US embassy cable - 05HOCHIMINHCITY398

UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 000398 
 
SIPDIS 
 
SENSITIVE 
 
DURBAN FOR A. PATEL 
 
E.O. 12958: N/A 
TAGS: PGOV, PREL, SOCI, KHIV, SNAR, PHUM, VM, CNARC, HIV/AIDS 
SUBJECT: SUBSTANCE ABUSE TREATMENT, HIV/AIDS AND HCMC'S DRUG 
REHABILITATION CENTERS 
 
REF:  A) HCMC 132; B) HCMC 160 
 
1. (SBU) Summary.  HCMC is struggling to provide effective 
substance abuse and medical treatment for injecting drug users, 
one of the principal vectors of the HIV/AIDS epidemic in Vietnam. 
HCMC maintains 21 rehabilitation centers for roughly 30,000 drug 
addicts, who are administratively -- and often involuntarily -- 
assigned to the centers for detoxification, follow-up treatment 
and vocational training.  Of these 30,000, at least 50 percent are 
HIV positive.  Personal drug use and commercial sex work in 
Vietnam are administrative rather than criminal offenses; control 
of these cases falls to local governments, not the criminal 
courts.  Officials responsible for managing the program privately 
tell us that their model for substance abuse treatment is not 
working, with recidivism rates approaching 95 percent within 18 
months, posing a real public health risk from both drug abuse and 
HIV/AIDS transmission perspectives.  They say they are ready to 
try new approaches, including substitution therapy for drug 
addicts, so long as foreign and domestic partners -- including 
religious organizations -- can provide needed technical, personnel 
and financial assistance.  End Summary. 
 
DRUG ABUSE, HIV/AIDS AND REHABILITATION CENTERS 
--------------------------------------------- -- 
 
2. (U) With 20,000 reported HIV infections, 10,000 persons 
diagnosed with AIDS and another possible 45-50,000 HIV infections 
unreported, Ho Chi Minh City has the highest prevalence of 
HIV/AIDS of all provinces and provincial-level cities in Vietnam, 
according to Dr. Tran Thinh, Vice-Director of the HCMC HIV/AIDS 
Committee.  On March 30, Thinh told the Ambassador that, according 
to the results of the HIV sentinel surveillance system in HCMC, 
intravenous drug use is the most common method of HIV transmission 
and as many as 80 percent of injecting drug users in HCMC may be 
HIV positive. 
 
3. (SBU) The high prevalence of HIV among injecting drug users 
presents a distinct challenge for preventing the spread of 
HIV/AIDS and treating victims of drug abuse.  The largest 
accessible pool of HIV-infected victims is in the city's 21 drug 
and prostitution rehabilitation centers, which house approximately 
30,000 residents.  According to HCMC administrators of the 
centers, between 85 and 90 percent of the residents are injecting 
drug users.  Case workers report that at least 50 percent, and 
perhaps up to 70 percent, of injecting drug users in the 
rehabilitation centers are HIV positive. 
 
4. (SBU) Placing addicts in rehabilitation centers is the 
established method for managing drug abuse in Vietnam.  In 
Vietnam, there are 84 rehabilitation centers for over 62,000 drug 
users and commercial sex workers.  Mr. Nguyen Van Minh, Vice- 
Director of HCMC's Department of Labor, Invalids and Social 
Affairs (DOLISA), which administers HCMC's rehabilitation centers, 
told us that the majority of the centers' residents are 
administratively ordered to enter the rehabilitation program.  He 
explained that after village or commune-level authorities become 
aware that a member of their community is using drugs, they will 
notify the individual's family and encourage the victim to seek 
treatment.  If the individual continues to use drugs after several 
months of local intervention, the case is referred to a 
consultative committee of the local People's Committee.  (Our 
DOLISA contacts added that families often petition local 
authorities to assign their addicted relatives to the 
rehabilitation centers.)  If the village-level committee 
recommends admittance to a rehabilitation center, the case is 
referred to the district level People's Committee, which will make 
the final decision.   There is no appeals procedure nor does the 
detainee have right to legal counsel as the process is an 
administrative, and not criminal, in nature.  (Under Vietnamese 
law, commercial sex work and intravenous drug use normally are not 
considered criminal offenses, but are "social evils" that 
government must combat.  Repeat drug offenders who have been 
through the rehabilitation program could be criminally prosecuted 
and imprisoned for two to five years.)  Minh added that police are 
not involved in the administration of the rehabilitation centers. 
 
5. (SBU) Our contacts maintain that the administrative process 
that assigns addicts to rehabilitation centers has adequate checks 
and balances.  They say that if Vietnam had no administrative 
process, most addicts eventually would be prosecuted under the 
criminal system.  They argue that injecting drug users require 
addiction and HIV/AIDS therapy irrespective of whether they are in 
a rehabilitation center, prison or another treatment facility. 
 
6. (U) Upon entering a rehabilitation center, residents receive a 
medical examination and treatment for existing medical conditions. 
Managers of the centers told us that HIV testing is voluntary and 
not part of the overall medical exam.  The patient usually spends 
the first ten days of treatment in a hospital or clinic while 
going through detoxification.  Traditionally, drug users are 
detained for up to two years while commercial sex workers are 
detained for three to eighteen months.  Residents spend their time 
working, receiving vocational training, and attending primary 
school classes, if needed.  Vocational training programs include 
welding, sewing, farming, and engine and automotive repair.  Our 
visits to a number of rehabilitation centers showed the facilities 
to be generally well-managed, not oppressive but spartan. 
 
REHAB PROGRAM NOT SUCCESSFUL 
---------------------------- 
 
7. (SBU) DOLISA representatives in HCMC and in the neighboring 
province of Binh Duong tell us that they estimate the recidivism 
rate is between 85 and 95 percent for IDUs released from the 
centers.  They say the high recidivism rate is due to the lack of 
reintegration programs to support residents returning to the 
community.  They add that local governments cannot afford 
substitution maintenance therapy -- methadone -- for addicts; this 
also hinders the success rate for rehabilitation. 
 
8. (SBU) In response to the high recidivism rate and what HCMC 
officials believe is the prohibitive cost of substitution 
maintenance therapy, HCMC extended the rehabilitation period for 
injecting drug users from two to four years.  HCMC officials tell 
us that during the first two years of the program, residents stay 
in a traditional rehabilitation center.  During the third and 
fourth years of detention, residents transfer to a "Stage Two 
Center," where they receive paid employment, vocational training, 
and further education.  Both state-owned enterprises (SOEs) and 
private companies, including cashew processing and garment 
companies, have set up factories within the Stage Two centers. 
Employed residents are paid monthly or weekly, depending on the 
terms of their labor contract, and officials say that wages are 
commensurate with similar jobs outside the centers.  Residents may 
place their earnings in savings accounts or purchase goods and 
services at stores within the centers.  The residents of the 
rehabilitation centers did not have the right to appeal the two- 
year extension of their detention period. 
 
9. (SBU) HCMC officials explained to us that the goal of the new 
initiative is to isolate injecting drug users from access to drugs 
for a longer period of time in hopes of giving them time to break 
their addiction as well as to give residents the time to acquire 
more marketable skills, which would ease their reintegration into 
the community.  HCMC authorities are awaiting the results of the 
release of the first group of residents in late 2005.  Prime 
Minister Phan Van Khai has praised the HCMC initiative and has 
indicated that, if successful, the GVN would encourage other 
provinces to follow suit. 
 
HIV/AIDS WITHIN REHABILITATION CENTERS 
-------------------------------------- 
 
10. (SBU) Our contacts readily acknowledge that most 
rehabilitation centers are not equipped to treat AIDS or the 
serious opportunistic infections AIDS causes.  Anti-retroviral 
(ARV) treatment and veritable voluntary counseling and testing 
(VCT) are not currently available at any centers, though some 
centers have residents who have been tested prior to entry based 
on their ability to afford the test. (Some centers in the north 
test all of their residents, but disclosure is not the norm.)  In 
Ho Chi Minh City, most residents are not tested for HIV/AIDS until 
they show symptoms of the disease and are transferred to a 
hospital or clinic for treatment.  As a result, many individuals 
in the centers are unaware of their HIV status and are often 
released without receiving any counseling or testing. 
Additionally, our contacts in DOLISA say that the city has been 
hard-pressed to recruit qualified health care providers to work at 
the city's rehabilitation centers.  Most centers are located in 
the countryside in neighboring provinces, where doctors and nurses 
are unwilling to relocate.  Additionally, the centers offer lower 
salaries and fewer opportunities for career advancement than 
private practice. 
 
11. (U) To begin addressing this need, in December 2004, DOLISA 
opened an HIV/AIDS clinic at HCMC's Trong Diem Rehabilitation 
Center -- the first clinic of its kind within a rehabilitation 
center in Vietnam.  The city has invested over $650,000 in the 300- 
bed clinic and plans to expand the clinic within two years into a 
1,000-bed hospital capable of treating AIDS patients from all 21 
of the city's rehabilitation centers.  DOLISA had been unable to 
find qualified doctors and nurses to work at the Trong Diem 
clinic.  In response, the city administration broke new ground by 
inviting the Catholic Church to provide doctors and nurses for the 
clinic.  According to its HCMC Vice-Director, DOLISA would like to 
expand its cooperation with the Catholic Church; the Vice-Director 
of the HCMC HIV/AIDS Committee similarly told the Ambassador that 
Trong Diem exemplified the future of public-private partnership in 
HCMC. 
 
COMMENT 
------- 
 
12.  (SBU) Government officials in HCMC and in neighboring 
provinces privately admit that their rehabilitation centers have 
not been successful in treating substance abuse and preventing 
HIV.  Some have expressed skepticism that extending the length of 
stay in rehabilitation centers from two to four years will make a 
meaningful reduction in recidivism.  However, they argue that cash- 
strapped local governments cannot afford substitution therapies 
and that addicts, if released after two years, would pose a clear 
public risk from drug abuse, crime and HIV/AIDS transmission 
perspectives.  HCMC authorities are eager to find ways to improve 
testing, care, treatment, and prevention activities within the 
city's rehabilitation centers.  They tell us that they are ready 
to cooperate with foreign and domestic groups to improve substance 
abuse and HIV/AIDS treatment. This includes the use of 
substitution maintenance therapy for drug addicts if funding is 
provided for such programs.  They also seek partnerships to deal 
with follow-up HIV treatment and community reintegration of 
rehabilitation center graduates. 
 
WINNICK