US embassy cable - 04HOCHIMINHCITY75

UNCLAS SECTION 01 OF 02 HO CHI MINH CITY 000075 
 
SIPDIS 
 
STATE FOR EAP/BCLTV, H 
STATE PASS USAID FOR ANE: AFERRARA DMCCLUSKEY 
STATE ALSO PASS USTR EBRYAN 
BANGKOK FOR USAID 
 
E. O. 12958: N/A 
TAGS: OREP, EAID, KHIV, SOCI, VM, HIV/AIDS 
SUBJECT: HIV INFECTION RATES CLIMBING IN HCMC -- NEARING 
GENERALIZED EPIDEMIC LEVEL 
 
1.  Summary:  On a visit to Ho Chi Minh City, Staffdel McCormick 
from the House Committee on International Relations met with local 
government officials and NGO partners involved in the city's fight 
against HIV/AIDS.  Current estimates indicate that the infection 
rate in Vietnam is approaching one percent, a key measure of 
whether the disease is about to breakout into the general 
population.   Damning statistics highlight the growing problem: 
0.9% of pregnant women at the city's primary maternity hospital 
test HIV positive as do 3.4% of HCMC's military recruits.  The 
staff delegation visited a USAID-funded anonymous testing and 
counseling center that opened in 2001, which only attracts two to 
three clients per day.  Follow-on care available to individuals 
infected with HIV is extremely limited in Vietnam and infection is 
effectively a death sentence.  End Summary. 
 
Fear Epidemic Poised to Enter General Population 
--------------------------------------------- --- 
2.  On January 3, 2004, a staffdel led by James McCormick, Staff 
Director of the House International Relations Committee's (HIRC) 
Subcommittee on Asia and the Pacific, met with officials from the 
Ho Chi Minh City AIDS Committee.  Staffdel members attending were: 
John Walker Roberts, Deputy Chief of Staff, HIRC; Peter Yeo, 
Minority Deputy Chief of Staff, HIRC; and, Douglas Anderson, 
Counsel, HIRC Subcommittee on Asia and the Pacific.  The AIDS 
committee, which is comprised of representatives of several city 
departments, is the last of its kind in Vietnam.  In mid-2003 the 
GVN restructured its response to the HIV/AIDS epidemic and 
replaced all other provincial level HIV/AIDS Committees with the 
Ministry of Health as the lead agency at both the provincial and 
national level. In HCMC, however, the AIDS Committee has been able 
to reach across departments for a more coordinated approach. 
 
3.  A detailed briefing by Dr. Tran Thinh, Project Coordinator of 
the city's AIDS Committee, highlighted the growing HIV/AIDS 
problem in the city.  According to the committee's statistics, 
0.9% of pregnant women at the city's primary maternity hospital 
test HIV positive, as do 3.4% of the city's new military recruits. 
This is more than double the national average.  In the city's 
primary treatment center for TB and Lung disease, 1216 patients 
were HIV positive or sick with full-blown AIDS.  This number has 
increased every year and was only 165 in the year 2000.  Dr. Thinh 
noted that trends of infection showed that the new cases were 
getting younger, and the disease was increasingly common among 
women.  He stated that the highest prevalence for HIV was among 
intravenous drug users (heroin), but was increasing among 
commercial sex workers.  The big news, however, was that Thinh 
stated that the disease is apparently making the jump from high- 
risk groups to the population at large.  Both Dr. Thinh and NGOs 
say that the infection rate is probably between one half and one 
percent of the overall population in Vietnam, and higher in Ho Chi 
Minh City.  A one percent infection rate is the point at which the 
spread is considered a "generalized" as opposed to a concentrated 
epidemic.  Every testing category, from military recruits to 
pediatric patients and from sex workers to pregnant women, is 
marked by an increase in prevalence. 
 
No Treatment for HIV/AIDS 
------------------------- 
4.  Dr. Thinh provided a window on the grim fate faced by those 
that develop AIDS in HCMC.  Basically, anti-retroviral drugs are 
not available to the general population.  They are simply too 
expensive.  According to Dr. Thinh, the only anti-retroviral 
therapies subsidized by the government are limited to health-care 
providers exposed in the course of their duties.  The health care 
system is only providing treatment of opportunistic infections 
associated with AIDS and palliative care. 
 
5.  In Dr. Thinh's words, he is "fighting a war with no soldiers, 
no supplies, and no strategy."  Trained healthcare workers are in 
short supply and the most effective therapies are in even shorter 
supply.  The nation spends only six cents per capita per year on 
HIV/AIDS, according to Dr. Thinh.  As for strategy, the HCMC AIDS 
Committee seems to understand that careful planning and 
coordinated action are key to countering the spread of the 
disease.  At this point, however, he noted that it is difficult 
for HCMC to take action without more policy guidance and material 
assistance from the central government.  Just the same, he said 
that even with the city's resource constraints, it was placing 
particular emphasis on testing and education, beyond the simple 
scare messages found on billboards nationwide.  He indicated the 
city was starting to provide some information to fifth graders 
(twelve year olds), since a lot of at-risk students left school 
after that.  Part of the overall effort is a USAID-funded 
anonymous testing center. In addition, USAID will be funding a new 
HIV/AIDS prevention program for high risk groups in HCMC. 
 
USAID Funds Anonymous Testing - 28% Positive 
-------------------------------------------- 
6.  Following Dr. Thinh's briefing, the staffdel met with program 
staff at the USAID-funded Anonymous Testing Site (ATS) in Binh 
Thanh District.  The ATS opened in November 2001 with funding and 
technical assistance from the University of California at San 
Francisco.  Currently, the ATS receives approximately 30,000 USD 
per year from USAID via Family Health International (FHI).  The 
ATS program, located above a `Condom Caf' on a busy street in a 
mixed commercial/residential area, is modeled after HIV testing in 
the U.S.  This model affords clients anonymity in the testing 
process and professional counseling, both before and after the 
test. 
 
7.  The center currently sees only about 80-100 individuals every 
month.  Most are in their twenties, and men outnumber women two to 
one.  Most admit to at least one high-risk activity such as IV 
drug use, participation in the commercial sex trade, or 
unprotected sex.  Of those that walk in the door, 90% decide to 
have the test that day and 84% of those tested actually return for 
the results.  Approximately 28% of ATS clients test positive for 
HIV.  Post-test counseling for ATS clients includes counseling on 
future behavior and medical referral. 
 
8.  The first floor of the building that houses the ATS is a 
`Condom Caf.'  In addition to the typical fare of coffee and pop 
p 
music, this caf's employees, all the beneficiaries of HIV/AIDS 
peer educator training, dispense literature on risky behavior as 
well as condoms.  The caf, reportedly popular with local youth, 
was founded by a French NGO but has since passed to the control of 
district health officials who operate and fund it. 
 
9.  The ATS program staff stated that they would like to expand 
the center's services to include U.S.-style support groups for 
those that test positive for HIV.  They also talked about the 
value of expanding the advertising campaign to increase the number 
of individuals taking advantage of the center's testing services. 
According to an American physician working with the ATS, an 
estimated 50-75% of Vietnamese infected with HIV are unaware of 
their status. 
 
10.  Comment: Without effective drug therapies available to the 
general population and without testing in meaningful numbers, the 
committee must find new resources, build capacity, and redouble 
e 
its public awareness campaigns if it is to make any kind of 
headway. 
 
11.  Staffdel McCormick did not have an opportunity to clear this 
cable before their departure. 
 
 
YAMAUCHI