HIV in Myanmar. HIV in Myanmar. Outline. Socio-economic context Epidemiology HIV cascade Testing Treatment Barriers Conclusions 21/02/2017

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1 ICTMM 21 Sept 2016 Mark Boyd Chair of Medicine/Professorial Fellow University of Adelaide/UNSW University of Adelaide 2 1

2 University of Adelaide 3 Myanmar BASIC SOCIO-DEMOGRAPHIC INDICATORS Total population (thousands) 53,719 Annual population growth rate 0.8 Population aged (thousands) 30,647 Percentage of population in urban areas 33 Crude birth rate (births per 1,000 population) 17.4 Under-5 mortality rate (per 1,000 live births) 52 Human development index (HDI) - Rank/Value 144/0.536 Life expectancy at birth (years) 65.2 Adult literacy rate (%) 92.7 ( ) Ratio of girls/boys in 1 0 and 2 0 education (%) 101 GDP per capita (PPP, $US) 1,126 Per capita total health expenditure (Int.$) 23 University of Adelaide 4 2

3 University of Adelaide 5 University of Adelaide 6 3

4 Number (estimate) 21/02/2017 Adults and children estimated to be living with HIV 2015 North America and Western and central Europe 2.4 million [2.2 million 2.7 million] Latin America and the Caribbean 2.0 million [1.7 million 2.3 million] Middle East & North Africa [ ] Western and central Africa 6.5 million [5.3 million 7.8 million] Eastern Europe & central Asia 1.5 million [1.4 million 1.7 million] Eastern and southern Africa 19.0 million [17.7 million 20.5 million] Asia and Pacific 5.1 million [4.4 million 5.9 million] Total: 36.7 million [34.0 million 39.8 million] Estimated number of people living with HIV, new HIV infections and AIDS-related deaths, , , , , , ,000 50, ,000 12,000 9,700 PLHIV New HIV infections AIDS-related deaths Source: Prepared by based on UNAIDS. (2016). HIV Estimates

5 Number (estimate) 21/02/2017 Estimated number of adults (15+) living with HIV and women (15+) living with HIV, , , , , , ,000 50,000 77,000 - Adults (15+ yr) living with HIV Women (15+ yr) living with HIV Source: Prepared by based on UNAIDS. (2016). HIV Estimates University of Adelaide 10 5

6 National Pathein Myitkyina Yangon Mandalay Taunggyi Tachileik National Pathein Mandalay National Myitkyina Yangon Muse 21/02/2017 National prevalence often masks the high prevalence in some geographical areas % 40 HIV prevalence among key populations, FSW MSM PWID Source: Prepared by based on National AIDS Programme, Department of Health, Ministry of Health and World Health Organization (2015). Results of HIV Sentinel Serosurveillance

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8 University of Adelaide 15 Cumulative cross sectional cascade for HIV treatment and care, 2015 University of Adelaide 16 8

9 University of Adelaide 17 HIV testing coverage among key populations, % Female sex workers (2015) Men who have sex with men (2015) People who inject drugs (2014) Source: Prepared by based on 1) Myanmar Global AIDS Response Progress Reporting 2016;and 2)

10 Proportion of spending on HIV prevention programmes from domestic and international sources, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % International sources % Domestic (public) sources Source: Prepared by based on University of Adelaide 20 10

11 Number 21/02/2017 Estimated PLHIV, people receiving ART and treatment gap, , , , ,000 50, People receiving ART Treatment gap Estimated PLHIV Source: Prepared by based on 1) UNAIDS. (2016). HIV Estimates ; 2) and 3) Global AIDS Response Progress Reporting 21 University of Adelaide 22 11

12 Proportion of spending on care and treatment from domestic and international sources, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % International sources % Domestic (public) sources Source: Prepared by based on University of Adelaide 24 12

13 Criminalisation of same sex sexual activity Compulsory detention of PWIDs Criminalisation of sex work Criminalisation of HIV transmission & exposure HIV-related restrictions on entry, stay & residence University of Adelaide 25 University of Adelaide 26 13

14 Conclusions A significant HIV epidemic KAP activities are proscribed and stigmatised Significant barriers obstructing progress social, economic, legal, fiscal Recent transition to semi-democracy may be transformative University of Adelaide 27 14