In Vietnam, the recorded number of people infected with HIV has nearly doubled since 2001, from 43,410¹ to 81,206². Vietnamese public health officials estimate that the actual number of people living with HIV is close to 200,000³ Although the percentage of people living with HIV/AIDS in Vietnam and other parts of Asia are relatively low, the actual numbers are extraordinarily high and on the rise.⁴

Shifting Populations Affected

This increase marks a shift in those who are at risk for infection. The progression of the epidemic in Vietnam is tracking that of the epidemic in other Asian countries. At first, HIV/AIDS was almost exclusively concentrated among intravenous drug users and sex workers who frequently engage in behaviors that pose a high risk of exposure to the virus. In 2000, the HIV-prevalence rate among intravenous drug users in Vietnam was approximately 24%. The prevalence rate among female sex workers that same year was 3.5%.⁵ Rates among people who are intravenous drug users or who engage in sex work continue to increase. In Ho Chi Minh City, for example, the rate among sex workers has grown rapidly to 24% in 2002.⁶

The virus is now spreading to lower-risk populations, primarily via clients of sex workers, who carry the virus to their other partners. As in many other parts of the world, women who are monogamous with their partners are more and more vulnerable to infection, despite engaging in extremely low-risk behavior. The HIV prevalence among pregnant women attending antenatal clinics increased more than 10 fold in seven years, from 0.03% in 1995 to 0.39% in 2002, and reaches up to 1% among pregnant women attending antenatal services in An Giang and Hai Phong.⁷ As women who become mothers are increasingly infected, infants will likewise become increasingly infected.

Young people are also becoming more at risk. Approximately 70% of HIV-infected people in Vietnam are now between the ages of 14-29.^8>

Existing Programs Inadequate

Advocates say that the infection rate has been exacerbated by stigmatization. The Vietnamese government has embarked on campaigns to eradicate so-called "social evils" (Te Nan Xa Hoi), particularly drug use and sex work. According to advocates, these campaigns undermine successful HIV/AIDS prevention and treatment by legitimizing stigmatization of already marginalized people who are most at risk for infection such as intravenous drug users. Such stigmatization makes it more difficult to reach at-risk populations with prevention messages and treatment. In addition, by reinforcing the idea that only these stigmatized groups are at risk for infection, prevention efforts and treatment for the general population is also much more difficult.

The Community of Concerned Partners, a coalition of HIV/AIDS stakeholders in Vietnam, says, "The campaigns against ‘social evils’ are not preventing drug use or sex work. Nor are they preventing the increase in HIV infections. Rather, the idea of ‘social evils" is adding to the problem, and the society cannot afford this approach any longer."⁹ This problem with stigmatization, they say, has facilitated and masked the spread of HIV to the general population.

The shift in patterns of infection has dire implications not only for an increasing number of individuals but also for Vietnamese society as a whole. Vietnam has struggled to regain economic stability and make progress on human development. According to the United Nation’s 2004 Human Development Report, Cultural Liberty in Today’s Diverse World, Vietnam has experienced a significant rise in its Human Development Index (HDI), which measures achievements in key areas such as standard of living, health, and education.¹⁰ The current spread of the HIV/AIDS epidemic, however, could undermine this progress. For example, if this younger generation continues to become infected, they will develop AIDS during the years when they are expected to be the most productive members of society. Vietnam will then lose a major component of its work force, future leaders, and the benefit of having invested in their education and health care. Already, half of the people living with HIV/AIDS with jobs lost their employment due to illness or stigma, and 60% reported difficulty in paying for food, education, healthcare, and other basic needs, according to Community of Concerned Partners.¹¹

Organizations Addressing the Need

Vietnam is at a critical juncture in the development of the epidemic, and immediate, thoughtful intervention can halt and even reverse the spread of the disease. A well-formulated treatment delivery system can preserve the health of those already infected. Advocates say that without strong and open leadership, adequate treatment programs, and widespread prevention programming, however, Vietnam faces the social and economic decline currently devastating many countries in Africa.

The Vietnamese government, local non-governmental organizations (NGOs), and the international community are engaged in a fight against HIV/AIDS. The Vietnamese government has actively responded to the epidemic since 1995, when it passed The Party Resolution and the National Assembly Ordinance on HIV/AIDS. Since that time, numerous government actions have attempted to address HIV/AIDS, including securing funding for HIV/AIDS-related programs and developing a National HIV/AIDS Strategy for 2004-2010.

A broad array of NGOs vigorously push the government to create improved responses to the crisis and provide programming and services to HIV-affected individuals and communities such as prevention education, voluntary counseling and testing for HIV, clean needle and syringe exchanges for injecting drug users, and condom promotion and distribution. Advocates also work to reduce the stigma associated with HIV/AIDS, and, more generally, with intravenous drug users and sex workers.

The international community is also active in Vietnam. International NGOs and foundations provide support and funding both to local NGOs and to the Vietnamese government. The Global Fund for AIDS, TB, and Malaria, an international partnership between governments, civil society, the private sector and communities affected by these diseases, funds programs.¹² The World Health Organization is implementing its "3 by 5" initiative in Vietnam. The"3 by 5" plan is an effort to get three million people living with HIV/AIDS in developing and middle income countries on antiretroviral treatment by 2005.¹³ Australia, Canada, Norway, and the United Kingdom are major donor countries supporting HIV/AIDS related initiatives in Vietnam.¹⁴

Most recently, the United States announced that Vietnam is eligible for U.S. support via The President’s Emergency Plan for AIDS Relief: U.S. Five-Year Global HIV/AIDS Strategy (PEPFAR).¹⁵ Vietnam is the 15th "focus country," and the only country in Asia to receive funding via PEPFAR.¹⁶ Some debate has surrounded the selection of Vietnam. Other countries, particularly China and India, are at a point in epidemic progression similar to that in Vietnam, but with much greater raw numbers.¹⁷ Some HIV/AIDS advocates argue that these countries should have been a priority for funding. Some anti-choice groups also question the choice because Vietnam permits abortion. According to the Family Research Council, Vietnam receiving assistance is "outrageous given the fact that Vietnam has a two child, forced abortion policy."¹⁸ The Bush Administration, however, has said, "We identified Vietnam as the nation where a dramatic increase in American support can make a tremendous impact."¹⁹ The Administration expects to spend approximately $10 million in Vietnam during the first year of funding.

More information at UNAIDS.

References

1. Viet Nam: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections, (Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Children’s Fund (UNICEF), and the World Health Organization (WHO, 2002).
2. U.S. HIV/AIDS official to visit Vietnam, (Hanoi: Associated Press, Jul. 8, 2004). Available on-line.
3. Ibid.
4. AIDS Catastrophe Set To Hit Asia, Warns U.N., (Bangkok: Inter Press Service, Jul. 6, 2004.) Available on-line.
5. Viet Nam: Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections.
6. R. Boucher, Spokesman, U.S. Department of State, Vietnam Named 15th Focus Nation in President Bush’s Global AIDS Plan and New $515 Million to fight HIV/AIDS in 15 Focus Countries Also Announced, (DC: U.S. Department of State, Jun. 23, 2004). Available on-line.
7. Vietnam: The Millennium Development Goals, closing the Millennium Gaps, MDG6-Combat HIV/AIDS, Malaria, and Other Diseases, Extract from the UN Viet Nam Country Team Millennium Development Report 2003: MDG 6 in Viet Nam, (Ha Noi: UNAIDS Vietnam, 2003). Available on-line.
8. T. Dat, All people participate in HIV/AIDS prevention, (Hanoi: Communist Party of Vietnam, July 30, 2004). Available on-line.
9. HIV/AIDS: A Social and Economic Challenge for Viet Nam, Statement of the Community of Concerned Partners, (Hanoi: Community of Concerned Partners, Dec. 2-3, 2003).
10. United Nation’s 2004 Human Development Report, Cultural Liberty in Today’s Diverse World, (New York: United Nations Development Programme, 2004). Available on-line.
11. HIV/AIDS: A Social and Economic Challenge for Viet Nam.
12. The Global Fund Website.
13. World Health Organization Website.
14. HIV/AIDS: A Social and Economic Challenge for Viet Nam.
15. R. Boucher, Spokesman, U.S. Department of State, Vietnam Named 15th Focus Nation in President Bush’s Global AIDS Plan and New $515 Million to fight HIV/AIDS in 15 Focus Countries Also Announced, (DC: U.S. Department of State, Jun. 23, 2004). Available on-line.
16. The other focus countries are Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia.
17. U.S. HIV/AIDS official to visit Vietnam, (Hanoi: Associated Press, Jul. 8, 2004). Available on-line.
18. T. Perkins, FRC Questions Decision to Give Pro-abortion Vietnam AIDS Funding, Jul. 15, 2004. Available on-line.
19. R. Boucher, Spokesman, U.S. Department of State, Vietnam Named 15th Focus Nation in President Bush’s Global AIDS Plan and New $515 Million to fight HIV/AIDS in 15 Focus Countries Also Announced.