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Providing care without stigma

Providing care without stigma

Myanmar is the world’s second largest producer of opium. Production is mainly concentrated in Kachin State, a region in the north with a large Christian community and home to numerous people who use drugs. Rejected by the local population and threatened by the police and Pat Jasan evangelical militias, people who use drugs are particularly vulnerable to HIV and Hepatitis C.

We have to hide from the police and local militias because, if they catch us, they’ll beat us and lock us up in some awful place.

Whereas their stories may not be the same, the paths their lives have taken are similar. Neen Lo, Mingwenn and Lolai all started using drugs when they were young, either encouraged by friends or under the pressure of bosses wanting to make them more efficient. They are now receiving a methadone substitution treatment and HIV treatment at one of the three Doctors of the World – Médecins du Monde (MdM) clinics in Kachin.

 

 

These three people are already being treated, but the challenge now facing MdM’s teams is to reach out to the largest possible number of people who use drugs, as they continue to suffer considerable stigma. “Our communities see us as weak people, with no willpower," says Neen Lo. People who use drugs often live secret lives and are afraid of exposing themselves by going to MdM clinics. “We have to hide from the police and local militias because, if they catch us, they’ll beat us and lock us up in some awful place,” adds Mingwenn. “We live in fear,” concludes Lolai.

 

Reaching out to people at risk

In January 2018, MdM launched an innovative system of mobile clinics to reach out to people at risk. The sun was already high in the sky when a clinic bus parked in Samo, a village chosen along with seven others after a comprehensive assessment of the area. With 4,000 inhabitants, most of them farmers, the village hosts many people who inject drugs and is almost an hour from the nearest MdM clinic.

The team quickly set up a tent and chairs in front of the minibus. MdM peer support workers had previously communicated and raised awareness among the population. Former members of the drug user community themselves, these support worker colleagues play a vital role in initiating contact, building trust and encouraging people to start the treatment programme. Around thirty villagers soon assembled and listened to some basic advice on good practices. They were then offered an HIV test. Syringes, condoms and a booklet providing information on high-risk practices and advice on how to stay safe were also handed out.

 

 

Fifteen or so people decided to have an HIV test. Among those present that morning were three young men in blue T-shirts. Belonging to a group of people who use drugs very much involved in the programme, they passed on information to the villagers. “These groups are now key to expanding our programme and reaching as many people among the target population as we can,” says Gitam, the technical head of the mission who brings expertise acquired during a similar project in Tanzania.

 

Mobilising the community

MdM calls on drug user communities to reach out to as many people as possible. This strategy is the outcome of a major project undertaken to improve how the organisation addresses and understands the needs of users in order to mobilise them. Today, most users know each other thanks to the setting up of formal groups in recent years, which has been a major success given the extreme discrimination experienced by their members.

 

MdM teams used mapping to identify and define the profiles of 12 or so groups, representing a total of around 500 people who use drugs. The teams’ missions vary substantially, but all focus on harm reduction and advocating for the rights of people who use drugs. They range from counselling on safe drug use, distributing syringes and condoms, treating people who overdose and collecting used syringes in places where drugs are used through to financial support for hospital treatments or funerals, and advocacy.

 

 

MdM teams have also instituted forums for discussion. These include Local Safety Committees that bring together the various stakeholders—authorities, police, associations, user groups and religious leaders— around a table to explore potential solutions, address the underlying issues and campaign for access to medical treatment and rights for all. This comprehensive approach aims to enable Neen Lo, Mingwenn, Lolai and many other people in similar situations to take action to improve their health, without fear of judgment or repression.

Jean-Baptiste Matray
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