Community Voices: "In my heart, I started to see [drug users] as my own children."

As part of the USAID HIV/AIDS Flagship (UHF) project managed by UNAIDS through Community Partners International (CPI), project partner Metta Development Foundation (Metta) helps establish and support Local AIDS Committees (LACs) for HIV/AIDS prevention in communities in Kachin State and Shan State, Myanmar. We recently sat down with Daw Saw Yu Htwe, a LAC member at Metta’s project site in Nant Mon, Kachin State, to discuss how her perception of people who inject drugs (PWID) has changed through her involvement with the committee and the importance of increasing access to harm reduction services within her community.

In cities in Kachin State, HIV prevalence among people who inject drugs (PWID) is nearly 50%[1]. To reduce transmission of HIV and other viruses through shared needles and syringes, Metta is working to increase access to harm reduction services such as the Needle and Syringe Exchange Program (NSEP) at drop-in center locations. Harm reduction services aim to “prevent or reduce negative health consequences associated with certain behaviors”[2] and are part of a broader UHF Project strategy to address the high HIV prevalence rate among PWID in Kachin State.

LACs increase local ownership of harm reduction services and awareness about HIV/AIDS. From advocating for the construction of methadone maintenance treatment (MMT) clinics to conducting health education sessions at public schools, Metta’s LAC members play a crucial role in increasing access to harm reduction services and decreasing stigma and discrimination against PWID and people living with HIV.

How have you been personally affected by either HIV/AIDS or drug use?

Daw Saw Yu Htwe: I have three children. Among my children, my eldest son didn’t pass the matriculation examination for college. He was about to start using drugs, but I was able to stop him. Since the environment was not good and drugs were easily accessible, I realized that our children could only be good when our environment was good. We need to create a better community and a better environment. I cannot do this alone; I must work with the community around me.

In your opinion, why is it important to implement harm reduction services in your community?

Daw Saw Yu Htwe: It’s related to health issues. HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) can be transmitted from shared needles.

You cannot ask a regular user to stop using drugs immediately. They will try to use drugs either way. To help them, since they are a part of the community, you have to help the community as well. You have to help drug users interact with the community. You have to help them repair and maintain their relationship with the community, which is why we provide clean syringes in exchange for used syringes[3] so that children do not accidentally step on them and drug users do not reuse them.

Please tell us briefly about your LAC.

Daw Saw Yu Htwe: The committee members are all from this community. We founded the committee with support from Metta. Since Metta’s project here may end one day[4], I think this committee should also be based on the knowledge and perseverance of local people to make it sustainable. The committee consists mostly of chairpersons of social service organizations, retired teachers, hospital administrators, and local volunteers. Just like the name of the organization[5], the committee does everything out of “loving kindness.”

Please describe some activities your LAC has implemented.

Daw Saw Yu Htwe: The committee was founded in 2016, and there was less activity then. In 2017, we helped give seminars at public high schools about the harmful effects of narcotic drugs. The staff members from Metta made presentations, and we connected them with schools. We also connected Metta with the public, social enterprises, and even government officials.

We plan activities with [Metta Center Coordinator] Doi Tsin from Indawgyi Metta. Indawgyi has eleven local villages. We help drug users have access to methadone[6] [as part of Opioid Substitution Treatment]; we hold education sessions about how to use syringes without transmitting HIV, HCV, and HBV; and we provide new syringes.

What are some challenges to implementing project activities?

Daw Saw Yu Htwe: Some students in high school start using drugs when they are in eighth, ninth, or tenth grade. When we know this, we need to take care of and protect them. We often run into difficulties with their parents. Although parents may learn about their children’s drug use, they do not want to accept it when other people tell them. We have to help parents accept that fact. It’s probably the most sensitive time because you can either make mistakes while trying to help them or do something good.

Speaking for yourself, how has your perception of PWID changed as a result of joining this LAC?

Daw Saw Yu Htwe: In my heart, I started to see them as my own children. Before, despite my well-intentioned desire for them not to become dependent on drugs, I found it challenging to trust drug users or have faith in them. But after working with Metta, interacting with drug users, and attending Metta’s classes, I re-evaluated my attitudes and approaches. I started thinking of how we can help and support them. I started thinking of them as my own children, putting “loving kindness” first in my thoughts and actions.

[1] According to the Myanmar Integrated Biological and Behavioral Survey (IIBS) PWID, 2014, HIV prevalence among male PWID respondents in Bamaw and Waingmaw were 45% and 47%, respectively.

[2] “Harm reduction among injecting drug users.” World Health Organization. Accessed July 31, 2018. http://www.wpro.who.int/topics/harm_reduction_injection/en/.

[3] Through the NSEP program, PWID clients can receive sterile needles and syringes (for HIV prevention) in exchange for used needles and syringes. ​

[4] Metta believes in the potential of all people and communities and conserves and builds on existing resources. To make the project sustainable, Metta establishes LACs at all project sites. After forming LACs and mobilizing communities, Metta provides technical support to the LAC and conducts various trainings on HIV/AIDS and harm reduction. The purpose of these trainings is to build the capacity of the LAC so that members can eventually run and drive the project forward independently. Once a project is stable, Metta gradually phases out of the project location, leaving the community to take charge. This process takes several years and varies between project locations.

[5] Metta is founded on “metta” or “loving kindness.” Metta works with the most disadvantaged communities regardless of ethnicity, religion, or gender and strives to respect people’s diversity—their different cultures, values, customs, and traditions.

[6] Methadone is used for opioid substitution treatment (OST). It is prescribed and administered at Methadone Maintenance Treatment (MMT) clinics in Kachin State. The LAC in this project location successfully advocated the construction of an MMT clinic. The clinic is expected to open soon. Metta will provide support with two nurses. Currently, the LAC supports the cost of travel for PWID clients to receive methadone at an MMT center in another village.

This interview has been translated and edited. The views and opinions expressed within this interview are those of the interviewee and do not necessarily reflect those of PEPFAR, USAID, UNAIDS, Community Partners International, or Metta Development Foundation.

USAID funds the UHF Project under PEPFAR through UNAIDS Myanmar. Community Partners International is providing project implementation support and management to partner organizations. The UHF Project supports Metta Development Foundation’s Kachin and Shan States drop-in centers.