Community Voices: "As long as I'm breathing, I will help more people like me."

Daw Theint Su, a peer educator at Population Services International’s (PSI) TOP Centers (formerly the Targeted Outreach Program), has been living with HIV since 2003. She shares her experiences and talks about her work supporting HIV education and prevention.

Daw Theint Su* stayed at a public hospital in Yangon about a year ago for surgery. During her stay, when a group of her friends were visiting her, Daw Theint Su requested a nurse to change the empty intravenous therapy bag. When the nurse began to do so without gloves, Daw Theint Su discreetly told her to wear gloves for her safety. Daw Theint Su’s friends, also present in the room, were unaware of her HIV-positive status. When the nurse

dismissed her concerns and proceeded to continue, another nurse arrived and began to scold the nurse loudly, openly discussing Daw Theint Su’s HIV-positive status in front of everyone. That moment, her friends found out that she was living with HIV.

“I felt sad,” says Daw Theint Su, tears in her eyes. “I was publicly shamed.”

For many in Myanmar, including Daw Theint Su, stigma and discrimination toward people living with HIV (PLHIV) act as barriers to accessing healthcare services. “For people like me, places like TOP are safe havens where we are treated equally.”

Since 2004, TOP has been meeting the health needs of communities that bear a disproportionate burden of HIV/AIDS yet face several barriers to accessing HIV services. Starting in late 2017, the UHF Project began providing support to PSI’s TOP service centers in Yangon and Mandalay to increase HIV testing and ART access for female sex workers (FSW), men who have sex with men (MSM), and transgender women (TGW).

At service centers, peer educators are vital in increasing access to prevention, testing, and treatment services for key populations. Daw Theint Su, for instance, regularly recruits her friends within the FSW community for HIV testing and treatment and conducts targeted outreach at places such as massage parlors and brothels. “As long as I am breathing, I will help more people like me. There will be another generation of sex workers, and we have to prevent transmission of HIV. I want them to have a happy and healthy family life.” Keep reading below for excerpts from our conversation.

What are you most proud of as a peer educator, and why?

Daw Theint Su: I am proud of the fact that I am giving HIV prevention information to my friends to help them change their risk behaviors for HIV and STIs. For example, if there are women who do not want to use condoms, I talk to them. We, as peers, work on prevention [of HIV]. The treatment is the medical professional’s job.

Some of my friends don’t know much about HIV, and I tell them about it. Some are already sex workers, and they know about it. Some are new sex workers [who are young]. There are plenty of them, and they don’t know about [HIV] prevention. They could have been sold, they could be from a family of low socioeconomic status, or they might begin work at Karaoke Television (KTV) bars or massage parlors without knowing that they might eventually become sex workers. They are vulnerable because they are inexperienced and know nothing [about HIV and STI].

What problems do you think only a peer educator could solve, unlike a non-peer staff member?

Daw Theint Su: If a girl who is on antiretroviral therapy (ART) were arrested, we would work to ensure ART adherence. Since she has to take ART daily without interruptions, she might call me for help from custody. Then, I would visit the police station, learn about the penal code she was arrested with, and ensure that our supervisors [from TOP] know about this and that she receives medications regularly. [1]

Please tell us more about your responsibilities.

Daw Theint Su: Every morning, I come to the office and take condom packets for both men and women. Then, I go to brothels, massage parlors, and KTV bars in our assigned townships. We give them information about free HIV and TB tests. They do not need to be afraid. If the test results are not HIV positive, then it is good. We tell them about our free ART and TB medications if they are. We also give information on contraception pills and other health services.

We explain the advantages of tests [for HIV, STIs, and TB] and give information about client confidentiality. Only the clients and the nurses will know about tests and results. I always tell them that TOP is very reliable. In addition, we explain how TOP can screen and treat sexually transmitted infections (STIs). I also persuade them to visit the center. If they want HIV tests, TOP can provide them. If not, we do not force them to take a test. The result of the test is confidential. I usually tell my friends all of the above, and they understand me and visit the center.

Would you like to add anything else?

Daw Theint Su: For legal protection, I want to request our supporters to hold workshops by legal experts for sex workers so that they know some rights. One year in prison is too much for us. When someone is arrested, they probably have family members they support, like an elderly father, mother, or children. Some have little brothers or sisters who are in college. If they go to prison for even a year, their siblings’ education will undoubtedly be disrupted. Part of the reason why we are so quickly arrested is that we do not understand the laws and procedures. If sex workers can learn from legal experts, they would at least know their rights. Then, they would not be arrested as often.

[1] TOP does not provide ART medication in prisons but provides referrals to medical teams in prison. Through medical teams, TOP ensures that patients continue ART when arrested or detained.

*Name changed to protect privacy.

This interview has been translated and edited. The views and opinions expressed in it are those of the interviewee and do not necessarily reflect those of PEPFAR, USAID, UNAIDS, Community Partners International, Population Services International, or TOP Center Myanmar. ​
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USAID funds the USAID HIV/AIDS Flagship (UHF) Project under PEPFAR through UNAIDS Myanmar. Community Partners International provides project implementation support and management to partner organizations, including Population Services International.