# The effect of location in mining or borderland areas on HIV incidence among people who use drugs attending a harm reduction programme in Myanmar, 2014–2021: A retrospective cohort study

## TL;DR

This study found higher HIV rates among drug users in border areas of Myanmar compared to mining areas, highlighting the need for targeted interventions.

## Contribution

The study identifies borderland areas as a key factor associated with increased HIV risk among drug users in Myanmar.

## Key findings

- HIV incidence was 3.8 per 100 person years among clients with multiple HIV tests.
- Injecting drug users had an HIV incidence of 6.8 per 100 person years.
- Borderland areas showed a 1.67 times higher HIV incidence after adjusting for confounders.

## Abstract

High HIV prevalence has been documented among people who inject drugs in Myanmar particularly in mining and borderland areas. We estimated incidence of HIV among people using drugs (via injecting and other routes) and examine associations between location in mining or borderland areas and risk of infection.

Analysis of data among clients registered at harm reduction programmes across Sagaing region, Kachin, and Northern Shan States between 2014–2021. Data on sociodemographic, drug use characteristics and clinic-level data on borderland or mining locations were collected at time of registration. Characteristics, repeat HIV testing and HIV seroconversion were analysed using a cohort approach. We use Poisson regression models to examine associations between location in a borderland or mining area and incidence of HIV, adjusting for confounders. Data were available for 85,093 clients, 52,526 reported HIV tests and 20.0% were seropositive. 38,670 clients had no or only one recorded HIV result. The median time between HIV tests was 1.1 years. Among 13,359 clients with 2 or more HIV tests the HIV seroconversion rate was 3.8 per 100 person years (pyrs) (95% CI 3.6–4.0). Incidence among those who injected drugs was 6.8 per 100/pyrs, 8.9 among those aged  ≤  25 years, 2.3 among women, 2.3 among those who had migrated, 5.6 among those located in border areas, and 3.7 among those in mining areas. After adjusting for confounders, HIV incidence remained higher for people located in borderland areas (Incidence Rate Ratio 1.67 95% CI 1.13–2.45) but there was no evidence of association between location in a mining area and HIV seroconversion.

Findings highlight the need to intensify harm reduction interventions with a focus on cross-border interventions. Increasing uptake of HIV testing alongside the scale up of evidenced based interventions is urgently needed to curb the high rates of HIV transmission associated with drug use, particularly among young people.