US embassy cable - 05HOCHIMINHCITY132

UNCLAS SECTION 01 OF 02 HO CHI MINH CITY 000132 
 
SIPDIS 
 
SENSITIVE 
 
DEPT FOR S/GAC - MANI 
 
E.O. 12958: N/A 
TAGS: KHIV, PGOV, EAID, PREL, SOCI, VM, HIV/AIDS 
SUBJECT: DEPUTY GLOBAL AIDS COORDINATOR VISITS HCMC 
 
1. (SBU) Summary.  Dr. Joseph O'Neill, Deputy U.S. Global AIDS 
Coordinator, heard from government officials, health care 
providers, and NGO directors who expressed thanks for USG 
assistance to combat HIV/AIDS and pointed out the need for further 
anti-retroviral (ARV) treatment and technical training.  The high 
prevalence of HIV among injecting drug users (IDUs) presents a 
challenge for treatment, care, and prevention to which city 
leaders are struggling to respond, particularly within the city's 
drug rehabilitation centers.  The Ministry of Health is poised to 
begin ARV treatment in the coming months with assistance from 
organizations funded by the President's Emergency Plan for AIDS 
Relief (Emergency Plan).  End Summary. 
 
2. (SBU) During a January 26-29 visit to HCMC, Dr. O'Neill called 
on the HCMC People's Committee and visited Emergency Plan partner 
sites and drug rehabilitation centers to discuss HIV/AIDS 
treatment, care, and prevention efforts.  Nguyen Thanh Tai, HCMC 
People's Committee Vice-Chairman and AIDS Committee Chairman, 
welcomed Dr. O'Neill to HCMC and said he hoped the visit would 
"lay the groundwork for future cooperation" between HCMC and the 
USG to combat HIV/AIDS.  While delivering standard GVN rhetoric 
that HIV is a "social evil" the GVN hoped to stamp out, Tai said 
the government was focused on preventing new HIV infections, 
caring for those with the disease, and reducing the stigma 
surrounding HIV/AIDS.  Tai admitted that HCMC was "not successful" 
in treating substance abuse at its drug rehabilitation centers and 
was struggling to care for the approximately 15,000 residents of 
the city's centers who are HIV positive.  He said HCMC is looking 
at foreign models that could be applied in Vietnam and welcomed 
Dr. O'Neill's advice.  Tai highlighted the city's cooperation with 
the Catholic Church to treat AIDS patients at Trong Diem 
Rehabilitation Center. 
 
HIV/AIDS WITHIN HCMC'S REHABILATION CENTERS 
------------------------------------------- 
 
3. (SBU) Dr. O'Neill visited Trong Diem and Duc Hanh 
rehabilitation centers, both managed by the HCMC Department of 
Labor, Invalids, and Social Affairs (DOLISA).  (Note:  There are 
over 28,000 people in HCMC's 18 rehabilitation centers.  The 
centers detain commercial sex workers and drug users for one to 
five years.  Authorities report a recidivism rate from 85 to 95 
percent for IDUs.)  Mr. Nguyen Van Minh, Vice-Director of DOLISA, 
said the majority of Trong Diem's 2,200 residents were IDUs.  He 
acknowledged the government's struggle to provide effective 
substance abuse treatment, noting that substitution therapy is not 
available at the centers.  HCMC responded to the high recidivism 
rate in 2003 by increasing the length of detention for IDUs from 
two years to four years and adding a vocational training program. 
 
4. (SBU) Dr. Le Truong Giang, Vice-Director of the HCMC AIDS 
Committee, reported that approximately 50 percent of 
rehabilitation center residents are HIV positive, a number that 
has increased each year.  Most centers have small medical clinics 
but are not equipped to treat AIDS patients.  ARV treatment and 
voluntary counseling and testing (VCT) are not currently available 
at the centers.  Dr. O'Neill toured the newly opened HIV/AIDS 
clinic at Trong Diem Rehabilitation Center -- the first clinic of 
its kind within a rehabilitation center.  HCMC invested over 
$650,000 in the 300-bed clinic and plans to expand it into a 1,000- 
bed hospital capable of treating AIDS patients from all 18 of the 
city's rehabilitation centers.  Dr. Giang said DOLISA was unable 
to find qualified doctors and nurses to work at the clinic and had 
invited the Catholic Church to provide staff.  The only doctor 
currently at the clinic was appointed by the Catholic Church, as 
were most of the clinic's nurses.  Catholic Relief Services (CRS) 
is also working with DOLISA to provide a clean water supply for 
the clinic.  The center is not currently receiving any USG 
funding. 
 
ARVs ON THE WAY 
--------------- 
 
5. (U) Dr. O'Neill visited three organizations that will soon 
begin providing ARV treatment using Emergency Plan funds:  Tam 
Binh Orphanage, the Anonymous Testing Site (ATS), and Medicine du 
Monde's An Hoa Clinic.  Tam Binh Orphanage -- a HCMC orphanage 
managed by DOLISA that cares exclusively for the city's growing 
number of HIV positive orphans -- plans to begin ARV treatment for 
25 of the 83 children at the center.  At An Hoa clinic staff 
briefed Dr. O'Neill on their plans to begin providing ARV 
treatment to the clinic's target population of drug users, 
commercial sex workers, Khmer migrants, and homeless women and 
children.  While the clinic has a well-established record of 
providing basic health care services, it is new to HIV treatment. 
Directors of Tam Binh Orphanage and the Medicines du Monde clinic 
cited a lack of trained staff with experience in ARV treatment as 
their major challenge.  Medicines du Monde will bring a team of 
French doctors to Vietnam for six months to provide training at 
their clinic. 
 
6. (U) Dr. O'Neill also visited the HCMC Anonymous Testing Site 
(ATS), which has provided voluntary counseling and testing to over 
2,800 clients since opening in 2001 and currently averages 140 new 
clients per month.  ATS attracts clients through its next-door 
coffee shop with a back-door entrance to its counseling, testing, 
and care center.  ATS also has an education and support program 
targeting the high-risk population of men who have sex with men, 
including an exercise facility and karaoke room.  Free condoms and 
HIV/AIDS information are available at both the coffee shop and the 
exercise facility.  Using Emergency Plan funds, ATS will open a 
medical clinic in March to treat HIV patients and provide ARV 
treatment for 200 clients. 
 
HOSPITAL STRUGGLES TO KEEP UP 
----------------------------- 
 
7. (U) At the HCMC Tropical Disease Hospital, Vice-Director Nguyen 
Tran Chinh said the hospital's HIV/AIDS Department needed more 
beds, medicines, test kits, and staff to keep up with the demand 
for treatment.  Dr. O'Neill observed an overcrowded inpatient 
HIV/AIDS ward.  While the hospital awaits government approval to 
build a larger HIV ward, it is squeezing 30-50 patients in a space 
designed for ten beds, often discharging patients prematurely to 
make room for others.  Current staff members are well trained, but 
their numbers are insufficient.  Dr. Chinh said 60-75 percent of 
the hospital's HIV patients are IDUs who pose a risk of spreading 
the disease to others without effective substance abuse treatment. 
 
8. (SBU) Comment.  While Tam Binh Orphanage, ATS, and the Tropical 
Disease Hospital are held up as models of HIV care in Vietnam, 
they face difficulties of their own, including shortages of 
medicines, and equipment, and lack of expertise in ARV treatment. 
The Emergency Plan will help to address these needs.  The 
concentration of HIV among IDUs presents its own challenge. 
Clearly, the city has not yet established an effective substance 
abuse treatment model, a step that would go a long way towards 
preventing the spread of HIV.  End Comment. 
 
9. (U) Dr. O'Neill did not have the opportunity to clear this 
message. 
 
WINNICK