Project BURMESE: Buddhist Understanding and Reduction of Myanmarese Experiences of HIV Stigma and Exclusion

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Project Summary/Abstract Myanmar is facing a looming HIV crisis and is listed as a “country of concern” by UNAIDS. After the first case of HIV was diagnosed in Myanmar in 1988, and the HIV epidemic rapidly escalated over the next decade, in particular among marginalized populations, such as substance users and sex workers. This resulted in Myanmar having the third largest population of PLWH in Southeast Asia, after only Indonesia and Thailand. Currently, the mortality rates among PLWH remain high, and are 16 times higher than that of the US and 20% higher than the international average. An important reason for this high mortality is that treatment coverage is still low, with only 56% of PLWH currently receiving medications. As a consequence, HIV remains in the top 10 causes of death in Myanmar. Adding to the challenges, major international aid organizations are scheduled to withdraw from Myanmar by 2020. Hence, there is an urgent need to collect evidence to develop optimal HIV care in a local healthcare setting and to scale up treatment coverage in response to this pending transition. Yet, the existing evidence regarding HIV care in Myanmar remains extremely limited, and there are few studies to assist Myanmar PLWH to manage barriers to care, such as HIV stigma. HIV-related stigma is negatively impact multiple domains of PLWH's health and lives. For example, HIV stigma may deter PLWH from utilizing health services necessary for their health and survival. Yet, there is still no published study exploring how Myanmar PLWH experience and manage HIV stigma beyond the UNAIDS report of social exclusion experienced by PLWH in Myanmar. In addition, as Myanmar is a typical Buddhist country where more than 85% of the population identify as Buddhists, it is necessary to take into consideration Buddhist understanding and interpretations of illness and suffering in general, and HIV specifically. Therefore, in this project, we propose to explore the Buddhist conceptualizations of HIV stigma in Myanmar by interviewing 30 HIV+ individuals and then culturally adapting an evidence-based intervention to reduce HIV stigma among Myanmar PWLH. These two specific aims are 1. We will conduct in-depth interviews with 30 people with HIV in Myanmar to explore and identify Buddhist conceptualizations of HIV stigma. 2. Based on the results from Aim 1, we will adapt Bogart and colleagues' stigma-reduction intervention to tailor it to the needs of Myanmar PLWH, applying a modified ADAPT-ITT approach with six focus groups that involves separate groups for substance users, sex workers, MSM, transgender individuals, and heterosexual men and women.