All of us at Asia Catalyst are thinking of you, our beloved friends, partners, allies, and colleagues. We hope this message finds you well. Staying connected and supported during this time is essential, and you should feel free to reach out for support if you need it. We are all in this boat together, and it’s a critical moment for us to, as a US AIDS activist recently wrote, “grab the wheel, and with a groaning, wide, ungainly sweep of the rudder, turn this country around as if our lives depended on it—because they do.”
Since the start, Asia Catalyst has been about protecting the most vulnerable and making healthcare a basic human right guaranteed to all. Since COVID-19 has spread worldwide, I’ve been joining with staff, partners, and allies to organize a strategy and response to keep our communities safe.
We are focused on:
* Fighting price-gouging by pharmaceutical companies by making sure COVID-19 drugs, diagnostics, and vaccines will be free, accessible, and available to all.
* Consulting the grassroots groups we work with – including those led by women living with HIV and women fighting gender-based violence – to meet the economic and social burdens that will fall hardest on them.
* Doubling down on advocacy to ensure people with HIV and people who use drugs get safer and more flexible access to opioid substitution therapy, naloxone, and safer injecting equipment while they cannot go in to doctor’s offices or harm reduction drop-in centers.
* Making sure the latest COVID-19 information, testing, services, and support are available to LGBT people, sex workers, drug users, and all those most often left out of public health initiatives.
As global activists, we will use this opportunity to bond, break out tried-and-true strategies, and come up with new ones to confront, and hopefully defeat the worst drivers and consequences of this pandemic. It’s what we do, and we are here to do it alongside you.
Below are a few resources we’ve found useful. Do not hesitate to get in touch if you have thoughts, concerns, or ideas to share as we do all we can to protect health and human rights.
In October, Asia Catalyst supported the #StrongerTogether Summit, a groundbreaking meeting of LGBTIQ leaders from across Vietnam, organized by Lighthouse Social Enterprise. We went to Hanoi to join the activists, and interviewed three dynamic people at the forefront of this movement to share their thoughts on the challenges and opportunities ahead.
Doan Thanh Tùng is an LGBTIQ and HIV activist, and the Executive Director of Lighthouse Social Enterprise, one of the first and largest LGBTIQ community-led organizations in Vietnam.
Q: Tùng, now that the first
community-led national summit on LGBTIQ has wrapped, what’s next? What
did it mean to you, putting on this ground-breaking summit?
A: This was the first national
LGBTIQ summit in Vietnam, and also the first time we had the
opportunity to bring diverse communities together – with over 70 LGBTIQ
activists and representatives from all over the country. The Summit
covered milestones in Vietnam’s LGBTIQ movements, sustainability models,
community challenges, and opportunities for collaboration.
We are particularly delighted with the Summit Statement, a powerful call
to recognize the rights of all LGBTQ people and work together to build
an equitable, sustainable and healthy future for everyone. An inclusive
and diverse technical working group formed to disseminate the statement
and address the issues faced by LGBTIQ community.
Our
belief: together, we glow brighter, we grow stronger. Hand in hand,
side by side, we can embrace an inclusive society with equity and health
for all.
Tùng is a recipient of a 2019 APCOM HERO Young Achiever award. To learn more, contact Tùng at thanhtung.lighthouse@gmail.com
Mia Nguyen is a counselor, professor, activist, speaker, and writer in Ho Chi Minh City. Mia works on transgender and LGBTIQ advocacy with the United Nations, governments, and community organizations.
Q: Mia, what is your role in supporting LGBTIQ mental health, and what are some of the most pressing issues facing the community?
A: My role is providing training to clinicians, professors, healthcare providers and teachers on LGBTIQ issues, gender equality and equity, human sexuality and sexual health across Vietnam. I build pressure against “conversion therapy,” which some social workers or therapists are still practicing. I also help my students and colleagues to incorporate “inclusive practices and gay affirmative approaches” in therapy and social work. This is an important starting point to understand what LGBTIQ clients need.
In Vietnam, the law is based on binary genders so LGBTIQ students so have no protection at school, work, and in the community in general. LGBTIQ youth are generally not accepted, so they often rely solely dating apps to explore their sexual orientation and gender identity in hope of finding a partner. They easily become victims of sexual abuse. Sex education and health is not taught at school.
Today, the young generation wants to come out and express their sexual orientation and gender identity as soon as possible. Still, some issues have not progressed much. Transgender people are still not protected by laws or supported by healthcare providers. Same-sex marriage is not permitted. Last but not least, suicide and mental health issues are common in the community and there is not enough attention to help people in the healthcare system.
Mia is part of Vietnam’s Network of People Living with HIV and was nominated twice for “Most Inspiring Person of the Year” by Vietnam’s ICS Center. To learn more, contact Mia atmia@ladiesofvietnam.net
Ha Thanh is a transgender activist and researcher who is passionate about raising the voices and visibility of Vietnam’s transgender community.
Q: Ha, Last year, you founded “It’s T Time VN.” Tell us about how you became a leading trans advocate. What are your dreams for this year?
“It’s T Time” was founded late last year, and with other trans-led organizations in Vietnam, we have been strong advocates for passing a Gender Affirming Law. You can read about the legal struggle here. We have worked closely with the community so they could participate effectively in discussions with the Ministry of Health.
This year, we conducted research on the experience of trans people living with gender dysphoria, with funding from USAID and presented our findings in Seoul at ILGA Asia. For the Transgender Day of Remembrance, we organized the largest Pride event ever for the trans community in Vietnam. The event sent a powerful message on tolerance, equality and diversity. We also alleviate some of the hardships trans people face during transitions so they can live the life they deserve.
My hope for next year is that “It’s T Time” keeps moving forward, stronger, to assist fellow trans men and women claiming their safe spaces and raising their voices.
For more info, contact Ha at itsttime.vn@gmail.com
Thanks for reading and supporting inspiring activists like Tùng, Mia, and Ha.
Greetings – It’s already been a busy fall at Asia Catalyst.
We were thrilled to bring Khine Su Win, our Myanmar Program Officer, to the United States in September. She traveled to New York and Washington, D.C., gave presentations to supporters and allies, and enjoyed some of the sites from Broadway to Chinatown! Khine started her career as a medical doctor in Yangon providing HIV-related care for sex workers and men who have sex with men. Motivated by her desire to understand the barriers to care clients faced, Khine went back to get a Master’s degree in public health. At Asia Catalyst she gets to address structural injustices that exclude people from healthcare by working with communities who are systematically discriminated against and denied access to public services.
It’s been two years since we launched our Myanmar Country Program. The hunger for our year-long intensive training program has been positively overwhelming. Over the past year, Khine has led our human rights documentation and advocacy program with rural women, LGBT communities, people who use drugs, women living with HIV, and opium farmers in Shan and Kachin states – and the demand is only increasing.
Khine’s work with the Mandalay-based LGBT rights group, TRY, is one example of how our partnerships foster positive change. Trans people and gay men were regularly being harassed and extorted for bribes or arrested by the police. In our program, TRY learned how to document cases of unfair arrests and present their evidence to local officials. When arrests escalated during a community festival, TRY honed in on the precinct where most of the arrests were taking place. They had a productive meeting with the police chief and set up an emergency legal response team. A year later, the arrests have gone down. And now, when people are detained, instead of being held for days or weeks, they are usually released by the next morning. Advocacy by TRY to address police behavior and spread awareness of LGBT people’s legal rights continues.
When asked how things have changed in the last year, the manager of TRY said: Police are afraid to do violations to LGBT people such as physical abuse, verbal abuse or asking for bribes. They feel like they have been watched and know we will not be silenced.
Kyle Knight, who works in Human Rights Watch’s LGBT right program said: To be able to get that kind of engagement from the police is amazing. It speaks volumes to how effective this advocacy has been.
This article explores how nonprofit Asia Catalyst implemented a rights-training program for community-based organizations (CBOs) in Myanmar and the positive outcomes of these collaborations. The three CBO partners discussed represent heavily marginalized groups in Myanmar: people who use drugs, people living with HIV, and sex workers. Through this program, Asia Catalyst taught rights-driven approaches to gathering data in interviews, which has helped the groups sharpen and enhance their advocacy skills, which in turn has enabled them to effectuate positive change.
Asia Catalyst is a nonprofit
organization empowering community-based organizations (CBOs) with tools
and resources to help them become more effective in human rights
documentation and advocacy, which strengthens organizations’ ability to
function democratically, sustainably, and more effectively cater to the
needs of their communities. We have worked domestically, nationally, and
internationally to empower hundreds of civil society groups across
Asia, primarily in China and Southeast Asia, since 2006. We began
working concertedly in Myanmar in 2015 with our Regional Rights Training
(RRT) program, which also included Viet Nam, Cambodia, and China. The
RRT program focused on strengthening CBOs through workshops on topics
such as a rights-driven approach to data collection and documentation,
regional coalition-building of like-minded organizations, publications
of comprehensive reports highlighting findings and policy
recommendations, and customized advocacy support to assist in
implementation of rights-based advocacy projects for each of the
participating groups. In 2017, Asia Catalyst established a country
program in Myanmar to focus on continued rights training demand from
local CBOs following our successful RRT engagement. Through this new
Human Rights Documentation and Advocacy Project in Myanmar, CBOs are
guided through the rights framework and identify priority issues to
document and create an evidence base for policy advocacy and coalition
building.
Myanmar has undergone widespread changes in government and expansion
of civil liberties since November 2010, when the long-ruling military
junta was replaced by a military-backed civilian government.[1]
Accompanying changes such as the revival of democracy, the installation
of a human rights commission, and the advent of legalized
demonstrations in Myanmar are the collective efforts of government,
nongovernmental organizations (NGOs), intergovernmental organizations
(IGOs), and international nongovernmental organizations (INGOs) to
improve access to healthcare for marginalized groups, such as people who
use drugs and people living with HIV. Focus in Myanmar on these areas
is crucial. Myanmar has the second highest HIV prevalence in Southeast
Asia after Thailand,[2] with an estimated prevalence of 0.7% of adults living with HIV.[3]
Myanmar is one of 35 countries accounting for 90% of new cases of HIV.
Illicit drug use is pervasive, with an estimated 83,000 people using
opium or heroin in Myanmar. HIV prevalence among people who inject
drugs is 34.9%. Among sex workers, another stigmatized group, 5.4% have
acquired HIV.[4]
Given these alarming statistics, and in line with global health and
development goals, in 2017, Myanmar pledged to end HIV as a public
health threat by 2030 through a robust educational program and universal
access to prevention, treatment, and care.[5] The Myanmar government also plans to achieve ambitious 90-90-90 targets.[6]
The 90-90-90 target means 90% of people living with HIV know their
status, 90% of people who know they are living with HIV have access to
treatment, and 90% of people in treatment have successfully suppressed
viral loads.[7] Myanmar aims to complete the 90-90-90 plan by 2020.[8]
Accurate data on people living with or at high risk of HIV is
essential for governments in order to address epidemics, yet
criminalized groups are frequently denied, ignored, or invisible in
national statistics and data collection efforts. Understanding HIV among
key populations,[9]
such as people who use drugs and sex workers, is essential for the
appropriate design of and access to effective prevention and treatment
programs.
To promote vital data collection by and for communities and to
promote effective government advocacy from findings, we implemented
workshops designed to expand the ability of CBOs to document rights
abuses, contribute to the local evidence base, and advocate for their
rights more effectively. This article highlights two recent examples
from our program. The first describes documentation and advocacy by
women living with HIV and sex workers, on access to healthcare including
sexual and reproductive services. The second describes community-led
data collection by people who use drugs on the impact of recent closures
of harm reduction[10] drop-in centers (DICs) in Yangon, Myanmar’s largest city.
Rights-Based Data Collection on Accessing Reproductive
Healthcare for Women Living with HIV and Sex Workers and Subsequent
Advocacy
A core component of our rights training program includes
building documentation skills to generate local evidence for advocacy.
We worked with Myanmar Positive Women’s Network (MPWN) and Right to
Health Action Myanmar (RHAM) to design and implement research on their
communities’ priority concerns. For RHAM, this was access to sexual and
reproductive health services for sex workers. For MPWN, this was
collecting rights-focused data about sex workers’ experiences accessing
health services at government healthcare facilities in Yangon. MPWN is a
country-wide organization dedicated to empowering women living with HIV
through training them to advocate for themselves to meet health,
economic, and social needs. RHAM is a Yangon-based CBO focused on
improving access to sexual and reproductive health services for sex
workers as well as fighting for improvement of policies that lead to
discrimination and violence against sex workers. It is imperative to
address the issues facing these groups because 5.4% of sex workers[11] and 0.7% of women aged 15 and over are currently living with HIV.[12]
Overall, women living with HIV reported negative experiences in
accessing treatment because of harassment from medical professionals and
staff, public exposure of their HIV status, and addition of unnecessary
treatment costs. In general, the interviewees reported feeling
comfortable accessing healthcare at National Aids Program treatment
centers. Interviewees reported easy access to condoms, but some sex
workers stated access was harder due to discrimination from doctors and
fear that their occupation would be disclosed to their families and
neighbors. However, interviewees reported having very little information
about preventing HIV transmission during pregnancy and childbirth.
Some women reported being shamed by healthcare workers for getting
pregnant, and they were not provided meaningful education on how to have
a healthy pregnancy with HIV. One interviewee reported forced
sterilization. Some reported further stigmatization because they were
also sex workers. Stigmatization sometimes took the form of having to
pay additional fees, such as cleaning costs and additional bedsheets,
when non-sex workers did not have to. Many respondents reported
emotional distress when medical providers or staff disclosed their HIV
status publicly. One interviewee stated that she “was traumatized
mentally. Because of them, my family knows that I am HIV-positive and I
faced a lot of family problems. The lab technician told my result to my
mother-in-law. My mother-in-law shouted at me in front of others, ‘you
are a prostitute. That’s why you got HIV. You deserve this.’”
The data gleaned from these interviews helped the CBOs construct
recommendations to township-level National AIDS Program team leaders
about the needs and requests of sex workers in Myanmar. It also enabled
the development of recommendations, such as nondiscrimination training
of medical staff and doctors, by women living with HIV to the National
Aids Program, INGOs, IGOs, NGOs, and the Ministry of Health and Sports.
Community-Oriented Data Collection on the Impact of Drop-in Centers for and Their Closures for People Who Use Drugs
We worked with five CBOs of people who use drugs in Myanmar to
understand their human rights and document barriers to evidence-based
harm reduction services. It is crucial to work with this population
because the Myanmar government chooses to address the epidemic, an
estimated 83,000 people who inject drugs, through prison sentences and
other punitive approaches by which numerous rights are violated.[13]
The example below provides results from documentation by Youth
Empowerment Team (YET), a Yangon-based organization run by young people
who have drug use experience. YET focuses on harm reduction programs
and is dispelling the notion that harm reduction is equivalent to
encouraging drug use. Below, we report on community research
methodology and findings as reported by YET.
YET trained four peer educators who interviewed 27 people who use
drugs about access to harm reduction drop-in centers, where participants
receive services such as methadone therapy, condoms, harm reduction
techniques, clean injecting equipment, and referrals to methadone
treatment centers and places where they could receive naloxone, which is
administered to reverse opioid overdose. Interviewees reported feeling
comfortable and welcomed at DICs, perhaps because they are partially run
by peer drug users and did not experience as much shaming. They
emphasized how crucial methadone is to their recovery and well-being.
One interviewee stated “because of methadone therapy I can concentrate
more on my work.”
By October 2017, many of these DICs were forced to close due to a
lack of funding. This was devasting for people who use drugs in the
Yangon area. They reported difficulties in accessing methadone therapy
and overdose treatments. DICs were also important social settings for
drug users. One interviewee described how the DICs provided him with
psychological benefits he can no longer access, stating “it was
difficult to get counseling, which I really needed.” They felt
comfortable meeting friends and counselors with similar struggles. One
interviewee shared that he “lost a place to rest.” Based on these
findings, closure of DICs has been devastating for people who use drugs
in Myanmar. One interviewee stated “I don’t get needles
anymore, so I share with others. I don’t know where to [get] blood
testing. I am worried that I could be infected by blood-borne diseases. I
can’t control my desire to use drugs.”
However, inspired by needs articulated in interviews, YET has
developed a plan to create its own harm reduction program with
wide-ranging services such as clean needle distribution, risk-reduction
education, and testing for sexually transmitted infections (STIs)
including HIV. YET encourages donors and the government to make efforts
to reopen centers like DICs for the crucial medical, psychological,
educational and social benefits they provided to vulnerable people who
use drugs in need. Notably however, CBOs such as YET engaging in
outreach programs face the possibility of arrest and harassment by
police. For the most meaningful change to occur in reduction of
drug-use-related harms including HIV and overdose, draconian laws
against drug use must be reformed and people who use drugs should be
decriminalized.
Looking Ahead
Myanmar has made significant strides in the post-military junta era
in addressing healthcare, such as establishing Universal Health Care,
which includes a Basic Essential Access to Health Services Package.[14]
It has also committed to addressing the HIV crisis through programs
such as comprehensive sex education for Myanmar’s youth population[15] and a five-year strategic plan aimed to end HIV as a public health threat by 2030.[16]
However, data from interviewees confirm that key populations still face
significant barriers to universal access to HIV services and other
rights. On April 29th, 2019, President Win Myint’s
spokesperson, U Zaw Htay, stated that Myanmar’s drug policy would be to
rehabilitate and reintegrate people who use drugs into society.
Reflecting a rehabilitative approach, Htay noted that people who use
drugs need assistance instead of punishment.[17]
Gains are being made regarding HIV law and policy as well. A bill
designed to help people living with HIV, prevent new cases of HIV,
eliminate discrimination on the basis of HIV status, and increase access
to healthcare for people living with HIV, which has been in the
drafting process since 2014, is about to be finalized.[18]
The political transition, the passage of progressive and transformative
bills, and the introduction of new bills can help create more robust
civil society, improved public health, and expand access to rights for
all in Myanmar.
The grassroots groups we supported through our Human Rights
Documentation and Advocacy Project continue to reap benefits from the
training provided. Based on recent feedback from interviewees, RHAM is
distributing condoms to sex workers in Yangon. It is also engaging in an
outreach program to interview more sex workers about their experiences
accessing healthcare for the prevention and treatment of HIV and STIs.
MPWN has worked closely with local service providers from the Myanmar
Ministry of Health and Sports. MPWN representatives presented their
interview findings, developed a regional strategy plan for improved
access to healthcare, and discussed how the Ministry and CBOs can
coordinate further in the future to meet the needs of women living with
HIV. MPWN also advocated to medical service providers to end
mistreatment of people living with HIV by medical personnel and
establish mechanisms to ensure appropriate interactions. YET has been
providing clean needles to people who use drugs and advocating to local
team leaders in the Ministry of Health and Sports for the need to reopen
spaces where people who use drugs are treated with dignity and can
avail themselves of evidence-based harm reduction interventions without
discrimination. In addition to advocacy at the local level, YET also
presented its interview findings at a National Harm Reduction forum in
December 2018.
Despite these critical lifesaving advancements, without investment in
groups like MPWN, RHAM, and YET, Myanmar’s traction and gains for its
civil society will wither, goals will not be met, and its people will
unnecessarily and unjustly suffer. Given the success of our rights
training programs, more groups than ever are requesting to take part. We
plan to expand our capacity to respond to increasing demands for our
training programs through staffing up and investing more in local
leadership and coalition-building to improve sustainable civil society
advocacy. For more information on how to help these groups continue to
perform their crucial work, please visit www.asiacatalyst.org or contact info@asiacatalyst.org.
[9]
UNAIDS defines key populations as “gay men and other men who have sex
with men, sex workers and their clients, transgender people, people who
inject drugs and prisoners and other incarcerated people as the main key
population groups. These populations often suffer from punitive laws or
stigmatizing policies, and they are among the most likely to be exposed
to HIV. Their engagement is critical to a successful HIV response
everywhere—they are key to the epidemic and key to the response.
Countries should define the specific populations that are key to their
epidemic and response based on the epidemiological and social context.
The term key populations at higher risk also may be used more broadly,
referring to additional populations that are most at risk of acquiring
or transmitting HIV, regardless of the legal and policy environment.”
UNAIDS Terminology Guidelines.” UNAIDS. 2015. Accessed June 19, 2019. https://www.unaids.org/sites/default/files/media_asset/2015_terminology_guidelines_en.pdf.
[10]
UNAIDS describes harm reduction as “a comprehensive package of
policies, programmes and approaches that seeks to reduce the harmful
health, social and economic consequences associated with the use of
psychoactive substances. The elements in the package are as follows:
needle and syringe programmes; opioid substitution therapy; HIV testing
and counselling; HIV care and antiretroviral therapy for people who
inject drugs; prevention of sexual transmission; outreach (information,
education and communication for people who inject drugs and their sexual
partners); viral hepatitis diagnosis, treatment and vaccination (where
applicable); and tuberculosis prevention, diagnosis and treatment. For
example, people who inject drugs are vulnerable to bloodborne infections
(such as HIV) if they use non-sterile injecting equipment. Therefore,
ensuring adequate supplies of sterile needles and syringes is a harm
reduction measure that helps to reduce the risk of blood-borne
infections.” Ibid.
[18]
This update has not been publicized yet. It was provided to us by our
partner, Community Network Consortium (CNC). CNC is a Myanmar national
consortium of nine community-based networks representing people living
with HIV and key populations. Its members have been involved in
consultations with government officials for current law reform
processes. CNC members have been co-authors of the new HIV bill titled Law related to People living with HIV and Affected Populations.
About the author
Julia K. Klein,
J.D. is a research fellow at Asia Catalyst. Klein is interested in
international human rights law and public interest law. Klein has
worked on matters such as health justice for low-income populations in
the United States, legal strategies for implementation of sex workers’
rights in Cambodia, and legal strategies for fighting human trafficking
in the Mediterranean. Klein received her Juris Doctor from Duke
University School of Law in 2018 and is currently awaiting admission to
the New York Bar.
Last month, Asia Catalyst joined 8,000 people from 165 countries at WomenDeliver2019,
the world’s largest conference on gender equality and the health,
rights, and wellbeing of girls and women. It was an exciting opportunity
to reconnect with colleagues, hear from practitioners about work across
the globe to empower girls and women, and learn about new funding
opportunities for grassroots advocacy.
Here are a few highlights from my experience at the Vancouver conference:
Every
morning, I attended plenary sessions with extraordinary leaders who
have taken their personal experiences and turned them into movements to
address inequality. One of my favorites was “The Power of Movements,”
featuring Tarana Burke, founder of #MeToo, and Ailbhe Smyth, who led the successful vote to ensure women in Ireland can make their own decisions in pregnancy and access abortion.
Another exciting moment was Prime Minister Justin Trudeau’s announcement that Canada will increase its funding for women’s health globally, reaching $1.4 billion annually by 2023 – including $700 million earmarked for sexual and reproductive health initiatives, making Canada a leader when it comes to this kind of international aid.
I participated in sessions like Feminist Frontline: Strategies for Resistance and Change, whose activist speakers described their groundbreaking work disrupting and dismantling the patriarchy and feminist philanthropy; and Women’s Rights and LGBTIQ+ Rights: Stronger Together, masterfully moderated by Jessica Stern, Executive Director of OutRight Action International.
What was missing? Unfortunately, the voices of extremely marginalized women – sex workers, women who use drugs, trans and intersex women – were hardly present. I found only one session, hosted by Frontline AIDS, where women who use drugs talked about their work.
We know that work to promote gender equality and “leave no one behind,” as part of the Sustainable Development Goals, requires everyone, not just the privileged, well-resourced, and well-connected, to unite and strategize. Clearly,
new opportunities must be created for these groups, while encouraging
Women Deliver to widen its lens of who to feature in 2020. We will
advocate for more diverse representation, and support more of our
grassroots partners to participate next year.
The biggest benefit of Women Deliver, in my opinion, is the opportunity for quality, in-person interaction – an increasing rarity in this digital age – with friends, allies, and donors. Often, discussions and debates there spark new ideas and relationships that help us unite around work and strategies to advance women’s health. I was thrilled to connect with people from Asia Pacific Alliance for Sexual and Reproductive Health and Rights, above, which we are a proud member of and puts sexual health rights on the agenda of policymakers.
Asia Catalyst advances women’s rights every day through our intensive human rights and advocacy programs that build leadership and give birth to grassroots organizations. To learn more about our work with marginalized women, visit www.asiacatalyst.org.
