NEW YORK, JULY 9, 2019—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) transferred its patients at an HIV clinic in Insein township, Yangon, to the care of Myanmar’s National AIDS Program (NAP). The closure of the Insein clinic represents a milestone for MSF and illustrates the country’s growing capacity to provide quality care and antiretroviral (ARV) treatment for people living with HIV.
The Insein clinic—which opened in 2014 and closed on June 27 with approximately 2,400 people still in treatment—is one of two clinics that make up MSF’s Yangon HIV project, which has been running since 2003. The clinic provided treatment to more than 12,000 people, and the Yangon project as a whole has provided treatment for more than 17,000 HIV-positive people, many from outside the region. MSF became the first provider of ARV treatment in Myanmar in 2003 with its Yangon and Kachin projects and for some time ran the largest HIV treatment program in the country, where approximately 220,000 people were living with HIV in 2017.
“At the Insein clinic, we built a community where people received high quality treatment in an environment free from stigma or judgement,” said Pavlo Kolovos, MSF’s head of mission in Myanmar. “The clinic exemplified a dignified standard of care, providing an example to follow and a standard for HIV care providers to meet.”
The care provided at MSF’s Insein clinic—and at all of MSF’s HIV treatment clinics in Myanmar—was comprehensive and patient-centered. Counseling was an integral element, particularly in the pre- and post-testing phases. Counselors also helped patients adhere to their treatment, especially vulnerable groups such as adolescents, sex workers, and drug users.
As stigma and discrimination against people living with HIV is widespread in Myanmar, counselors also helped patients cope with social challenges and educated patients, their families, and communities about HIV. Stigma often prevents people with HIV from participating in community activities, and in some cases even deprives people of livelihoods since many employers require health checks and HIV tests as part of their recruitment process.
“When my HIV positive status was confirmed, I was depressed,” said MSF Patient U Myo Win*. “I even thought about committing suicide. But the staff at the clinic showed me that I could stick to my treatment and have a normal, healthy life again. They were supportive and kind, encouraging me to stay strong and fight for life.”
At the Insein clinic, patients with HIV also received treatment for life-threatening, HIV-related opportunistic infections such as tuberculosis (TB), multidrug-resistant TB, hepatitis C, pneumonia, and meningitis, all within the same clinic. This unique model for integrated care eased the burden on patients and made it easier for them to adhere to their treatment, in turn helping prevent the spread of HIV and other illnesses. MSF continues to advocate for these innovative approaches to care to be taken up by other HIV providers.
As NAP aims to provide 75 percent of all ARV treatment in Myanmar by 2020, MSF will work with the NAP as it continues to scale up HIV care to standardize improved models of care and push for greater decentralization of services so people can access treatment closer to their homes.
The closure of the Insein clinic marks the conclusion of one of MSF’s most significant projects since it began working in Myanmar in 1992. MSF continues to provide comprehensive HIV care in Yangon, Kachin, Shan, and Tanintharyi.
*Name changed to protect patient’s privacy.