IOM Mission in Myanmar No. 318 (A) •Ahlone Road •Dagon Township• Yangon • Myanmar Tel: +95 1 210 588; Fax: + 95 1 210 588 (ext: 5010) E-mail: [email protected] • Website: http://www.iom.int The opinions expressed in the report are those of the authors and do not necessarily reflect the views of the International Organization for Migration (IOM). The designations employed and the presentation of material throughout the report do not imply the expression of any opinion whatsoever on the part of IOM concerning the legal status of any country, territory, city or area, or of its authorities, or concerning its frontiers or boundaries. IOM is committed to the principle that humane and orderly migration benefits migrants and society. As an intergovernmental organization, IOM acts with its partners in the international community to: assist in meeting the operational challenges of migration; advance understanding of migration issues; encourage social and economic development through migration; and uphold the human dignity and well-being of migrants. The publication has not undergone professional editing by IOM. Authors: Montira Inkochasan Kyaw Myint Tun Patrick Duigan Paula Bianca Blomquist Jaime Calderon Min Yu Aung Publisher: International Organization for Migration No. 318 (A) Ahlone Road, Dagon Township Yangon Myanmar Tel: +95 1 210 588 Fax: + 95 1 210 588 (ext: 5010) E-mail: [email protected] Website: www.iom.int © 2015 International Organization for Migration (IOM) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of the publisher. 87_15 Contents List of tables ................................................................................................. v List of figures ............................................................................................... vi List of maps ................................................................................................ vii Abbreviations .............................................................................................. ix Operational definitions ................................................................................ ix 1. Background ..............................................................................................1 1.1 Overview ................................................................................................................ 1 1.2 HIV in Myanmar ...................................................................................................... 1 HIV Vulnerability 1.3 Mobility, migration and infrastructure development .............................................. 1 and Service Availability 1.4 Rationale and objectives ......................................................................................... 2 in Mobility Settings 2. Methodology ............................................................................................5 of Myawaddy and 2.1 Method overview .................................................................................................... 5 Kawkareik 2.2 Location ................................................................................................................. 6 2.3 Target groups and eligibility criteria ........................................................................ 6 2.4 Data collection methodology .................................................................................. 7 2.4.1 Mapping ............................................................................................................. 7 2.4.2 Qualitative methods ............................................................................................ 7 iii 2.4.3 Rapid assessment ................................................................................................ 7 2.4.4 Quantitative survey ............................................................................................. 8 2.5 Analysis ................................................................................................................... 9 2.6 Tool development and data quality ....................................................................... 10 2.7 Ethical considerations ........................................................................................... 10 3. Results .................................................................................................... 11 3.1 Migration and mobility in Myawaddy and Kawkareik ............................................ 11 3.1.1 Reasons for migration ....................................................................................... 12 3.1.2 Qualitative results: Migration patterns in Myawaddy and Kawkareik .............. 13 3.1.3 Migration and trafficking ................................................................................... 17 3.1.4 Rapid assessment: Migration and mobility patterns ......................................... 20 3.1.5 Quantitative survey: Migration patterns ........................................................... 20 3.2 History of illness and health care-seeking behaviour ............................................. 23 3.3 STI and HIV/AIDS knowledge and awareness ......................................................... 26 3.3.1 HIV awareness and risk assessment among risk groups.................................... 28 3.4 Attitudes towards HIV/AIDS .................................................................................. 30 3.4.1 Affiliations and perceptions of people living with HIV/AIDS among risk groups .................................................................... 31 3.4.2 Perception of groups at risk of HIV transmission .............................................. 33 3.5 Health services and accessibility ........................................................................... 33 3.5.1 Health services for migrants and MARP ............................................................ 38 3.5.2 Health services - referral ................................................................................... 40 3.6 Quality of health-care services and difficulties accessing health-care services ...... 41 3.6.1 Quality of HIV and health services in the areas ................................................. 42 3.7 HIV services and HIV testing history ...................................................................... 45 3.7.1 HIV testing history among migrants .................................................................. 49 3.8 Barriers to accessing HIV services .......................................................................... 49 3.9 Challenges in providing HIV services ..................................................................... 52 3.10 Sexual behaviour ................................................................................................. 54 3.10.1 Sexual behaviours and living conditions of risk groups ................................... 55 3.11 Condom use ........................................................................................................ 63 3.11.1 Condom use among risk groups ...................................................................... 63 3.11.2 Female condom ............................................................................................... 66 3.12 Condom availability and accessibility .................................................................. 67 3.12.1 Condom availability among risk groups........................................................... 69 3.12.2 Condom accessibility among risk groups ........................................................ 70 3.13 Drug and alcohol consumption ............................................................................ 71 3.14 Media and health communications ..................................................................... 74 3.14.1 Sources for HIV prevention advocacy .............................................................. 74 4. Discussion...............................................................................................77 4.1 Study findings ....................................................................................................... 77 4.1.1 Migration and mobility in Myawaddy and Kawkareik ....................................... 77 4.1.2 HIV knowledge and attitudes ............................................................................ 78 4.1.3 HIV risk behaviours ............................................................................................ 78 4.1.4 Condom availability and accessibility ................................................................ 79 Contents 4.1.5 Health care availability and health referral ....................................................... 80 4.1.6 Quality of health-care services and barriers in accessing health services ....... 80 4.1.7 HIV and health communications ....................................................................... 81 4.1.8 Representativeness and validity ........................................................................ 81 iv 5. Key findings and gap analysis ..................................................................83 6. Recommendations .................................................................................. 87 Bibliography ............................................................................................... 91 Appendices.................................................................................................95