In January, Population Action International (PAI) released its latest in a series of country case studies focused on the impact of U.S. foreign policy in developing countries.  The report, Uncharted Waters: The Impact of U.S. Policy in Vietnam spotlights the possibilities and challenges for HIV/AIDS programming under the President’s Emergency Plan for AIDS Relief (PEPFAR).1

Vietnam became one of the 15 PEPFAR focus countries in 2004 with an initial influx of $17 million, making the U.S. the largest foreign donor of HIV/AIDS assistance to that country.  In 2005, that budget increased to $27 million. Unlike many of the other PEPFAR focus countries, all of which are located either in Africa or the Caribbean, Vietnam’s AIDS epidemic is concentrated with a relatively low prevalence, and is primarily driven by Injecting Drug Users (IDUs) and commercial sex workers.  Implementation of a comprehensive prevention, care, and treatment plan in Vietnam has been challenging because of the country’s unique epidemic and  the stigmatization of AIDS and high risk behaviors.  These challenges have been compounded by the rapid influx of U.S. funds in a short time period and a lack of available infrastructure to distribute these funds.  Restrictions on how U.S. funding may be used has also contributed to these challenges. 

Excluding High-Risk Groups

According to PAI’s report, reaching high-risk groups in Vietnam has been particularly problematic.  Drug use and sex work are both illegal in Vietnam furthering the stigmatization of AIDS in Vietnamese society and creating a barrier for those needing to access services. 

In addition, restrictions in U.S. policy, especially for drug users and sex workers, have hindered outreach to these high-risk populations.  Under PEPFAR, for example, funds cannot be used for needle-exchange and distribution programs despite the fact that the sharing of needles and syringes among drug users is one of the main drivers of the epidemic in Vietnam. 

PEPFAR also prohibits the use of funds to address the needs of inmates within Vietnam’s compulsory rehabilitation and residential detention centers for drug users and sex workers, known as “05/06 centers.”  These “05/06 centers” contain a large number of HIV-positive individuals in need of comprehensive health services.  Although rightly concerned about the human rights issues surrounding the centers, the U.S. government’s decision that no PEPFAR funding can be used for prevention, care, or treatment in these facilities has effectively excluded an entire high risk population from receiving needed services.  PAI’s report argues that this U.S. policy “represents another missed opportunity to tackle the epidemic head-on, engage a captive audience in need of information and collaborate with the Vietnamese government to advance the rights of detainees.”2

Interrupting Condom Distribution

Another challenge in implementing comprehensive HIV prevention in Vietnam has been the interruption of condom promotion because of ongoing litigation over the U.S. requirement that non-government organizations receiving PEPFAR money have a policy explicitly opposing prostitution and sex trafficking.  In 2005, DKT International, the main provider of condoms in Vietnam since 1998, refused to comply with the requirement and lost its contract with PEPFAR causing disruption to the supply of condoms.  According to PAI, condom promotion aimed at high-risk groups is set to ramp-up with a different NGO partner.

Still at issue, however, are other PEPFAR policies that require communication materials about condoms to include information on condom failure rates.  According to one NGO staffer quoted in the report, “no public health intervention is 100% effective,” and to include information on failure rates is “so contrary to public health that it will sabotage any condom promotion.”3

Experiences in 2004 and 2005 have illustrated to the PEPFAR country-team in Vietnam that prevention efforts in the country must be paramount if the treatment and care programs are to have any lasting impact.  With that in mind, PAI’s report indicates that there appears to be a stronger commitment to addressing the needs of IDUs in Vietnam as well as strengthening behavior change and condom promotion among high-risk groups.

“This report from Population Action International underscores the ongoing negative impact that foolish and ideologically driven provisions in U.S. HIV/AIDS assistance are having on countries most in need of help,” said William Smith, vice president for public policy at SIECUS.  “Good intentions and wads of cash are only helpful if we let evidence be the guide and PAI’s report suggest layers of other less-than-noble intentions.”

Population Action International’s full report on Vietnam can be accessed at: http://www.populationaction.org/resources/CaseStudies/Vietnam/VietnamCS.pdf

For more information about the PEPFAR program in Vietnam, see SIECUS’s PEPFAR Country Profile at: http://www.siecus.local/inter/pepfar/Viet_Nam.pdf

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