VietNamNet Bridge – With international development assistance to Viet Nam for HIV/AIDS prevention and control expected to decrease significantly by 2015, there is increasing concern that the country will lose its momentum in the battle against HIV/AIDS. Viet Nam News reporter Le Quynh Anh spoke to relevant stakeholders on how Viet Nam should move forward.

* Professor Chung A, senior advisor to the Government on HIV/AIDS affairs

The fight against the HIV/AIDS epidemic has been going on for 20 years. There was a period from 1995 to 2005 where we faced extreme difficulties as HIV spread rapidly. However, because the desire to combat this disease remains strong throughout the entire political system, we have gradually brought the situation under control. In addition, our strategies to fight HIV/AIDS have been consistent with international practice. For that reason, we received a lot of support from the international community. Since 2009, the number of new HIV infections has steadily decreased. Also, we have built well-trained task forces that are on active duty around the country. Another remarkable figure is that nearly 70,000 HIV/AIDS patients have received treatment – an achievement we did not dare to dream of 10 years ago. The HIV-infected patients have growing confidence in the Government so they participate more actively in the HIV/AIDS efforts initiated by the Government.

As we have successfully emerged from poverty to become a low middle-income country, we now face the challenge of reduced international assistance. It makes sense that donors would relocate resources to more economically challenged countries. We are facing an imminent shortage of resources for HIV/AIDS. Over the last decade, we have increased the level of funding for HIV/AIDS activities from US$0.06 to $1 per capita. International assistance accounts for 80 per cent of the total: the annual funding from the State hovers around $7 million, while contributions from donors can be as high as $87 million. Once these contributions stop, we will face an enormous challenge. And in the absence of international support, our capacity to build HIV/AIDS task forces will be greatly affected. These are concerns that the Government has started to address.

Meanwhile, the reduction of international assistance occurs as the HIV epidemic in Viet Nam is undergoing a dramatic shift. HIV infection is no longer concentrated in urban areas but has begun to spread to remote rural districts. As HIV finds its way to ethnic people who have struggled with poverty for years, new challenges emerge. Another new challenge is that drug users, especially youngsters, have switched to synthetic drugs. Without continued funding, we may face a new wave of the HIV epidemic.

To move forward, first of all, we need to maintain the strong political will to combat this disease that was displayed in previous years. Secondly, the National Assembly should revisit its budget plan to allocate more funding for HIV/AIDS prevention and treatment. While it is inevitable that we must increase the funding from the State budget, we also need to draw resources from other stakeholders. Why don't we begin with the community itself? As of now, all of the HIV-related treatment expenses are fully covered, so we should come up with mechanisms that are more selective. For example, patients who are in better financial condition should be required to share their burdens with the State. We could also seek support from enterprises, charity organisations and religious groups. Advisors even recommended the Government use Official Development Assistance in the fight against the HIV epidemic, just as these funds are used to develop infrastructure.

* Tony E. Lisle, Country Director, UNAIDS Viet Nam

Viet Nam has made great progress in responding to HIV in recent years. Coverage of antiretroviral treatment (ARV) has increased 22-fold since 2005, providing life-saving treatment for more than 60 per cent of adults and more than 80 per cent of children living with HIV. New infections among injecting drug users and sex workers are stable following the scale-up of the needle and syringe program, the condom program and the methadone maintenance treatment program.

Mr. Tony E. Lisle, UNAIDS Country Director in Vietnam. -- Photo: Courtesy of UNAIDS

The international community currently funds more than 70 per cent of Viet Nam's HIV response and an even greater percentage of HIV treatment and prevention programmes targeting key populations at higher risk of infection. However, that will change. Viet Nam is one of the 21st century's economic success stories, and soon it will no longer need international development assistance. As aid slowly reduces, Viet Nam will need to invest more domestic resources on evidence-informed, cost-effective and rights-based approaches. The priority should be a smooth continuum of HIV prevention, treatment and care services for people who inject drugs, sex workers and men who have sex with men. The ARV program also needs special attention. We now know that people on treatment are much less likely to transmit the virus to others, so we need to diagnose people living with HIV and get them on treatment as soon as possible. In order to do this, Viet Nam must take additional measures to reduce stigma and discrimination related to HIV.

And during the transition from international to domestic funding, UN organisations and the international community will continue to provide policy and technical assistance as Viet Nam transitions to a more efficient and more sustainable phase of its national response to HIV.

Regarding the shift pattern in the mode of HIV infections, it is true that there has been a gradual increase in the percentage of new HIV infections through sexual intercourse. However, injecting drug use remains the most important mode of transmission in Viet Nam. Ministry of Health data shows us that men still account for about two-thirds of new infections, and most of those infections are from unsafe injections. Among women, 15 per cent who tested positive for HIV reported that their only risk was a male sexual partner who injected drugs. This shows us that many of the HIV infections through sexual transmission are linked to drug-use. Some people call this "intimate partner transmission" or "secondary transmission".

This only emphasises that we need to focus on the primary sources of new infections – drug injection, sex work and male-to-male sexual intercourse. The Government of Viet Nam has taken some bold steps to address these issues more effectively. The National Assembly made a decision to stop sending sex workers to five centres. The Government is working to shift more rapidly to community-based and voluntary drug treatment services. All of these brave efforts are facilitating greater access to HIV services. Viet Nam is an emerging regional leader on these issues. UN organisations would like to congratulate the Government of Viet Nam for this and encourage additional focus on HIV services that are proven to be effective and focus on the populations in greatest need.

* Dinh Thi Thanh Ba, director of Do Son medical centre, Do Son District, Hai Phong City

Since the first case of HIV/AIDS in Viet Nam was reported in 1990, Hai Phong City has consistently been listed among the 10 provinces with the highest HIV incidence. That is why donors have so far implemented a lot of prevention and care programmes in Hai Phong. This has contributed remarkably to the positive outcomes of the city's efforts to combat HIV/AIDS. The rates of new infections and AIDS-related deaths have been on a downward trend from their peak in 2003.

One of the most important legacies of such long-term interventions is that awareness about the disease and knowledge about how to protect oneself from it have found its way into people's mind-sets. This is strongly demonstrated in Do Son – a coastal resort 20km away from the city's centre. Do Son was notorious as a centre for prostitution and it used to be a hot spot for HIV spreading via sexual transmission. However, now the situation has been reined in due largely to a major change in attitudes and behaviour. According to our field surveillance, the level of condom use among female sex workers is high. Sex workers in Do Son, unlike in other places, are not street prostitutes in the sense that most of them work inside restaurants or karaoke bars and are managed by these shops' owners. It might be a surprise to many people that it is the owners themselves that take the initiative to distribute condoms to their sex workers and require them to be used. In some exceptional cases, some prostitutes refuse to have intercourse because their clients do not wear condoms: radical progress compared to just a few years ago.

So I think it is safe to say that the component to raise awareness about HIV/AIDS has done its job quite well and it may not create so big a disruption if we scale it down. However, the reduction of international assistance will greatly affect our efforts in the area of providing HIV treatment and care services. As in the case of Hai Phong City, all ARV drugs are provided for free by our development partners. So the top concern here is how we will find alternative resources to keep providing ARV drugs to those in need. The monthly cost of ARV drugs for one patient is about VND300,000 ($14), not including the expenses for a number of blood tests. One solution that has been widely discussed is to list ARV drugs under the medicine that is eligible to be covered by health insurance. We would also like donors to transfer the technology to produce ARV drugs so Viet Nam can manufacture the drugs in Viet Nam to reduce costs.

Another concern is how we can continue to make use of well-trained human resources. For example, under many donor-supported projects, a doctor specialising in treating HIV is posted in each health centre for HIV/AIDS patients and receives a salary from the projects. But as many projects are going to terminate by 2015, it is very likely that these experts will be relocated to other workplaces because no one will pay them if they stay. This will be a waste of resources, as those who are trained will not do what they are trained for while there is still a need for experts in HIV treatment.

Source: VNS