VietNamNet Bridge – Nguyen Thi Thanh (not her real name), who lives in Ha Noi's Dong Anh District, was completely isolated after word got out she was HIV-positive after contracting the virus from her husband six years ago.

Villagers who once hired her as a child minder and housekeeper no longer welcomed her in their houses. Thanh said neighbours avoided her and relatives treated her indifferently. In their ignorance they feared the virus might somehow be transferred to them. Their best protection was to isolate Thanh.

Worse still, her husband, who got the virus from a sex worker, neglected all family affairs and refused to share financial burdens.

Thanh's story and thousands like her have prompted the Ministry of Health to push for a new national HIV/AIDS strategy to confront gender power imbalances in sexual relationships and provide more widespread information on virus transmission and prevention.

"Those were the worst days of my life," Thanh said. "I was treated as if I had caused all these terrible things. I had to earn a living and take care of my children and an ill husband without any help."

Thanh was luckier than most, however, she overcame the discrimination and managed to live reasonably well. But at least 70 HIV-positive women from the local support group of which she is a facilitator are not so well off and are still suffering neglect and even abuse by their husbands.

"Most of the women are unemployed or farmers and they all get the virus from their husbands who are either drug addicts or had unprotected sex with prostitutes," Thanh said.

"They didn't get enough clear information about the virus until they were HIV-positive."

They also did not know of their husbands' behaviour and that they might be at risk or how to communicate with him.

Figures from the Ministry of Health's Administration of HIV/AIDS Control show the percentage of infected women has increased from 15 per cent to 23 per cent during 2005-09 and is forecast to increase further.

The ministry's HIV Sentinel Surveillance shows the number of men living with HIV in 2007 was three times higher than that of women in 2007 and forecasts this gap to decrease to 2.6 times by 2012 with about 198,000 men and 76,700 women living with HIV.

The number of HIV-positive pregnant women is expected to reach 4,800 by 2012.

Doctor Khuat Thi Hai Oanh, executive director of Supporting Community Development Initiatives, said these figures proved women had become a vulnerable group in the past few years.

Traditional gender norms, especially Confucian beliefs, which encouraged women to avoid negotiating safe sex practices with their husbands or boyfriends as a way of proving their faithfulness and trust, contributed to the increase of intimate partnership transmission, Oanh said.

"Most are reluctant to say no to their husbands' demands to have sex without condoms. Some fear abuse while others are afraid of drawing attention to themselves in the village by causing an argument," she said.

"This puts women at greater risk of HIV."

However, few HIV information programmes or policies had directly addressed this group. Also, regulations which banned HIV-positive couples from using artificial insemination had pushed many women who were free of the virus to risk infection by having intercourse with their HIV-positive husbands.

"Couples who want to have children have no other choice but unsafe sex," Oanh said.

Dr Le Minh Giang, of Ha Noi Medical University's Centre for HIV/AIDS Research and Training, said HIV and reproductive health laws and policies had yet to address the individual's responsibility to protect their intimate partners or to confront sensitive issues of gender power imbalance in sexual relationships.

For example, the national strategy on HIV/AIDS prevention and control had no specific information on reproductive and sexual health for vulnerable women and the husband's responsibility to protect his partner and children.

In the meantime, the rate of condom use remained very low, at about 9 per cent of women who are either married or in committed partnerships, figures from the General Statistics Office showed in 2009.

Recently, UNAIDS and UNWomen shared findings of their Viet Nam gender analysis which show gender gaps in the current National Strategy on HIV/AIDS Prevention and Control.

UNAIDS regional gender advisor Jane Wilson said there was a global increase in women acquiring HIV but in Asia 90 per cent of HIV-positive women got the virus from their long-term intimate partners.

"The access to information and counselling of women whose intimate partners are drug users, men who have sex with men and women who are drug users remain restricted," Wilson said.

"This needs to be fixed."

Currently, China, Cambodia and Myanmar had considered such issues in their new strategies; Viet Nam's Domestic Violence Law and Law on HIV/AIDS Prevention and Control could easily be adapted, she said.

Wilson has joined a chorus of UN experts who have proposed initiatives on the importance of testing, guiding partners over risky behaviour, targeting vunerable women, especially those whose husbands were migrant labourers, and improving reproductive health of people living with HIV.

Administration of HIV/AIDS Control director Nguyen Thanh Long said more data and study were needed to build a new strategy.

However, he said gender issues should be covered in three key points of the strategy: HIV/AIDS prevention, treatment and impact reduction.

The new national strategy on HIV/AIDS Prevention and Control was being formulated and would be submitted to the Government in due course.

VietNamNet/Viet Nam News