Identities and HIV-Related Risk Behaviors Among Transgender Women in Myanmar: Perspectives from Transgender Women and Service Providers.

In Myanmar, transgender women (TGW) have historically been grouped into the men who have sex with men (MSM) population in program and surveillance data. There is no direct translation for the term transgender in Myanmar language, and there are no data on HIV prevalence or HIV-related risk behaviors among TGW. Therefore, this study aimed to explore how TGW identify and express themselves in Myanmar and their HIV-related risk behaviors. This qualitative study consisted of 11 key informant interviews with service providers and 20 in-depth interviews with TGW participants in Yangon in 2017. All participants said that TGW in Myanmar were assigned male at birth, but none identified as men; they all self-identified as women or another gender, such as trans. Such identity emerged from an internal sense of being a woman or an alternative gender. In addition, many participants reported that TGW changed their appearance through changes in clothing or mannerisms. TGW are particularly vulnerable to violence: Often reported during transition, transgender women were exposed to transphobia, violence and discrimination from their family, relatives or workplace. Many participants reported TGW being the receptive partner during sex and engaged in high-risk sexual behaviors, such as sex with multiple partners, group sex, and condomless sex. Our findings can help to define this population in the Myanmar context and assess needs for health services.

Role of small private drug shops in malaria and tuberculosis programs in Myanmar: a cross-sectional study.

BACKGROUND: The role of community drug shops in providing primary care has been recognized as important in Myanmar as in other countries. The contribution by private community drug shops to National Tuberculosis case notifications and National Malaria testing and positive cases is significant. Population Services International Myanmar (PSI/Myanmar) has been successfully training and engaging community drug shops to screen presumptive Tuberculosis to make referrals to public health clinics and perform malaria rapid diagnostic tests (mRDT) to malaria fever cases and provide management accordingly. OBJECTIVES: The study aims to identify barriers to service provision of the trained providers at the drug shops that are currently engaged in PSI/Myanmar Tuberculosis and malaria programs. Exploring their needs enabled us to identify and address barriers, to provide evidence for better linkage with the primary care system. METHOD: A mixed method study was conducted with the service providers at the drug shops. A quantitative follow up survey was done with 177 trained Tuberculosis service providers and 65 trained malaria service providers. A total of 32 qualitative in-depth interviews were completed. Seventeen Tuberculosis trained providers and 15 malaria trained providers participated in individual interviews. Content analysis approach was used to generate themes for the data analysis. RESULTS: From the survey, the majority of drug shops reported that they performed appropriate first steps, particularly referring symptomatic Tuberculosis cases and offering mRDT testing to fever cases. Nevertheless, in-depth interviews with them revealed they did not adhere to the national guidelines for every client. There was a need to emphasize the importance of following the national guidelines for referring patients with prolonged cough and fever cases management. For those who were trained in Tuberculosis case referral, support from program staff was needed to make smooth referrals. Those who were trained in malaria often considered differential diagnosis of fever other than malaria and did not test with malaria rapid diagnostic test due to declining numbers of malaria cases. CONCLUSION: The study findings highlighted that the drug shops trained in Tuberculosis referral seemed to have the potential to fully engage into the primary care health system if provided with suitable support and supervision. On the other hand, those trained in malaria case management might be less motivated to engage in the era of declining malaria endemicity.

Barriers to exclusive breastfeeding in the Ayeyarwaddy Region in Myanmar: Qualitative findings from mothers, grandmothers, and husbands.

BACKGROUND: Myanmar has low rates of exclusive breastfeeding despite many decades of efforts to increase this practice. The purpose of this study is to examine the barriers to exclusive breastfeeding and how different household members participate in decision-making. METHODS: We conducted semi-structured interviews with mothers with an infant 6-12 months (24), and a subset of their husbands (10) and their mothers/mothers-in-laws (grandmothers) (10) in rural and urban areas of Laputta, Myanmar. RESULTS: Respondents had high levels of knowledge about exclusive breastfeeding, but low adherence. One of the primary barriers to exclusive breastfeeding was that mothers, husbands, and grandmothers believed that exclusive breastfeeding was not sufficient for babies and solid foods and water were necessary. Water and mashed up rice were commonly introduced before 6 months of age. Mothers also faced barriers to exclusive breastfeeding due to the need to return to work outside the home and health related problems. Other family members provide support for mothers in their breastfeeding, however, most respondents stated that decisions about breastfeeding and child feeding were made by the mother herself. CONCLUSIONS: Mothers in this part of Myanmar know about exclusive breastfeeding, but need more knowledge about its importance and benefits to encourage them to practice it. More information for other family members could improve adherence to exclusive breastfeeding, as family members often provide food to children and support to breastfeeding mothers. Support for mothers to be able to continue breastfeeding once they return to work and in the face of health problems is also important. Finally, additional information about the types of foods that infants need once they cease breastfeeding could improve infant and child health.