Safeguarding access to essential HIV services, empowering communities and mobilizing resources

Strengthening all health systems is one of the main aims of the UN COVID-19 response in Myanmar.

The UN Secretary-General has launched the UN Comprehensive Response to COVID-19 to save lives, protect societies, recover better.

In Myanmar, the United Nations came together as one to work in partnership with the Government and other NGOs to respond rapidly to the growing crisis. It was equally determined that the new pandemic would not prevent ongoing work in other health areas including malaria, TB, and HIV.

UNAIDS urged the community to be agile and innovative to support the continuation of HIV services while also appropriately dealing with the new pandemic.

By taking on board lessons learned through HIV, fighting COVID-19 can aid in reimagining systems of community support to accelerate the health-related commitments of the 2030 Agenda for Sustainable Development. At the same time the COVID-19 pandemic will undoubtedly yield lessons that can benefit both the HIV response as well as broader efforts to strengthen health systems.

Sometimes more than 100 people will be staring at Dr. Myo Kyaw Lwin on screen, and he feels the stress.

“Reaching consensus and bringing people to the table for dialogue and coordination is challenging at the best of times,” Dr Lwin says. “But the outbreak of COVID-19 in Myanmar created additional challenges for the national AIDS response working to improve access to HIV services.”

“We are dependent on online meetings where we must reply on the spoken word and sometimes this can be a barrier to full participation.

“So much is lost when we can’t see each other’s body language. This makes meeting preparation an intensive process and this has increased my stress levels.

“I don’t always have sufficient time to coordinate and make bilateral preparations with all of the meeting participants.

“The national health system was not designed with a pandemic in mind so I do feel very concerned that the more complicated cases there are, the more the health system will be overwhelmed.

“On the other hand, I have seen that stakeholders are trying their hardest, and everyone wants to contribute in the best way that they can.

“We really appreciate such high levels of cooperation.”

There are currently an estimated 240,000 people living with HIV in Myanmar, including about 11,000 children under the age of 15 years old.

Dr Lwin works for UNAIDS, the Joint United Nations Programme on HIV/AIDS, which is leading the global effort to end AIDS as a public health threat by 2030 and brings together the efforts of 11 Cosponsors, UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank.

Since scientists discovered the virus that causes AIDS, 78 million people have become infected with HIV and 35 million have died from AIDS-related illnesses.

UNAIDS began in 1996 to lead and inspire global, regional, national and local leadership, innovation and partnerships to ultimately consign HIV to history.

UNAIDS places people living with HIV and those affected by the virus at the decision-making table and at the centre of designing, delivering and monitoring the AIDS response.

It provides strategic direction, advocacy, coordination and technical support needed to catalyse and connect leadership from governments, the private sector and communities to deliver life-saving HIV services.

In Myanmar Dr Lwin is part of that advocacy and coordination effort.

Ending the AIDS epidemic is more than a historic obligation to the people who have died of the disease. It also represents a momentous opportunity to lay the foundation for a healthier, more just and equitable world for future generations.

Myanmar is close to reaching the national AIDS targets set for 2020, including that

  • 90% of all people living with HIV know their HIV status,
  • 90% of those living with HIV receive antiretroviral therapy, and
  • 90% of those on antiretroviral therapy experience viral suppression.

Yet more progress is still needed on HIV prevention focusing among at-risk populations and ensuring the legislative changes that impede access to prevention and health services.

Dr. Lwin started his career in primary health care in the remote areas of Myanmar and has worked for UNAIDS since 2017 as a Community Support Adviser.

In Myanmar Dr Lwin and his colleagues comes across people like “A”, who was 15 when he first injected drugs.

A went out with some people who were using heroin: “…and they persuaded me to try,” he said, puffing on a traditional Myanmar cigarette while squatting around a small fire with his friends. Now 20 years old, “A” lives in Putao, a remote area at the northern tip of Myanmar a lush and pristine environment home to a severe drug epidemic fueled by the availability ofcheap heroin. Widespread injecting drug use is resulting in high rates of HIV and Hepatitis C co-infection.

A and his friends were at one of the two Medical Action Myanmar (MAM) facilities in the Putao district for people who inject drugs. (See Community members are driving the AIDS response in northern Myanmar)

The clinic serves as a satellite centre of the National AIDS Programme and provides needle exchange, HIV counselling and testing, HIV treatment and care, primary health care, testing and treatment of sexually transmitted infections and family planning.

Dr Lwin also works with government counterparts, communities, donors and all kinds of stakeholders for coordination at the national level for HIV responses, and supports institutional development, advocacy, and strengthening community-led services.

“There are challenges to bring everyone to the table, everyone has a point of view and sometimes there are conflicting views due to diverse interests.

“But I find it fascinating to understand the different points of view and witness how a consensus can be achieved.

“With my colleagues, I am committed to support Myanmar in achieving the target of ending HIV/AIDS as a public health threat by 2030. In the times of COVID-19, this is even more important.

Since March 2020, as the impact of COVID-19 became increasingly evident the UN with the help of people like Dr Lwin has supported the National AIDS Programme to prepare, implement and monitor a contingency plan for HIV prevention, treatment and care.

“The aim was to ensure the maintenance of essential services.”

“I have also played a meaningful role in mobilizing resources from the Global Fund COVID-19 Response Mechanism for the maintenance of essential HIV services.

“Working across the UN, we were able to mobilize more than US$ 18 million to safeguard access to essential HIV services, as well as TB, Malaria, and the strengthening of national disease surveillance system, laboratory system and community systems to mitigate the impact of COVID-19 and reinforce the national COVID-19 response.”

Dr Lwin is proud of his role but doesn’t deny COVID-19 - has made his life difficult.

“While I find myself in a privileged position, one of the biggest personal challenges is finding a new work-life balance.

“My wife and I both work and we have a four-year-old son.

“His preschool closed because of COVID-19. He can’t go outside to play and his grandparents can’t come over to visit, so it’s not easy.

“There are lots of distractions, and often the days tend merge into one another.

“Some weeks, I am managing two important national dialogues with numerous stakeholders and also supporting community meetings that often take place at the weekend.

“It can be tough, as each of the meetings requires a lot of effort and it can be a big responsibility, especially when the issues have been about critical issues such as maintaining essential HIV services in the context of COVID-19.

“It is hard to maintain a healthy balance.

“I am learning to delegate work to colleagues, sometimes I will take a day off for rest and recuperation, and unless there is an urgent issue, I avoid responding to work emails in the evening. Though I am not fully successful I am trying to adapt.

“One of the things that has helped me to relax and recuperate has been getting involved in the UNAIDS internal culture transformation global initiative.

“I am volunteering my time to support the rollout of some of the activities. It brings in a new perspective. I am learning new things and find this to be professionally refreshing.

“Covid has taught me we must always be ready to adapt to change.”