What has happened globally since 2004- access to treatment has increased; the proportion of new infections among women is increasing. more recognition of women’s vulnerabilities and the fact that addressing them needs a collaborative approach at the same time focusing on empowering women socially and economically while involving men and boys in prevention programmes In less than ten years this figure has increased from 19% (2000) to 35% (2008).
Priorities for prevention usually includes scaling up HIV prevention interventions among sex workers, men who have sex with men and injecting drug users but lack a strong additional component of reaching out to their long-term intimate sexual partners. Other interventions include preventing intimate partner violence, including sexual violence, promoting gender equality, reducing economic inequities, promoting property rights, reducing vulnerability conditions associated with migration, reducing stigma and discrimination, and improving disclosure within serodiscordant couples. Need to better understand t he impact of gendered norms and expectations which: cause women to have limited opportunities to inform and protect themselves sexually promote male behaviour such as having pre-marital and extra marital sex partners may fuel stigma towards individuals not conforming to dominant norms and limit health seeking behaviour
From Spectrum 2009 Estimated 238 000 PLHIV*, Adult Prevalence 0.6%** [ *Technical Working Group on Estimates and Projections, 2009) ** WHO; National AIDS Programme, 2009] Within the overall declining number of people living with HIV, an increasing proportion are women* HIV prevalence among sex workers (2009) estimated to 18%
Increasing proportion of new infections among women who are long term partners of key populations at higher risk of infection
Joint initiative led by National AIDS Programme and UNAIDS, also a Joint UN Team on AIDS priority. Involvement of stakeholders from all parts of the HIV response including affected communities as team members.
therefore not reached by positive prevention interventions; Stigma Index Study carried out by Myanmar Positive Group among their members show significantly lower education level among female respondents, where the majority had completed primary school. Access to information is low. If VCCT offered as part of routine RH and STI care this is believed to make it easier for the woman to explain to her partner/husband why she was tested. Stigma Index sample size: 324
2.these decisions not made on medical criteria 3. Increase of about 400 mother-baby pairs from 2008-2009. 2008: 1923 (total) 172 on ART. 2009: 2352 (total) 281 on ART. For programmes with only PMCT, effective referral is still an issue.
Transcript of "Gender and hiv in myanmar"
Women and HIV Roundtable Discussion on the Occasion of International Women’s Day 2010 “ Equal Rights, Equal Opportunities: Progress for All” Annami Löfving, UNAIDS
Women and HIV Global and Regional Situation <ul><li>International Women’s Day 2004 dedicated to Women, Girls, HIV and AIDS; </li></ul><ul><li>HIV is still the leading cause of death and disease among women of reproductive age (15-49 years) worldwide; </li></ul><ul><li>Today women account for 50% of People living with HIV worldwide; </li></ul><ul><li>In Asia, steep increase in proportion of People Living with HIV who are women from 19% in 2000 to 35% in 2008 </li></ul>
Women’s vulnerabilities to HIV Mostly female partners of MARPs
Responding to Gender and HIV in Myanmar <ul><li>Desk review on Gender and HIV (Sept/Oct 09) </li></ul><ul><li>Multi-stakeholder Gender Review of NSP 2006-10 (Oct/Nov 09) </li></ul><ul><li>Operational research and pilot on prevention of HIV in intimate partner relationships (planned for 2010) </li></ul><ul><li>Formation and capacity building of Positive Women’s Network </li></ul>
<ul><li>Many men get tested late and go for treatment late </li></ul><ul><li>Women often decide to get tested after their partner/husband has fallen ill or passed away </li></ul><ul><li>Men less likely than women to disclose their status to their partner </li></ul><ul><li>Study among PLHIV shows 63% of respondents find disclosure empowering </li></ul><ul><li>Recommendations from gender review of NSP: </li></ul><ul><li>strengthen capacity among health care workers to help men and women personalise and evaluate risk, to promote benefits of knowing one’s status; </li></ul><ul><li>Offer VCCT as part of routine reproductive health care and STI care </li></ul><ul><li>Develop interventions which support men to disclose and access treatment earlier </li></ul><ul><li>Reduce stigma and discrimination to promote voluntary HIV testing and disclosure among couples. </li></ul>Knowing one’s HIV status and disclosing to others:
Accessing Sexual and Reproductive Health and Prevention Services <ul><li>Women often fall into category ‘men and women of reproductive age’ where HIV risk is thought to be low and targeted prevention strategies are lacking </li></ul><ul><li>A recent study among PLHIV found (female respondents): </li></ul><ul><li>40% reporting being denied family planning services in the last 12 months. </li></ul><ul><li>75% decided not to have more children after learning of their HIV status </li></ul><ul><li>Recommendations from Gender Review of NSP </li></ul><ul><li>Develop and strengthen targeted services for: </li></ul><ul><ul><li>female partners of MSM and clients of SW and IDU and; </li></ul></ul><ul><ul><li>female drug users </li></ul></ul><ul><li>Conduct operational research on reproductive health needs, family planning and pregnancy decision making among PLHIV on treatment </li></ul><ul><li>Develop SOPs for reproductive health and HIV services to promote positive prevention, encourage partner testing, support disclosure. </li></ul>
<ul><li>43% of ART patients in Myanmar are women </li></ul><ul><li>Some reports of wives sacrificing their treatment opportunity in favour of their husband </li></ul><ul><li>Coverage of PMCT is improving but still not full coverage of pregnant women who need ART </li></ul><ul><li>Recommendations from Gender Review of NSP </li></ul><ul><li>Increase treatment literacy and preparedness to support scale up </li></ul><ul><li>Create stronger links between PMTCT sites and treatment centres </li></ul><ul><li>Ensure women meeting eligibility criteria begin ART during pregnancy </li></ul>Accessing Treatment
Promoting a protective socio-economic environment for People Living with HIV <ul><li>Findings from MPG Stigma Index Study (female respondents): </li></ul><ul><ul><li>Over 35 % fear physical assault and harassment; </li></ul></ul><ul><ul><li>As a result of their HIV positive status: </li></ul></ul><ul><ul><li>50% decided not to get married; </li></ul></ul><ul><ul><li>45% decided to isolate themselves from family and friends </li></ul></ul><ul><li>( female sex worker respondents): </li></ul><ul><ul><li>85% report low self esteem </li></ul></ul><ul><ul><li>36% currently feel suicidal; </li></ul></ul><ul><li>Recommendations from Gender Review of NSP </li></ul><ul><li>Conduct further research on the relation between GBV and HIV transmission </li></ul><ul><li>Explore approaches for livelihood support to mitigate impact </li></ul>
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