Overall infection rate is low, but high among people in their 20s-the most economically productive age group.
Bank projects include “peer education” among IV drug users.
Stigmatized farmers and wives are shunned in communities.
November 28, 2007— Pham Ba Dung is a former intravenous drug user. He says he is lucky to have escaped getting HIV from the needles he used. He lives with his wife and baby in rugged mountains in the west of Vietnam, and spends his days encouraging his friends and neighbors to use clean needles if and when they use drugs.
Ba Dung is participating in a project funded by the World Bank that aims to keep HIV prevalence low in Vietnam. "In those first days of working here, I was like a fish out of water, I was nervous," he says. But, with training, he says he has settled into his new role on the front lines of HIV prevention.
Though Vietnam has a relatively low rate of HIV infection, health officials in the country say the next few years are critical. According to the Ministry of Health, about a quarter of a million people in Vietnam were living with HIV at the end of 2003. The goal is to keep the disease out of the general population. Right now it is mostly confined to IV drug users and sex workers. What worries officials is that HIV rates among those groups are high-and rising.
Most worrying are recent reports revealing more than 60 percent of reported HIV cases involve young people between the ages of 20 and 29. "Similar to many countries in the world, most of the infected are at a young age," says Dr. Nguyen Thanh Long, Deputy Director General of the Vietnam Administration of HIV/AIDS Control. "The trend toward a younger age is quite clear in Vietnam."
This age group is the most economically productive part of the population, and if the epidemic continues to spread through that age group, there will be serious economic consequences in the future.
The World Bank has given Vietnam a US$35 million grant to support its HIV/AIDS program in 18 provinces and two cities, Ho Chi Minh City and Hai Phong. The two cities contain 42 percent of the population and 55 percent of the country's reported HIV cases. Prevention activities range from needle exchange, to condom promotion and outreach and counseling. Decisions on such activities get made according to local need.
Besides seeking to curb the transmission of the disease, the project aims to lessen the stigma and discrimination faced by those who have it.
Used needles are retrieved at park.
Needle Exchange Programs
One of the activities supported is in a remote area of Vietnam near the Lao border, where "peer educators" run a needle exchange program. Most of the peer educators have been IV drug users, and many are HIV positive.
In the Quan Hoa district, in the mountains near Laos, peer educators provide clean needles to drug users in their houses. There are about 4,000 IV drug users in the province, and HIV rates are higher here than average. About one third of the IV drug users in Quan Hoa are HIV positive.
Lo Van Toan, a peer educator in Quan Hoa, says, "Everybody is made aware of the impact of this disease, everyone is scared of it, and I am, also. Before working here, I went for blood test, and the result was I'm infected."
De-Stigmatizing the Disease
While much of the work involves increasing awareness of the disease, perhaps the harder task is changing attitudes and behaviors about the disease.
A social club in the provincial city of Thai Binh, offers sex workers free tests for HIV and sexually transmitted diseases. It is a place for sex workers to get condoms, but also a place for karaoke, make-up lessons, and a chance to chat. This club tries to bring HIV out into the open: to inform, to educate, to destigmatize the disease and the people who have it.
Chu Thi Cay, victim of discrimination.
In the agricultural heart of Vietnam, farmers and their wives face HIV often alone, shunned by their communities. Many farmers do migrant work elsewhere in Vietnam, and some come home with a drug habit and HIV. The Green Sun Rising Club offers farm families a place to meet, get health advice and small loans to buy a pig or start an embroidery business.
Chu Thi Cay got money from the club to buy a cow. She lost her husband to AIDS and is living with HIV herself. She has two boys, 13 and 5 years old. She said the younger boy was told he will not be allowed to go to school next year because he is HIV positive. She says such discrimination is a fact of life in Vietnam.
"It seems I am the only one in our district who lets people know about the disease. Others still hide…In my case, my husband was infected, and then, me, and our child. My child is in kindergarten now. Next year he will be old enough to enter first grade, but he won't be admitted to a school."
It is not an unusual story. Several children in this region are affected by HIV. They either have it or have a parent who has it. And despite laws and communication campaigns, discrimination remains widespread. Stigma has discouraged many vulnerable people from asking for help in preventing and managing the disease.
Using Songs to Change Minds
To help change perceptions, a singing group made up of people with HIV travels to villages to put a face on the disease, and its songs ask people not to discriminate. The singers say their performance is generally well received.
Hoang Thi Tho, an HIV-positive performer, says she's learned a lot through working with the singing group. "I know the ways which HIV is transmitted. With support from the community, I am making them-those who discriminated against me-understand, and now they no longer have their past attitude. They are even sympathetic with me and love me more."
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