Reducing Injecting Drug Use and HIV/AIDS Vulnerability in Myanmar: Technical Coordination Unit (TCU) (AD/MYA/03/H08)

Introduction

UNODC's mandate in relation to HIV prevention and care focuses on drug use, prison settings and trafficking in persons. Regarding drug use, the demand and supply reduction initiatives of UNODC necessitate close contact with injecting drug users (IDU), as well as with those in regular contact with injecting drug users, such as Law Enforcement and Health Authorities; and are complementary to HIV prevention, treatment, care and support initiatives amongst injecting drug users. As such, in Myanmar UNODC is the leading support agency in HIV prevention and care initiatives amongst injecting drug users.

To facilitate UNODC's fulfilment of this role, the Technical Coordination Unit (TCU) was established in 2003 as a vehicle through which to promote and facilitate a comprehensive programme on 'Injecting Drug Use and HIV/AIDS vulnerability' within the wider national response.

Currently, the national response is guided by the Myanmar National Strategic Plan (NSP) on HIV/AIDS, 2006-2010, developed by the Government, with support from the UN, local and international NGOs and donors. This framework provides a national, comprehensive, prevention, care and treatment strategy, which builds on previous experiences and enrols the participation of all actors committed to this goal.

Hence, the TCU is structured to provide support to implementing partners in the effective coordination and implementation of activities in the area of injecting drug use and HIV prevention. In this way, the TCU aims to prevent the overlapping of activities; draw attention to priority areas; create/adapt culturally appropriate guidelines to implement HIV/AIDS prevention programmes for drug users; and provide overall direction and support in this area. As such, TCU's involvement aims to increase the efficiency and effectiveness of the response, ensuring that the limited resources available are well utilised.

The TCU's activities are expected to continue as the need for support in coordination, monitoring and scaling-up of HIV interventions with a focus on injecting drug users still exists. Plans for the future include developing further integration between the operations and objectives of UNODC's Demand Reduction and HIV activities.[ top]

Objective

Main Objective: To reduce injecting drug use and the transmission of HIV among injecting drug users, and from them to the general population.[ top]

Strategy

The general project strategy is to provide managerial, administrative and technical support in the national response to HIV and Injecting Drug Use. It is, by nature, both an inter-agency undertaking, as far as it is part of the UN response to the HIV/AIDS epidemic in Myanmar, as well as a multilateral endeavour, as it relies on partnerships with local and international NGOs and related government departments, such as the Central Committee on Drug Abuse Control (CCDAC), the Ministry for Progress of the Border Areas and National Races and Development Affairs, (NATALA, the Myanmar abbreviation for this department) and the Ministry of Health, in coordinating approaches at the macro level.

The TCU has three main areas of responsibility and activity:

1. Coordination and Monitoring of IDU-related Projects and Activities

• Organize and participate in technical cooperation and coordination meetings, prepare notes and follow up on issues as necessary.
• Assist in the identification of sound projects with other agencies and preparation of funding requests for interested donors.
• Prepare annual work plans, monthly situation reports and semi-annual progress reports for UNODC and for UNAIDS.
• Ensure effective coordination between the Drug User and HIV/AIDS strategies and other national strategies, the Government's overall drug control policies, and national AIDS programmes.
• Foster integration between the Drug User and HIV/AIDS strategies, and other UNODC initiatives with regard to drug demand reduction, particularly in the fields of prevention, treatment and rehabilitation.
• Keep abreast of other global, regional and bilateral initiatives to ensure cross-fertilization.

2. Networking and Advocacy Support

• Maintain regular contact with national government departments and agencies, UN agencies, national and international NGOs and other implementing partners, to strengthen the network and share information on policy, programmes and project development.
• Raise awareness amongst counterparts of the need and opportunity for cooperation with UNODC with regard to IDU issues and HIV/AIDS prevention.
• Advocate the pursuit of demonstrated "best practices" in combating drug abuse and HIV/AIDS, while recognizing the particularities of the Myanmar context.
• Engage and support the Central Committee on Drug Abuse Control (CCDAC) and other Government agencies in areas such as policy development vis-à-vis the National AIDS programme.
• Design and support the delivery of targeted advocacy strategies.

3. Data Collection, Programme Development and Implementation

• Formulation of meetings with implementing partners and specialists in developing Outreach Programmes.[ top]

Project Components

Component 1: A Technical Coordination Unit is established and is operating.

Activities:

• Lead the formulation and development of detailed outreach programmes with the participation of implementing partners.
• Engage Government agencies (including CCDAC) in delivering vertical advocacy support through local power structures (including police).
• Engage and support CCDAC, the Ministry of Health and others in areas such as policy development vis-à-vis the National AIDS programme.

Component 2: Ensure that the programmes and activities focusing on HIV in the context of injecting drug use are being implemented by relevant partners, and coordinated and monitored by UNODC in order to ensure proper synergies.

Activities:

• Support outreach interventions and outreach-based service delivery activities.
• Support the monitoring of all projects and activities related to injecting drug use.
• Raise awareness of counterparts over needs and opportunities for cooperation with UNODC in the area of IDU and HIV/AIDS prevention.
• Identify needs and coordinate the provision of capacity building activities for implementing partners.
• Ensure effective coordination at the strategic level of the national response to HIV, the Government of Myanmar's overall drug control policies and the National AIDS Programme.
• Keep abreast of and coordinate with other global, regional, bilateral and NGO initiatives in the field of injecting drug use and HIV/AIDS vulnerability to ensure cross-fertilisation.
• Foster integration between Drug Demand Reduction and HIV/AIDS strategies, particularly in the areas of prevention, treatment and rehabilitation.

Although the core activities of the TCU lie in the areas of coordination, facilitation, and providing managerial, administrative and technical support to implementing partners, the TCU also functions as a support unit for some projects, such as the Lashio Outreach Project (LOP) and UNODC's G54 Project.[ top]

Lashio Outreach Project (LOP)

The LOP was established to implement a comprehensive approach to HIV amongst Drug Users, which includes: outreach; peer education; HIV/AIDS prevention, treatment and care initiatives among injecting drug users, drug users and vulnerable youth; advocacy for government and community leaders; organisation of training workshops on outreach and peer education; and treatment and care for injecting drug users living with HIV/AIDS.

The TCU has supported the establishment of the Township Steering Committee in Lashio, which has both facilitated the participation of local authorities and paved the way for new partners to provide other aspects of service delivery, based upon their own strengths. This has enabled the provision of comprehensive interventions, making the project a leading model of its kind in Myanmar. This cooperative, collective approach, involving Government, NGOs, INGOs and UNODC has increased efficacy and strengthened the ability of the project to provide optimum services and coverage to injecting drug users.

The success of activities in Lashio has since prompted the development of similar outreach activities in three other sites. Muse Outreach Project, jointly developed by the Myanmar Anti-Narcotics Association (MANA) and TCU is now well into implementation. Theinni Township was originally receiving assistance via mobile outreach, but recently permission from the authorities has allowed for the implementation of a project within this area. Finally, the Tachileik Outreach project, (also in partnership with MANA) began implementation in June, 2006.[ top]

Support for the G54 Project

The TCU also supports the the EU-funded project 'Reducing Injecting Drug Use and its Harmful Consequences in the Union of Myanmar', (commonly referred as G54) in partnership with MdM and CARE. The project conducts community-based activities in three townships of the Kachin State (Myitkyina, Moegaung and Moehyin/Hopin) and in selected townships in Yangon, Mandalay and Lashio. UNODC/TCU supports the project's overall coordination and monitoring, and oversights additional activities in Yangon and Insein hospitals, correctional departments in the Yangon division, 20 public community-based service centres in Northern and Southern Shan State, and six major drug treatment and rehabilitation centres. [ top]

Read more: Reducing Injecting Drug Use and its Harmful Consequences in the Union of Myanmar (AD/MYA/03/G54)

Background

At present, there are approximately 70,000 officially registered drug users in Myanmar, the vast majority of whom are heroin users, mainly from the Northern Shan and Kachin States. However, estimates suggest that the number of injecting drug users could be much higher - as many as 300,000 - as stigma and discrimination often mean that the drug using population are 'hidden' from official view.

Injecting drug use is a predominant mode of HIV transmission in many settings and, in Myanmar, is estimated to be responsible for 26-30% of all new HIV infections (UNODC, 2004). Among injecting drug users, the median HIV prevalence in six sentinel sites examined in 2003 was 48%. In some border areas, however, the rate of prevalence was found to be as high as 80%.

In 2004 WHO and UNAIDS jointly estimated the overall number of people living with HIV in Myanmar to be between 170,000 and 610,000 - with the high-end value representing a prevalence rate of 2.2% among adults. This suggests Myanmar is facing a generalised epidemic, over 1% prevalence, where HIV is now sustained within the general population, rather than contained amongst groups engaging in high-risk behaviour. This assertion is also supported by the fact that, based on sentinel surveillance, the national prevalence rate among pregnant women in some parts of Myanmar was as high as 5% in 2001.

The Government of the Union of Myanmar and the UN system have recognised the rapid spread of HIV as one of the major humanitarian challenges facing the country. Prior to the current National Strategic Plan, in 2003, Government institutions and concerned UN agencies, with the support of international NGOs, identified five areas that required urgent action to counter the HIV epidemic. The five priority areas were:

1. Individual risk of sexual transmission of HIV.
2. Individual risk of HIV transmission among injecting drug users and their partners.
3. Knowledge and attitudes towards HIV/AIDS among the general population, particularly young people.
4. Access and quality of care, treatment and support for people living with HIV/AIDS.
5. Essential elements of the enabling environment for a strengthened and effective expanded national response.

These formed the cornerstones of the comprehensive "Joint Programme for HIV/AIDS: Myanmar 2003-2005." The primary aim of the Joint Programme was to reduce HIV transmission and improve the quality of life of those living with HIV, thus reducing and minimising the negative effects of the epidemic on the Myanmar population as a whole. Strengthening the enabling environment and the capacities of local, national and international actors to effect HIV prevention, treatment and care activities were seen as the means to promote achievement of these goals.

The Government of Myanmar endorsed the Joint Programme as a whole and demonstrated commitment to combating the epidemic in collaboration with the international community. Indeed, reducing rates of HIV/AIDS prevalence among drug injectors is a top priority within the new National Strategic Plan on HIV/AIDS. Stronger Government participation can contribute greatly in the implementation of a multi-sectoral, comprehensive and coordinated response.[ top]