US embassy cable - 04HANOI2960

UNCLAS SECTION 01 OF 03 HANOI 002960 
 
SIPDIS 
 
SENSITIVE 
 
STATE FOR EAP/BCLTV AND S/GAC 
STATE PASS TO HHS FOR STEIGER OGHA 
AID FOR GH/OHA AND ANE/EAA FOR DWINSTON 
 
E.O. 12958: N/A 
TAGS: PREL, SOCI, VM, HIV/AIDS 
SUBJECT: HIV/AIDS:  AMBASSADOR VISITS U.S. GOVERNMENT- 
SUPPORTED HIV/AIDS PROJECTS IN HAIPHONG 
 
REF:  Hanoi 2946 
 
1.   (SBU) Summary:  During an October 29 trip to Haiphong, 
the Ambassador visited three HIV/AIDS projects supported by 
the President's Emergency Plan (EP) and met with city 
officials.  Haiphong is Vietnam's fourth most-populous city 
and suffers from the country's second highest HIV incidence 
rate.  Senior city officials described a number of HIV/AIDS 
awareness programs and public health measures they are 
taking to deal with the disease and outlined their anti- 
narcotics efforts.  The director of a voluntary counseling 
and testing center described efforts to identify HIV- 
infected individuals, to refer them to care and also to 
prevent the spread of the virus to others.  Participants in 
a support group for HIV-positive people identified as 
particular priorities changing public attitudes towards 
people living with HIV/AIDS and helping children of HIV- 
positive people.  Finally, the manager of a center for 
injecting drug users (IDUs) described the center's efforts 
at risk reduction for its clients.  End Summary. 
 
2. (SBU) The Ambassador visited Haiphong, Vietnam's fourth 
largest city and a provincial-level administrative entity, 
October 29 for meetings with local officials, community 
leaders and religious workers (the Ambassador's discussions 
with religious leaders will be reported septel).  Haiphong 
People's Committee Chairman Trinh Quan Su told the 
Ambassador that he is "delighted" that Vietnam had been 
chosen as part of the President's Emergency Plan (EP) and he 
pledged the Haiphong authorities' "strong cooperation" with 
the efforts of the United States and other donors to combat 
HIV/AIDS.  Provincial Department of Health Director Nguyen 
Van Vy, also present at the meeting, elaborated on the 
province's efforts to combat HIV/AIDS.  He seconded the 
Chairman's comments on foreign aid, saying that the health 
authorities seek to "mobilize communities" in their effort 
to fight HIV/AIDS and welcome USG assistance to Haiphong 
NGOs which are carrying this out.  Haiphong initiated 
HIV/AIDS prevention efforts in 1989, which Vy said was "very 
early" for Vietnam. 
 
3. (SBU) The city's greatest HIV threat comes from injecting 
drug users (IDUs), Vy continued.  The province has "strong 
leadership" on HIV prevention, and the People's Committee 
has held three sessions solely to discuss prevention 
measures.  In addition, the Provincial Party Committee had 
issued a resolution on HIV/AIDS prevention three years 
before.  Through government awareness efforts, 90 percent of 
Haiphong residents are aware of the disease and 50 percent 
know how to take preventive measures.  The city is now 
focusing on increasing HIV testing, strengthening safety 
measures during healthcare activities (such as testing 
donated blood), preventing mother-to-child transmission and 
providing syringes to IDUs in order to reduce HIV 
transmission.  There are 6,300 individuals infected with HIV 
in Haiphong, and 1,100 local residents have died of the 
disease.  The city has two facilities for treating the 
disease, each with 50 beds.  Vy claimed that, as a result of 
the authorities' efforts, the rate of new cases is down 30 
percent compared with previous years. 
 
4. (SBU) Specifically addressing the spread of HIV/AIDS 
through drug users, Haiphong public security director Nguyen 
Binh Doan said that there are 4,000 IDUs in the Haiphong 
area, and that Haiphong has two treatment centers -- one for 
300 addicts and a second for 200.  One third of the people 
in these centers had entered voluntarily, Doan claimed. 
(Note:  These drug rehabilitation and treatment centers, 
known as "06 centers," provide for the involuntary detention 
and treatment of repeatedly identified addicts.  The 06 
centers are essentially the only drug rehabilitation 
programs currently available in Vietnam.  A large minority 
of residents are "voluntarily" admitted by themselves or, 
more commonly, by their families.  End note.) 
 
5. (SBU) The Ambassador said he welcomed cooperation with 
the Haiphong authorities in prevention and treatment efforts 
and noted that the President's Emergency Plan would 
potentially allow them to expand activities.  He urged the 
authorities to lend their support to USG efforts to bring 
medicines for AIDS treatment into Vietnam tariff-free, 
noting that this would allow a 15 percent savings which 
could be used in other efforts.  Because being frank and 
open about the disease is important, the Chairman should 
speak out more publicly on AIDS, the Ambassador stressed. 
In fact, during a meeting the day before, Prime Minister 
Phan Van Khai had made a pledge to the Ambassador to raise 
his voice on HIV/AIDS (reftel).  On the subject of 
rehabilitation centers, the USG shares the GVN's desire to 
stop the use of illegal drugs.  However, we have a 
difference of opinion regarding the centers and are 
presently not able to work with them for policy reasons. 
Chairman Su closed the meeting by pledging to "personally 
speak out" on the danger of HIV/AIDS. 
 
6. (SBU) At a LIFE-GAP Voluntary HIV Counseling and Testing 
Center (VCT), which is funded by the Centers for Disease 
Control and Prevention (CDC) in a cooperative program with 
the Vietnamese Ministry of Health (MOH), Project Director 
Dr. Tran Thi Thanh Thuy identified the main activities that 
the two-year-old program carries out.  With a staff of eight 
trained counselors and three laboratory technicians, the VCT 
center has in its 23 months of operation counseled and 
tested more than 5,000 clients at high risk for HIV.  Using 
a MOH-required standard test strategy requiring two visits, 
90 percent of the center's clients returned for post-test 
counseling and were also referred to additional services if 
"indicated."  Dr. Thuy explained that the center receives 
clients through referral cards placed in health facilities 
across the province and also gave additional cards to all 
visitors to pass to their acquaintances.  Currently serving 
200 to 300 clients per month, the numbers of visitors tend 
to be higher in the fall and winter, as well as after the 
center conducts advertising campaigns.  Of those who have 
been tested, just over 22 percent were found to be HIV- 
infected, indicating that the services, which are free and 
anonymous (no name is reported to the Government), appear to 
be attracting higher risk clients.  Some 76 percent of the 
positive tests were among drug users, but sexual 
transmission appears to be rising, Dr. Thuy noted. 
 
7. (SBU) In addition to the VCT center, the CDC-funded 
program provides technical and financial support for an 
HIV/AIDS outpatient clinic attached to the provincial 
hospital; a community outreach program staffed by peer 
educators who work in high-risk neighborhoods to provide 
information, skills, condoms and referrals to IDUs and other 
vulnerable populations; and a program to detect and prevent 
mother-to-child transmission.  This USG-funded project also 
supports monitoring rates of sexually transmitted disease 
infections among persons at high risk for HIV, tracks the 
connection between tuberculosis and HIV in order to both 
enhance identification of co-infection and better coordinate 
the two provincial programs and distributes condoms to 
persons with high HIV risk.  Dr. Thuy noted that clients of 
the VCT site preferred the Vietnamese-produced condoms to 
the American condoms provided by the USAID Commodities Fund. 
Clients complained that the American condoms have an 
undesirable smell.  The stigma against AIDS suffers remains 
strong in Vietnam and it is sometimes difficult to recruit 
employees to work in the project.  In response to 
Ambassador's question, Dr. Thuy said that, with more 
funding, the center would like to expand its VCT and 
community outreach activities to more of Haiphong's 
districts, especially those in outlying areas. 
 
8. (SBU) Mrs. Pham Thi Hue and four members of "Red Flame 
Tree," a support group for HIV-positive people, described 
for the Ambassador their efforts to raise awareness of 
HIV/AIDS in Vietnam.  Mrs. Hue gives talks at schools and 
businesses, and said she was planning a trip to HCMC to 
speak at an Adidas factory the following day.  Ha Minh Thao, 
Hue's husband and a continuing drug user, noted he has 
spoken to IDUs about HIV/AIDS.  Most people have a basic 
idea about AIDS, Hue said, but "people are surprised to find 
out that someone who looks like me" is HIV-positive. 
Although the group has the support of local leaders and some 
funding from CARE, members have little or no access to 
medicines to treat the disease, Hue said. 
 
9. (SBU) Hue and the other members of the group told the 
Ambassador that people living with HIV/AIDS in Vietnam need 
both "spiritual support" from the public and help in caring 
for their children.  Support from Vietnam's leaders would be 
very useful in this.  Children with HIV/AIDS in particular 
often suffer as they are left by their parents, who either 
shun them or who have themselves died of the disease.  Mrs. 
Hue noted that her own son (who is not HIV-positive) is 
unable to attend preschool, although she is attempting to 
meet with teachers and parents to explain his condition and 
is hopeful that he will be able to begin soon.  The group 
had recently organized a festival for children who are HIV- 
positive and assisted families to purchase materials to help 
children with their schoolwork.  This "deeds, not words" 
assistance is most welcome by people living with HIV/AIDS 
and their families, Hue said. 
 
10. (SBU) The Ambassador's final HIV/AIDS-related site visit 
in Haiphong was to the Seagull Club, a drop-in and outreach 
center for IDUs partially funded by USAID through Family 
Health International (FHI).  Dr. Hoang Thi Tuyet Minh, 
Manager of the Seagull Club, explained that the club focuses 
on HIV risk reduction though consultancy activities, medical 
checks, peer-to-peer counseling, supplying condoms and by 
providing and exchanging hypodermic needles.  (Note: 
Syringe and needle access is legal in Vietnam without 
prescription, and, in this program, the needles are provided 
by the provincial health department.  No USG funds are used 
to procure or supply syringes or needles.  End note.) 
 
11. (SBU) Dr. Minh said that the club is known as a place 
where IDUs can relax, with a large number of visitors also 
coming to acquire needles.  She added that the club also 
attempts to spread knowledge about HIV/AIDS and makes 
referrals to the LIFE-GAP VCT center.  Approximately 60 
percent of the club's clients are HIV-positive.  In response 
to the Ambassador's question about the moral hazard of 
providing needles to IDUs, Dr. Minh explained that the club 
has a "hierarchy of harm reduction."  This prioritizes the 
encouragement of people not to use drugs, but, for those who 
are unable to stop injecting, the program also includes 
teaching methods of protecting injectors from acquiring HIV 
or transmitting HIV to others.  Dr. Minh said she does not 
know how many IDUs continue to share needles, but 
acknowledged that an estimate of ten percent by Mr. Thao of 
Red Flame Tree may be accurate.  Rates may be higher in 
distant areas and among groups that are harder to reach, 
such as prostitutes, she said. 
 
12. (SBU) In response to the Ambassador's question, Dr. Minh 
said that, if the club had more funds available, it would 
like to carry out a drug substitution (methadone) program to 
help eliminate injecting and, ideally, drug use overall. 
They would also like to help people released from 06 centers 
to identify long-term jobs.  The treatment these centers 
provide is by itself not enough, because a lack of new 
opportunities and the low price of heroin lead almost all 
former addicts to relapse.  Only one of the 5,000 IDUs 
reached by the club had successfully quit drugs.  FHI staff 
member Vuong Thi Huong Thu noted that the program has been 
effective in reducing HIV, as indicated in a recent FHI 
survey that showed the HIV infection rate among IDUs to be 
decreasing.  However, both drug use and HIV incidence are 
moving from urban to rural areas through seasonal laborers, 
she added. 
 
13. (SBU) Comment:  Haiphong's authorities showed a positive 
commitment to treating people living with HIV/AIDS in their 
city, and we hope we can use their positive example to 
encourage other leaders in northern Vietnam.  Nonetheless, 
our visits to the three organizations show an overall effort 
that is barely keeping its collective head above water.  It 
appears that these groups could be further expanded or 
duplicated to meet very immediate needs.  As more 
President's Emergency Plan money hopefully becomes 
available, we will be in a position to help improve on these 
existing efforts, as well as replicate them in other, less- 
prepared provinces in Vietnam.  End Comment. 
 
MARINE