HIV prevalence among the female sex workers in major cities in Myanmar and the risk behaviors associated with it

Swe, Lin Aung; Rashid, Abdul

doi:10.2147/hiv.s50171

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…Overall 8.5 % of new tuberculosis patients are HIV sero-positive in Myanmar, but information about age and sex differences in TB-HIV co-infection is not available [ 39 ]. Studies of female sex workers in Myanmar have indicated higher HIV prevalence in younger women [ 40 ]; HIV-TB co-infection in Myanmar, and its impact on the tuberculosis epidemic, requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Are current case-finding methods under-diagnosing tuberculosis among women in Myanmar? An analysis of operational data from Yangon and the nationwide prevalence survey

Khan

Khine

Hutchison³

et al. 2016

BMC Infect Dis

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BackgroundAlthough there is a large increase in investment for tuberculosis control in Myanmar, there are few operational analyses to inform policies. Only 34 % of nationally reported cases are from women. In this study, we investigate sex differences in tuberculosis diagnoses in Myanmar in order to identify potential health systems barriers that may be driving lower tuberculosis case finding among women.MethodsFrom October 2014 to March 2015, we systematically collected data on all new adult smear positive tuberculosis cases in ten township health centres across Yangon, the largest city in Myanmar, to produce an electronic tuberculosis database. We conducted a descriptive cross-sectional analysis of sex differences in tuberculosis diagnoses at the township health centres. We also analysed national prevalence survey data to calculate additional case finding in men and women by using sputum culture when smear microscopy was negative, and estimated the sex-specific impact of using a more sensitive diagnostic tool at township health centres.ResultsOverall, only 514 (30 %) out of 1371 new smear positive tuberculosis patients diagnosed at the township health centres were female. The proportion of female patients varied by township (from 21 % to 37 %, p = 0.0172), month of diagnosis (37 % in February 2015 and 23 % in March 2015 p = 0.0004) and age group (26 % in 25–64 years and 49 % in 18–25 years, p < 0.0001). Smear microscopy grading of sputum specimens was not substantially different between sexes. The prevalence survey analysis indicated that the use of a more sensitive diagnostic tool could result in the proportion of females diagnosed at township health centres increasing to 36 % from 30 %.ConclusionsOur study, which is the first to systematically compile and analyse routine operational data from tuberculosis diagnostic centres in Myanmar, found that substantially fewer women than men were diagnosed in all study townships. The sex ratio of newly diagnosed cases varied by age group, month of diagnosis and township of diagnosis. Low sensitivity of tuberculosis diagnosis may lead to a potential under-diagnosis of tuberculosis among women.

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Section: Discussionmentioning

confidence: 99%

Are current case-finding methods under-diagnosing tuberculosis among women in Myanmar? An analysis of operational data from Yangon and the nationwide prevalence survey

Khan

Khine

Hutchison³

et al. 2016

BMC Infect Dis

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“…According to the 2011 HIV sentinel serosurveillance, HIV prevalence rates among FSW dropped from 18.4% in 2008 to 9.4% in 2012. 77 It is estimated that there are 40,000 to 80,000 FSW in Myanmar. The number of MSM is estimated at 240,000, mostly in Yangon and Mandalay, with an overall HIV prevalence of 7.8% (Mandalay 9%, Yangon 5%), with more than 81% having used a condom at last sex.…”

Section: Myanmarmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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“…[13] Although our sample was older (median 36 vs 30 years) than the IBBS sample and other surveys [13,38,39] and with lower reported illiteracy (4.6% vs 15.7%). [39] National AIDS Programme guidelines recommend HIV testing every 6 months, but the median time between tests was 1.1 years among our sample with 38.3% of clients not being tested at all and only 26.4% with repeat tests.…”

Section: Discussionmentioning

confidence: 99%

The effect of migration, location in mining or borderland areas on HIV incidence among people who use drugs attending a harm reduction programme in Myanmar, 2014-2021: a retrospective cohort study

Platt,

Wut Yee Kyaw,

Rathod

et al. 2023

Preprint

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BackgroundHigh HIV prevalence has been documented among people who use drugs (PWUD) in Myanmar particularly in mining and borderland areas. We estimated incidence of HIV among PWUD (via injecting and other routes) and examine associations between location in mining or borderland areas, migration and risk of infection.Methods and findingsAnalysis of data among PWUD registered at harm reduction programmes across Sagaing region, Kachin, and Northern Shan States between 2014-2021. Data on sociodemographic, drug use characteristics and clinic-level data on borderland or mining locations were collected at time of registration. Characteristics, repeat HIV testing and HIV seroconversion were analysed using a cohort approach and Poisson regression models examining associations between location in a borderland or mining area, migration and incidence of HIV, adjusting for confounders. Data were available from 85093 clients, 52526 reported HIV tests and 20.0% were seropositive. 38670 clients had no or only one recorded HIV result. The median time between HIV tests was 1.1 years. Among 13,359 clients with 2 or more HIV tests the HIV seroconversion rate was 3.8 per 100 person years (pyrs) (95% CI 3.6-4.0). Incidence among those who injected drugs was 6.9 per 100/pyrs, 8.9 among those aged ≤ 25 years, 2.3 among women, 2.3 among those who had migrated, 5.6 among those located in border areas, and 3.7 among those in mining areas. After adjusting for confounders HIV incidence remained higher for people located in borderland areas (Incidence Rate Ratio 1.67 95% CI 1.13-2.45) and lower among those who had migrated (IRR 0.56, 95% CI (0.39-0.82). There was no evidence of association between location in a mining area and HIV seroconversion.ConclusionsFindings highlight the need to intensify harm reduction interventions with a focus on cross-border interventions. Increasing uptake of HIV testing alongside the scale up of evidenced based interventions to address sexual and injecting risk practices including PrEP, distribution of condoms, needles/syringe distribution and opioid agonist therapies is urgently needed to curb the high rates of HIV transmission among PWUD particularly among young people.Author summaryWhy was this study done?Increased availability of drugs in producer countries or along trafficking routes alongside political instability and reduced enforcement has been linked to elevated drug use and outbreaks of HIV infection.Few studies focus on the extent to which structural factors, that is, political, social, or physical aspects of the environment, are associated with HIV infection in Myanmar though elevated HIV prevalence has been observed in rural and borderland areas.This study contributes to the limited evidence base on HIV incidence in South East Asia and Myanmar specifically.What did the researchers do and find?This study measures HIV incidence among people who use drugs using routine programmatic data and provides estimates of differential HIV risk associated with location in borderland and mining areas and experience of migration.We estimate HIV incidence to be 3.8 per 100 person years among people who use drugs, with higher incidence among those who inject and younger ages (<25 years)We identify people who use drugs registered at services in borderland areas to be at elevated risk of HIV acquisition and migrants at decreased risk.What do the findings mean?Findings point to the imperative for expanding HIV prevention interventions among PWUD, with a focus on cross-border interventions and addressing injecting and sexual risk practices.Findings support the emerging body of evidence highlighting the utility of programmatic data to estimate HIV incidence among key populations.Understanding differential risk in infections among people who use drugs and structural determinants is key to creating enabling environments through which effective HIV treatment and prevention interventions can be delivered.

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HIV prevalence among the female sex workers in major cities in Myanmar and the risk behaviors associated with it

Cited by 9 publications

References 15 publications

Are current case-finding methods under-diagnosing tuberculosis among women in Myanmar? An analysis of operational data from Yangon and the nationwide prevalence survey

Are current case-finding methods under-diagnosing tuberculosis among women in Myanmar? An analysis of operational data from Yangon and the nationwide prevalence survey

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

The effect of migration, location in mining or borderland areas on HIV incidence among people who use drugs attending a harm reduction programme in Myanmar, 2014-2021: a retrospective cohort study

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