Myanmar detected its first case of HIV in 1988. To date, the country is experiencing a concentrated HIV epidemic in spite of the downward trend in HIV prevalence in the general population aged 15-49, from 0.8% in 2001 to 0.6% in 2009. However, Myanmar still ranks the third highest among countries in the South-East Asian Region in terms of HIV prevalence [1]. The estimated number of people living with HIV in 2009 was 240,000 [1]. In 2008, the National AIDS Programme documented 77,088 HIV cases [2]. The ratio of HIV-infected male-to-female had changed from 8 to 1 in 1994 to 2.4 to 1 in 2008, showing a shift in the characteristic of the epidemic as well as the increasing vulnerability of women. This shift can be explained by the relatively successful reduction of HIV transmission between sex workers and their male clients. However, this still leaves a pool of HIV infected men who were infected earlier and could potentially transmit the virus to their spouses. [2]  

Evidence from the annual sentinel surveillance revealed that IDUs, men who have sex with men (MSM) and sex workers are at risk of exposure to HIV. The 2009 sentinel surveillance showed that HIV prevalence was highest among IDUs (34.6%), followed by MSM (22.3%), FSWs (11.2%), newly diagnosed TB patients (9.2%), male sexually transmitted infection (STI) patients (4.9%), new military recruits (1.6%), pregnant women (1.0%) and blood donors (0.3%) [3].The prevalence of active syphilis among MSM was 6.3% in 2009 [3].

HIV prevalence is particularly high in few specific geographical areas – each with a varying trend. In 2009, HIV positivity rate among FSWs appeared to fall in all sentinel sites. For instance, a significant continuous decline in prevalence was seen since 2007 in Yangon and Mandalay, which have been the sentinel sites for decades. This could be due to: better coordination among partners in sample collection that led to a higher level of representativeness of the collected sample; the turn-over of the FSWs; and the wider reach of the newly recruited group or the actual declines in HIV prevalence given the intensive Targeted Condom Promotion (TCP) program that has been in place for a long time.

Among the vulnerability factors include: political turmoil coupled with international pressures and sanctions from international donors that hindered the effectiveness of HIV interventions in the areas most in need; the very high HIV prevalence among sex workers, IDUs, and MSM; high mobility (with high numbers of internal and international migrants and a large mobile population) due to socio-economic and political hardships; and the lack of nationally coordinated HIV prevention programs for pre-departure (potential) migrants, returning and circular migrants, and the mobile population in general.

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic, 2010

[2] UNGASS Country Progress Report, 2010

[3] NAP, DOH, WHO, Report of the HIV Sentinel Sero-Surveillance Survey, 2009, Myanmar