Harmonizing to consequences of HIV sentinel sero-surveillance 2011 in Myanmar, HIV prevalence among MARP continues decelerate worsening way since 2009. Among MARP, HIV prevalence in Female Sex Worker ( FSW ) was 4.3 % in 1992, rose to 38 % in 2000, and so declined to 9.4 % in 2011. HIV prevalence was 4.7 % in Lashio, 5 % in Mandalay, 7.5 % in Taungyi, 9 % in Myitkyina, 11 % in Kyaingtong, and highest in Yangon ( 18 % ) . Prevalence of Venereal Disease Research Laboratory trial ( VDRL ) positive was highest among FSW and male who have Sexually Transmitted Infection ( STI ) . Comparing VDRL positive rate between urban and rural populations, it was significantly higher in FSW in urban country comparison to Intravenous Drug Users ( IDU ) , Men who have Sex with Men ( MSM ) , pregnant adult females, Tuberculosis ( TB ) patients, and male who have STI. Prevalence of pox was found significantly higher in FSW who have HIV positive ( MOH, 2012a ) .
1.2 Socio-cultural and economic of Myanmar at a glimpse
Myanmar is made up of 135 national races, multi-society state. Buddhism is major faith, and 89 % of population practiced it. Socio-cultural norms are much more influence on adult females. Inflation is high in Myanmar ; year-on-year per centum alteration is 10.7 in 2005 comparison to other low income states in Asia continent. It fluctuated a batch 32.9 in 2007 and down to 8 in 2009 and 7 in 2010, severally. Out-of- pocket outgo on wellness is high ( 86.9 % in 2006 ) . Poverty head count index is 32 % at national degree ( UNFPA, 2010 ) .
2. Socio-cultural and economic factors that shape HIV/AIDS hazards to female sex worker
Like many Asiatic states, sex work is non encouraged and illegal in Myanmar. Criminalization of sex work and sex workers involuntarily leads to mistreatment of adult females with sex work. Most of the FSWs mentioned that they have chosen this type of business because of limited occupation chances and options. Economic factors make immature adult females to go sex workers. Socio-cultural and economic factors make a individual more likely to prosecute in hazard taking behaviours that finally incline to HIV infection ( UNFPA, 2010 ) .
FSWs are by and large regarded as the people who defy the acceptable societal norms and behaviours. Not merely deficiency of societal position but besides afraid of losing the clients, most of the clip FSW failed to negociate safe sex patterns with clients. Lack of societal or economic position, female sex workers are often the victims of pack colza or opprobrious conditions. FSW used barrier method less with regular or intimate spouses due to the fact that their spouses might see them as sex workers ( Talikowski & A ; Gillieatt, 2005 ) ( UNFPA 2010 ) .
3. Schemes to cut down HIV/AIDS hazards
3.1 Brief account of response by Health attention System to HIV/AIDS
Since 1989, bar and attention activities sing HIV/AIDS are carried out in Myanmar as one of the disease of national concern with high political committedness. Multi-sectoral National AIDS Committee ( NAC ) was formed in 1989. Currently, national response to HIV and AIDS was implemented with purpose of Three Zeros ; Zero New HIV infections, Zero Stigma and Discrimination, and Zero Death. It was guided by Three Ones rule ( One HIV/AIDS Action Framework, One National Coordinating Authority, and One monitoring and rating system ) of National Strategic Plan ( NSP ) on HIV and AIDS ( 2011-2015 ) . NSP was developed with inputs from all stakeholders under the counsel of NAC and was monitored harmonizing to national monitoring and rating program ( MOH, 2012b ) .
3.2 Schemes to cut down HIV/AIDS hazards to Female Sex Workers
( Note: I will concentrate merely on female sex workers among sex workers )
Due to the concentrated nature of epidemic, targeted intercession will chiefly concentrate for FSWs in high precedence townships identified by National AIDS Program ( NAP ) where greatest potency for spread of infection. All schemes and targeted intercessions of the undertaking will transport out in line with Three Ones rule of NSP on HIV and AIDS ( 2011-2015 ) and Three Zeros purpose. Undertaking will execute up to 2015 get downing from 2012.
The primary donees of the undertaking will be FSWs in precedence townships. Board end of the undertaking is to cut down HIV/AIDS hazards to FSWs. Following are the specific objectives – decrease of transmittal of HIV and exposure, peculiarly among people at highest hazard particularly FSWs ; betterment of quality and prolong life of FSW populating with HIV through appropriate intervention, attention and support ; to increase FSW entree to and usage of Voluntary Confidential Counseling and Testing ( VCCT ) services ; and extenuation of socio-cultural and economic impacts of the epidemic particularly on FSWs.
The intent of the undertaking is to increase intercession coverage for FSWs ( consistent usage of rubber by FSWs will be over 95 % in 2015 ) , more figure of FSWs populating with HIV or affected by HIV are able to have support in conformity with assessed demands, protection of human right of adult females if they are to avoid infection and defy the impact of HIV, to early sensing and dainty STI among FSWs, cut down the stigma and favoritism on FSWs in NAP identified precedence countries or townships, and advance cognition and credence of HIV/AIDS among establishments such as schools, infirmaries, etc and communities.
The cardinal undertaking scheme is subsidised the rubber for bar of transmittal of infection, Pre-Package Treatment ( PPT ) kits for intervention of STI, quality diagnostic trial kits for sensing, Targeted Outreach Program ( TOP ) through Interpersonal Communicators ( IPC ) , provide Drop In Centre ( DIC ) , VCCT service Centre and referral tracts with spouses, and supply merchandises to trained wellness suppliers ( physicians, primary attention suppliers ) , International Non-Governmental Organizations ( INGOs ) , local community based organisations ( CBOs ) , and so that they may function the undertaking ‘s primary donees. By providing quality merchandises and services within precedence countries identified by the NAP, is of import to turn to the issue of entree and handiness, one of the most important restraints related to undertaking the load of HIV/AIDS in FSW in Myanmar. In add-on to that, following two activities will transport out at the same time to cut down the HIV/AIDS hazards for FSW ( 1 ) distributing of high quality assured PPT kits for STI with holograph via largest pharmaceutical distributer with subsidized monetary value to deluge the market for pressing replacing monotherapy, with message to seek the diagnosing and intervention of STI from trained wellness suppliers ( 2 ) distributing of male rubbers ( with different spirits and colorss ) and female rubbers through pharmaceutical distributer with subsidized monetary value to available everyplace, with message to protect yourself and do n’t presume cleanliness based on physical visual aspect.
Social selling scheme is appropriate for an intercession to cut down HIV/AIDS hazards for FSWs in identified countries by NAP.
Target population- Female Sex Workers in high precedence townships identified by NAP
Using rubber for personal protection against HIV/AIDS, and seeking wellness attention and taking full class of quality assured PPT kits in instance of STI ( that will be facilitated by distribution of high quality PPT kits with subsidize monetary value to suppliers, INGO, local CBO, and drug stores which are enhanced by promotional activities ) .
Using DIC for improvement of wellness of FSW where bar of HIV/AIDS plans and activities are taking topographic point by equal, testing and intervention for STI, and HIV proving can transport out by trained wellness attention suppliers ( that will be facilitated by referral tracts between INGO, local CBO, and general practicians )
Using VCCT centres to acquire the HIV proving done anonymously and VCCT centres will play a function in cut downing stigma and favoritism to FSW who seek HIV position. It besides sensitizes the general population perceptual experience on HIV/AIDS and plays a function in decreasing stigma and favoritism on HIV/AIDS.
Subsidized monetary value for rubbers ( male and female ) and PPT kits for STI ( subsidized the monetary value is harmonizing to willingness to pay survey before the undertaking )
With added values harmonizing to products/services, you are able to protect yourself from HIV/AIDS ; you can seek quality assured intervention from trained wellness attention suppliers ; you can cognize your HIV position anonymously.
On the other manus, monetary value is regarded as what other costs or barriers are associated with making the behaviour. For illustration – Inconsistent usage of rubber, unconsciousness of breakage of rubber which will happen due to miss of cognition how to have on rubber ( improper usage of rubber ) , unaware of the possible dangers of acquiring HIV/AIDS from clients, self-medicated patterns in handling STI, non seeking attention from trained wellness suppliers due to unavailability ( or ) stigma and favoritism, unaffordable to allow wellness services /medicines
The context of where the communicating may take topographic point may depend upon the products/services which are mentioned above. The topographic points are at hot spots, whorehouse, hotel, and eating house, dark nines, DIC, VCCT centres, markets, tea stables, clinics / infirmaries, drug stores, during Night show of traditional common people media, after top 10 songs plan of wireless channel, local sporting & A ; amusement events ( Local aa‚¬A“chin loneaa‚¬A? lucifers or music related events ) .
Integrated communications scheme will be implemented through bing resources with utilizing IEC ( information, instruction, communicating ) stuffs such as posting, booklets, verifiers by IPC, and distribute to whorehouses, DIC, VCCT centres, suppliers ‘ clinics or drug stores, Using traditional common people media, Using hoarding and wireless channels, Health negotiations will be provided by suppliers ( physicians / trained wellness workers ) to promote bar of STI & A ; HIV/AIDS, prompt diagnosing and intervention of STI, Update intervention guidelines in conformity with National intervention guidelines for STI will give to suppliers.
Social selling scheme can supply non merely services and merchandises, but besides behavior alteration communicating activities to cut down the HIV/AIDS hazards for FSWs. During the intercession, it ‘s necessary to beef up the enabling environment for FSW through protagonism to policy shapers to do certain intercessions are every bit effectual as possible. Advocacy meeting should be held on legal reform workshop & A ; enforcement of policy sing ownership of rubber is non used as liability of sex work.
Concentrated attempts and a high figure of activities in a focussed country are needed in concentrated epidemic. Decrease of HIV/AIDS hazards for FSW can ne’er be able to make by a individual intercession because it is a complex issue. But, this can merely be achieved by a strong many-sided attack concentrating on long term and short term solutions. For carry throughing decrease of HIV/AIDS hazards for FSW, societal selling scheme is the suited manner to acquire things done with vigorous responses and timely mode through assorted channels in short term, and besides give the manner for sustainability comparison with other scheme. Last, societal selling model can integrate into bing substructures, and resources with low cost, and it makes diffusion of thought and coveted products/services into mark groups more expeditiously and efficaciously.