What works: reviewing harm reduction responses in Myanmar
Yangon (Myanmar), 18 June 2010 - Since 2002, 36 drop-in centres for drug users have been established across Myanmar and various non-governmental organizations have become involved in providing comprehensive HIV prevention and care services to drug users.
In order to assess the quality of these services, analyse shared experiences and consider international and regional best practices, UNODC organized a far-reaching review of the services available to injecting drug users in Myanmar between 21-24 May. The objective was to have an overview of what works - and what doesn't - from an evidence-based perspective in the context of Myanmar itself.
It was immediately recognized that a key challenge preventing drug users from seeking treatment is that they are obliged - by law - to register. Other challenges the meeting identified are: the appearance of new drugs such as amphetamine-type stimulants, drug law enforcement crackdowns, punitive drug law such as the Narcotics Drugs and Psychotropic Substances Law (1993), the lack of coverage of harm reduction services, the lack of funds available to key entities like the Ministry of Health to deliver such services and a high staff turnover among service providers.
In addition, participants in the review agreed that more must be done to ensure that needle and syringe programmes and methadone maintenance treatment programmes reach more people, that service providers coordinate more and that there should be more harm reduction service providers.
In 2008, the HIV Sentinel Sero-Surveillance in Myanmar indicated that 37.5 per cent of injecting drug users are HIV positive. In some areas the figure reached as high as 54 per cent. Given the relatively high incidence of HIV among injecting drug users, it was agreed that HIV/AIDS is an important public health issue for the Government of Myanmar to address and that antiretroviral therapy should become more widely available.
On the final day of the review, stakeholders agreed on specific recommendations on drug treatment, services in closed settings, legal aspects, the establishment of services specifically for women and the importance of involving drug users in decision-making. Additional recommendations were made with regard to referrals, sexual health, coordination activities, improved data collection and donors. The recommendation will be presented to the Ministry of Health so as to incorporate the recommendations into the National Strategic Plan for HIV and AIDS (2011-2015) and the Ministry of Home Affairs with the intension of complementing drug control and drug trafficking policies with harm reduction interventions.
It is expected that the outcomes of the review will be published and disseminated to all stakeholders such as the Central Committee for Drug Abuse Control (CCDAC), the Ministry of Health, the Ministry of Public Affairs, the Myanmar National AIDS Programme and other relevant government bodies. The report will also be shared with the Australian Government's overseas aid programme, drug users and injecting drug users, non-governmental organizations, people living with HIV and the United Nations.
The review was carried out by UNODC in collaboration with CCDAC and the Myanmar National AIDS Programme. It was led by Mr. Alex Wodak and Ms. Katya Burns. Alex Wodak is a physician and has been Director of the Alcohol and Drug Service, St Vincent's Hospital since 1982. He is also the President of the Australian Drug Law Reform Foundation and works frequently in developing countries on HIV control amongst injecting drug users. Ms. Burns is an international consultant who has extensive experience in harm reduction and methadone maintenance treatment review and assessment work in South, Southeast, East, and Central Asia. In addition, Ms. Burns has expertise in gender and harm reduction, and has worked on a number of projects designed to increase women's access to harm reduction and methadone maintenance therapy. Among the participants were drug users and people living with HIV as well as representatives of the Ministry of Health, the Ministry of Home Affairs, non-governmental organizations and the United Nations.
Speaking on the government's involvement Dr. Khin Ohnmar San, Programme Manager of the Myanmar National AIDS Programme said that "the participation of government bodies such as the Ministry of Health enhances the government's ownership of the review process and ensures that future commitments with regards review recommendations will be honoured".