Family Planning in Asia and the Pacific - International Council on ...

23 human resources for health (physicians, nurses <strong>and</strong>midwives) per 10,000 people are likely to experienceshortages <strong>in</strong> <strong>the</strong> coverage rates for <strong>the</strong> basic primaryhealth-care <strong>in</strong>terventions prioritized by <strong>the</strong> MillenniumDevelopment Goals 89 . In Myanmar, <strong>the</strong> doctor-topopulationratio is 1:3315, while <strong>the</strong> nurse/midwife-topopulationratio is 1:1195 90 . There are about 14 healthcareproviders per 10,000 people. The majority of highlyskilled medical doctors are concentrated <strong>in</strong> urban locations,where only 30 per cent of <strong>the</strong> total population resides. Tomeet <strong>the</strong> <strong>in</strong>ternational threshold <strong>and</strong> secure availabilityof skilled birth attendants at deliveries, strategic plann<strong>in</strong>gshould be done to ensure <strong>the</strong> susta<strong>in</strong>ability of <strong>the</strong> healthworkforce.HIV/AIDSThe estimated prevalence of HIV <strong>in</strong> Myanmar is 0.61per cent. The estimated number of people liv<strong>in</strong>g withHIV between 15 to 49 years of age is 230,000 (35%female) <strong>in</strong> 2009. The ma<strong>in</strong> mode of <strong>in</strong>fection of HIVis sexual transmission (73%). HIV prevalence is highamong vulnerable groups: 37.5 per cent among <strong>in</strong>ject<strong>in</strong>gdrug users, 28.8 per cent among men who have sex withmen, 18.4 per cent among female sex workers <strong>and</strong> 5.4 percent among males with an STD. HIV prevalence amongpregnant mo<strong>the</strong>rs was 1.26 per cent <strong>in</strong> 2009; prevalenceamong blood donors was 0.48 per cent, <strong>in</strong> new militaryrecruits 2.5 per cent <strong>and</strong> <strong>in</strong> new tuberculosis patients 11.1per cent.HIV prevalence among pregnantwomenIn relation to MDG <strong>in</strong>dicator 6.1 on HIV prevalenceamong <strong>the</strong> population aged 15-24 years, HIV prevalenceamong pregnant women <strong>in</strong> that age group decl<strong>in</strong>ed from2.78 per cent <strong>in</strong> 2000 to 1.01 per cent <strong>in</strong> 2008. However,a large gap rema<strong>in</strong>s before MDG target 6B on achiev<strong>in</strong>g,by 2010, universal access to treatment for HIV/AIDS forall those who need it is achieved. The proportion of <strong>the</strong>population with advanced HIV <strong>in</strong>fection hav<strong>in</strong>g accessto antiretroviral drugs is only 20 per cent. In addition,only 38.7 per cent of women <strong>in</strong> need of preventionof mo<strong>the</strong>r-to-child transmission treatment received acomplete course of antiretroviral prophylaxis <strong>in</strong> 2008.There is a chronic fund<strong>in</strong>g gap, which currently st<strong>and</strong>s ata shortfall of approximately 38 per cent, accord<strong>in</strong>g to <strong>the</strong>operational plan of <strong>the</strong> National Strategic Plan <strong>in</strong> 2008.The health system needs streng<strong>the</strong>n<strong>in</strong>g, <strong>and</strong> <strong>the</strong>re needs tobe a reduction <strong>in</strong> stigma <strong>and</strong> discrim<strong>in</strong>ation aga<strong>in</strong>st peopleliv<strong>in</strong>g with HIV/AIDS, <strong>and</strong> <strong>in</strong>creased outreach to remotepopulation groups.RH <strong>and</strong> HIV support for <strong>the</strong> migrantpopulationProgrammes also need to be targeted at <strong>the</strong> large mobilepopulation of <strong>in</strong>ternal <strong>and</strong> <strong>in</strong>ternational migrants. Thereis an <strong>in</strong>adequate range of services, with low coverage ofvoluntary confidential counsel<strong>in</strong>g <strong>and</strong> test<strong>in</strong>g, for thosegroups.Condoms for HIV prevention <strong>and</strong>gender issuesIn Myanmar, based on an estimation workshop report<strong>in</strong> 2009, <strong>the</strong> epidemic also spread to women where anestimated 35 per cent of <strong>the</strong> cases are female. The rout<strong>in</strong>emonitor<strong>in</strong>g report of <strong>the</strong> National AIDS Programme<strong>in</strong>dicated that <strong>the</strong> ratio of female-to-male AIDS cases had<strong>in</strong>creased from 1:3.6 <strong>in</strong> 2000 to 1:2.4 <strong>in</strong> 2008 91 , while <strong>the</strong>HIV prevalence rate among pregnant mo<strong>the</strong>rs attend<strong>in</strong>gantenatal cl<strong>in</strong>ics <strong>in</strong> 32 sites had decreased.Women’s personal risk perception was also low <strong>in</strong> spiteof <strong>the</strong> existence of high-risk behaviour of some men <strong>and</strong><strong>the</strong> prevalence of HIV <strong>in</strong>fection <strong>in</strong> <strong>the</strong>ir community 92 . In2007, <strong>the</strong> Behavioural Surveillance Survey of <strong>the</strong> generalpopulation noted that women had lower knowledge of HIVtransmission than men <strong>and</strong> uneducated women dependenton <strong>the</strong>ir partners were even less knowledgeable 93 .In common with o<strong>the</strong>r countries <strong>in</strong> <strong>Asia</strong>, a 2009 draftdesk review of gender <strong>and</strong> HIV <strong>in</strong> Myanmar <strong>in</strong>dicatedthat <strong>the</strong> <strong>in</strong>creas<strong>in</strong>g rate of HIV transmission to femalesis thought to be due to sexual relationships with <strong>the</strong>irhusb<strong>and</strong>s or long-term sexual partners who have alsopatronized sex workers. This process is termed “<strong>in</strong>timatepartner transmission” <strong>and</strong> can be prevented by consistentcondom use.Social norms <strong>and</strong> unequal gender roles <strong>in</strong> <strong>the</strong> family <strong>in</strong>Myanmar 94 may render women more vulnerable to HIV<strong>in</strong>fection as women generally fail to negotiate condomuse with <strong>the</strong>ir partners 95 . A culture of submissiveness <strong>and</strong><strong>the</strong> one-sided faithfulness of wives may lead to women’sheightened risk of HIV <strong>in</strong>fection. Ow<strong>in</strong>g to fear ofaccusations of <strong>in</strong>fidelity, <strong>in</strong>clud<strong>in</strong>g fear of be<strong>in</strong>g labeled assexually promiscuous, disclosure of HIV status to sexualpartners <strong>and</strong> spouses is thought to be low 96 .The majority of Myanmar women are economicallydependent on men <strong>and</strong> this means that <strong>the</strong>y have lessdecision-mak<strong>in</strong>g power than men. Moreover, women havemore responsibility for look<strong>in</strong>g after children, as well as <strong>the</strong>care of o<strong>the</strong>r family members, such as <strong>the</strong> elderly, orphanedrelatives <strong>and</strong> those liv<strong>in</strong>g with long-term illnesses, <strong>in</strong>clud<strong>in</strong>g279