HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

Abstract

Introduction In Myanmar, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV, despite national HIV program scale‐up. However, limited HIV surveillance capacity prevents monitoring of epidemic trends and program impact. This study aimed to estimate HIV prevalence and incidence and explore associated sexual risk behaviours among MSM and TW clients attending HIV testing clinics in Myanmar. Methods An electronic data management system was implemented in two community‐based, MSM and TW ‐tailored HIV testing clinics in Myanmar in August 2016. Unique client identifiers enabled prospective monitoring of service engagement, testing frequency and outcomes. We estimated HIV incidence and rate of HIV diagnosis at baseline testing visit among clients over a 15 month period. Correlates of HIV diagnoses were identified using multivariable logistic regression. Results 2794 MSM and TW were tested for HIV. At their baseline test, 38% of clients reported any previous testing and 93% reported being sexually active over the previous three months, with 74% reporting sex with casual male partners and 28% reporting consistent condom use with casual partners. 291 clients tested positive for HIV for the first time at baseline (10.4%; 95% CI: 9.3 to 11.6). Twelve incident cases were detected among 279 clients receiving ≥2 tests (incidence = 10.1 per 100 person‐years; 95% CI: 5.73 to 17.8). HIV diagnosis at baseline was significantly associated with being a transgender woman or a non‐openly disclosing man who has sex with men, age 26 to 39 years, and reporting no testing history. Conclusions High HIV incidence and new diagnoses being associated with reporting no testing history points to undiagnosed HIV driving transmissions in Myanmar. Repeat testing was uncommon. HIV programs in Myanmar must focus on promoting frequent HIV testing alongside adequate coverage of education and primary prevention interventions among MSM and TW.

The impact of gender and the social determinants of health on the clinical course of people living with HIV in Myanmar: an observational study

“…Young women in Myanmar may be more likely to access the health system–and routinely screened for HIV–during antenatal and obstetric care. Meanwhile men who have sex with men (MSM) may be less inclined to seek healthcare due to concerns about discrimination and stigmatization in a country where same-sex intercourse remains illegal [ 17 ]. In a country where between 4 and 32% of MSM have disclosed to their family that they have sex with men, it is estimated that only 44% of MSM are receiving ART [ 18 ].…”

“…Greater access to self-testing [ 20 ], the creation of specific clinics that recognise the differences in the way that men access healthcare [ 21 ], and even financial incentives [ 22 , 23 ] have been used successfully in other parts of world to improve engagement with care. However, the feasibility and sustainability of these interventions in Myanmar needs to be established and would be the basis for future research [ 8 , 17 ].…”

The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming

“…[30][31][32][33][34][35][36][37] In Yangon, 15.5% of MSM tested positive in a 2016 study. 38 Older investigations were found from Metro Manila, where the HIV prevalence among MSM was 11.5% during 2009-10 39 and from Ho Chi Minh City, where it was 14.8%, also during 2009-10 40 (Table 1).…”

“…In these studies (Table 3), HIV prevalence ranged from 7.3% between 2012 and 2013 to 12.2% between 2011 and 2016. [30][31][32] HIV prevalence among TGW in a study from Kuala Lumpur in 2014 was 12.4%, 45 in Ho Chi Minh City in 2015, it was 17.7% 46 and in Yangon in 2016, 19.2% 38 (Table 3). Estimated HIV incidence HIV incidence data among TGW are scarce.…”

“…30,32,35,37,41 In Myanmar, a recent study among MSM at HIV testing centres in two cities found HIV incidence among repeating HIV testers was high, at 10.1 per 100 PY. 38…”