The impact of political instability on HIV services in conflict-affected areas of Myanmar following the military coup: a qualitative study

INTRODUCTION: People living with HIV (PLHIV) and individuals at risk require consistent access to comprehensive HIV services. Political instability exacerbates existing challenges in HIV care by disrupting health systems, leading to medicine shortages, depletion of the healthcare workforce, and damage to essential infrastructure. Since 2021 military coup in Myanmar, there has been a lack of updated information on the status of HIV services in conflict-affected areas. METHODS: A cross-sectional online qualitative study was conducted from July to December 2024 in conflict-affected regions (Sagaing, Magway and Bago regions) of Myanmar. In-depth interviews (IDIs) and key informant interviews (KIIs) were conducted via the Zoom platform with 18 healthcare providers from hospitals/clinics and health administrators, and 10 PLHIV from a trusted network. Participants were recruited through purposive sampling. Thematic analysis was applied, and triangulation was performed across different participant groups to enhance the validity of the findings. RESULTS: A total of 28 participants were included in the study. Since 2021, HIV prevention services have been severely constrained due to limited resources and ongoing conflict. While all pregnant women are screened for HIV during antenatal care, the availability of PMTCT (prevention of mother-to-child transmission) syrup for newborns remains extremely limited. Antiretroviral drugs for post-exposure prophylaxis (PEP) are available in only certain facilities, and in limited quantities. HIV testing services are available in most areas, primarily at health facilities, but confirmatory testing is restricted to a small number of general health centers. Early infant diagnosis is not universally available. Many PLHIV remain on waiting lists to start antiretroviral therapy (ART), with prioritization based on disease severity and local security conditions. Baseline investigations and medications for opportunistic infections are largely unavailable. Some PLHIV have been referred to the TeleRed HIV telemedicine clinic. ART interruption has been reported due to travel restrictions, internet and mobile service disruptions, and security threats. Many areas are affected by airstrikes, conflict, and a lack of essential medicines and supplies. CONCLUSIONS: This study highlights the impact of political instability on HIV services in conflict-affected areas of Myanmar. Key challenges include limited prevention services, ART shortages, and reduced accessibility to care. Without timely and comprehensive interventions to address these gaps, a rise in new HIV infections and advanced HIV disease is anticipated in the coming years.