics provide an essential service to many of the most vulnerable people, including low-pay sex workers and the very poor. In addition, UNICEF supports training of basic health staff on STI management and care, covering 65 townships. Working so closely with reproductive health services provides a perfect channel to reach highly vulnerable groups with HIV/AIDS prevention information.

Young monks in Nyauk U

Prevention of Mother-to-Child Transmission

Steps to prevent mother-to-child HIV transmission are needed urgently in Myanmar. Following a joint UNICEF/UNFPA assessment of the need and feasibility of PMCT interventions, 2001 saw the launch of two UNICEF-supported PMCT pilots projects in areas of high maternal HIV incidence, one in Tachileik on the northern Thai border and the other in Kawthaung, the port city opposite Thailand's Ranong.

The projects make voluntary confidential counselling and testing (VCCT) available in ante-natal care settings. An HIV/AIDS counselling manual has been adapted for Myanmar, with particular emphasis on prevention of mother-to-child transmission, and health staff and volunteers have been trained in counselling. By February 2001, 69 midwives from mother and child health and reproductive health care centres around the two sites, along with nurses from township hospitals and auxiliary midwives working in areas near Tachileik not accessible to professional health staff, had been trained in PMCT. UNICEF will provide further training for basic health staff on safe delivery and infant-feeding counselling.

UNICEF supplies both the test kits and antiretroviral drugs (nevirapine) to reduce perinatal transmission. The goal is to have PMCT running in 17 townships by the end of 2002, and in 25 by the end of 2005.

Concurrently with the activities in the field, UNICEF is helping the Myanmar Government to design a national strategy, policies and guidelines on prevention of mother-to-child transmission. At a multi-agency workshop held in Yangon in March 2001, UNICEF, UNFPA, the Department of Health and others drafted a national strategy for PMCT communications, ranging from primary prevention with youth, men and women to promoting the services to improving social perceptions towards PMCT and HIV-positive women.

Acceptance, Care and Support

Building acceptance, care and support for people with or affected by HIV/AIDS is an urgent priority in Myanmar, where social services are under-resourced and discrimination and misconceptions related to HIV/AIDS remain strong. Existing projects like SHAPE, PMCT and the World Vision Myanmar and CARE Myanmar seafarers projects provide some opportunities to promote acceptance, care and support. UNICEF will continue to support research into the needs of people affected by HIV/AIDS and look for more opportunities for action.

Myanmar seafarers crowd around a condom demonstration at a temple fair

Buddhist monks from Myanmar's Shan State have been interacting with Thailand's Sangha Metta project for several years with the help of UNICEF-EAPRO. This relationship has flourished with monks and nuns receiving training from Sangha Metta and a range of others to enrich community-level HIV/AIDS prevention and care initiatives. A Myanmar version of With Hope and Help is planned.

Tuberculosis and HIV/AIDS

Tuberculosis has reached epidemic proportions in Myanmar. According to the National AIDS Program, in 1998, 85% of reported AIDS cases in Myanmar were concurrently infected with tuberculosis. TB is a massive threat to the health of people with HIV/AIDS, and likewise its high incidence among this group threatens to accelerate the spread of TB among the general population. UNICEF, in consultation with the National TB Program and the National AIDS Program, is supporting the establishment of a nationwide TB program that will implement pilots in 30 of the worst-affected townships.

Medecins du Monde

UNICEF Myanmar has been working with Medecins du Monde since 1996 for prevention of HIV infection among high-risk behaviour groups in Kachin State. The main aim of MDM's work in Kachin is to reduce transmission of HIV and sexually transmitted infections among the general population, with focus on two high-risk behaviour groups: sex workers and injecting drug users. MDM promotes adoption of safer sex practices among sex workers and low-risk behaviours among their potential clients. Alongside this, MDM seeks to improve the quality and coverage of STI care for sex workers. MDM works to improve harm reduction knowledge and develop harm-reducing practices among injecting drug users, and to increase HIV/AIDS and STI awareness among the general population.