US embassy cable - 05HOCHIMINHCITY984

UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 000984 
 
SIPDIS 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: PGOV, PREL, SOCI, SNAR, PHUM, VM, KHIV, CNARC, HIV/AIDS, RELFREE 
SUBJECT: SUBSTANCE ABUSE TREATMENT AND HIV/AIDS IN HCMC (UPDATE) 
 
REF:  A) HCMC 132; B) HCMC 160; C) HCMC 398 
 
Summary 
------- 
 
1. (SBU) The visit of an INL-led team to HCMC underscored the 
need for new approaches in drug rehabilitation and in HCMC's 20 
drug rehabilitation centers.  HCMC is still struggling to provide 
effective substance abuse and medical treatment for the 30,000 
injecting drug users and commercial sex workers in its 
rehabilitation centers, the primary populations in Vietnam for 
acquiring and/or transmitting HIV.  Contacts in the HCMC Catholic 
Archdiocese report that local corruption, bureaucratic ineptitude 
and discrimination against persons with HIV/AIDS are undermining 
the Church's efforts to act as an effective NGO partner with the 
HCMC government in the battle against HIV/AIDS.  End Summary. 
 
REHABILITATION CENTERS AND HIV/AIDS 
----------------------------------- 
 
2. (U) The visit of INL/C Gregory Stanton and Fernando Perfas of 
Daytop International to HCMC August 17 to 19 highlighted the 
challenges confronting HCMC in rehabilitating drug abusers and 
combating the closely linked problem of HIV/AIDS.  The team came 
to HCMC to lay the groundwork for Daytop International, a U.S.- 
based NGO, to implement an INL project to train 140 staff of 20 
rehabilitation centers throughout Vietnam on a new drug 
rehabilitation model.  The team was in HCMC to identify which of 
its rehab centers will participate in the program, slated to 
begin in November 2005.  (HCMC has 20 rehabilitation centers -- 
05/06 centers -- housing 30,000 inmates.  The HCMC Department of 
Labor, Invalids and Social Affairs (DOLISA) directly manages 12 
centers.  The HCMC Youth Federation manages the other eight 
centers.) During their visit to HCMC, the INL team met with Le 
Thanh Tam, Director, HCMC Department of Labor, Invalids and 
Social Affairs (DOLISA), Dr. Lan Thao of the HIV/AIDS Committee 
in HCMC, staff from 3 rehabilitation centers, and Father Dinh 
Thoai, Coordinator for HIV/AIDS programs for the HCMC Catholic 
Archdiocese. 
 
3.  (SBU) HCMC is still struggling to provide effective substance 
abuse and medical treatment for injecting drug users and 
commercial sex workers, the most vulnerable populations in 
Vietnam for acquiring and/or transmitting HIV.  Le Thanh Tam, 
Director of HCMC DOLISA stated that 50 to 60 percent of inmates 
in the city's rehabilitation centers are known to be HIV 
positive.  The actual number may be higher since HCMC does not 
have compulsory HIV testing. In many centers residents are tested 
but do not receive test results; thus, a significant number 
return to home communities unaware of their HIV status. 
 
4. (U) Tam said that the HCMC model divides drug rehabilitation 
into two phases.  Phase one focuses on detoxification, health 
improvement and therapy.  This phase lasts for two years.  At the 
end of phase one, the inmates are "encouraged" to enroll in the 
second stage of the program, which focuses on education, 
vocational training and job placement.  The length of the second 
stage is between one and three years.  According to 
rehabilitation center managers, the length of stay is determined 
by the inmate's ability to meet risk-mitigating criteria such as 
family support, prospective stable employment, and guaranteed 
housing in a neighborhood declared as a "drug-free zone."  The 
Phu Van center officials acknowledged that most inmates are 
unable to meet the early release criteria and remain in centers 
for the full term.  The officials also stated, "It takes a lot of 
effort by staff to get the inmates to volunteer to stay.  Risks 
of early re-entry (to society) must be explained and reiterated 
to residents and families."  Once the inmates agree to stay, they 
must sign a contract, which is submitted to local government 
authorities.  The HCMC government hopes that the extra three 
years in a rehabilitation center will reduce the relapse rate, 
which stands at over 90 percent.  The first class of five-year 
program clients will graduate in November 2005.1 
 
5. (SBU) Le Thanh Tam stated that the HCMC rehabilitation program 
faces numerous serious challenges, including low education levels 
in the client population.  Between 45 and 60 percent of inmates 
at different centers have not completed primary education.  A 
significant number are illiterate, making vocational and 
counseling activities difficult to organize.  Up to 25 percent of 
inmates were abandoned when they were children and have criminal 
records.  Up to 90 percent of inmates in some centers never had a 
stable job or occupation before entering the center. 
 
6. (U) Compounding the challenge of rehabilitation and 
reintegration into society, Dr. Thao of the HCMC HIV/AIDS 
Committee reported a significant increase in the number of known 
people living with HIV/AIDS (PLWHA) in 2005.  The increase of 
PLWHA is due to a new generation of drug users who are more 
sexually active and take drugs in group settings, often sharing 
needles.  The exact figures are unknown as very few persons use 
the city's voluntary testing program, Thao said.  Thao noted that 
in HCMC there is no aid or other benefits available for those 
identified as having HIV, and people fear the stigma of 
considerable societal discrimination against PLWHA in Vietnam. 
 
COLLABORATION BETWEEN CHURCH AND STATE ON THE ROCKS 
--------------------------------------------- --------- 
 
7. (SBU) Father Phuong Dinh Toai, in charge of HIV/AIDS programs 
for the HCMC Archbishop's office, expressed growing frustration 
with the inability of the Church to collaborate effectively with 
HCMC to care for persons with HIV/AIDS.  At a senior level, the 
Archdiocese's relationship with the HCMC government is generally 
positive.  The HCMC government has licensed the Church to operate 
a hospice for terminal AIDS patients in the Cu Chi District of 
HCMC and invited the church to staff and run the HIV/AIDS 
hospital in the city's Trong Diem rehabilitation center.  Father 
Thoai noted that the city administration also turns a blind eye 
to the Church's other initiatives such as opening a shelter for 
women and children with HIV/AIDS and running a private health 
clinic for HIV/AIDS patients. 
 
8. (SBU) However, the HCMC government has thus far been unable or 
unwilling to intervene with other local officials in support of 
the Church's activities.  For example, although the Church has 
complained to the HIV/AIDS Committee and DOLISA about corruption, 
malfeasance and incompetence in the Trong Diem center, nothing 
has changed.   Church volunteers at the center protested the 
local administrator's "no dying in the center" policy. According 
to Thoai, the center's managers do not want to deal with the 
paperwork associated with recording the deaths of patients in 
center and press for the patients to be transferred to hospitals 
to die.2 The Church has protested that such a policy is inhumane 
and impossible to implement in any case.  Administrators have 
asked Church caregivers to falsify death records in cases where 
patients have died at the center.  Administrators "counsel" the 
Church-supplied staff to tell visitors that they have no 
shortages of medicine and equipment, although medical supplies 
are in fact inadequate.  The Church also has reported situations 
when government-assigned staff members beat patients and smuggled 
cigarettes and other contraband into the center to sell to the 
patients.  Other government staff reportedly accepted bribes from 
inmates to allow them to escape.  As a result, administrators in 
Trong Diem have delayed signing new personnel contracts with the 
Church and have made working conditions for Church-supplied staff 
very difficult, Father Thoai said.  Additionally, local officials 
only permit the Church staff four days of leave per month, making 
life very tough for them. 
 
9. (SBU) The Church also is dissatisfied with the HCMC 
Government's response to local police "harassment" against its 
unofficial shelter for abandoned women and children with 
HIV/AIDS.  Father Thoai said he complained to the HIV/AIDS 
committee that local police had begun harassing staff, checking 
documents, threatening closure and conducting snap inspections, 
after they found out the shelter was for persons with HIV/AIDS. 
The HCMC HIV/AIDS Committee offered to legalize the center, but 
on the condition that the Church cede managerial control to it. 
Thus far, the HCMC Cardinal has refused. 
 
10. (SBU) According to Father Thoai, HCMC parish priests and even 
other bishops have criticized privately HCMC Cardinal Man for 
trying to regularize church HIV/AIDS humanitarian activities and 
expand them in cooperation with the state.  Thoai stated that the 
Cardinal is particularly frustrated that HCMC authorities have 
sought to steer potential donors from offering assistance 
directly to the Church.  In response, the Cardinal plans to 
organize his own international charitable conference on HIV/AIDS 
in HCMC in late October.  Current plans call for the HCMC 
Archdiocese to invite sister church organizations such as such as 
Caritas Germany, Secours-Catholique of France, Catholic Relief 
Services, and MISERO Germany.  The Archdiocese would invite local 
GVN organizations including the Fatherland Front, HIV/AIDS 
Committee, and possibly the HCMC Union of Friendship Associations 
to participate. 
 
11. (SBU) Comment: The visit of the INL team and subsequent 
discussions with NGO implementers at the rehabilitation centers 
underscored the timeliness of the INL project as well as the 
challenges before it, particularly in tackling the petty 
bureaucracy, occasional corrupt practices and discrimination 
against those with HIV/AIDS inside and outside of the centers. 
The visit also highlights the utility of having an NGO presence 
in the rehabilitation centers to act as an independent source of 
information on conditions within the centers.  End Comment. 
 
WINNICK 
 
 
_______________________________ 
1This is the first information I've had that there is anything 
voluntary about the second 1-3 year stage of treatment.  The 
requirement for residents to return to a "drug-free" zone is also 
problematic.  If this requirement were applied comprehensively, 
no one would be eligible for release. 
2Interesting...when we visited Trong Diem, Dr. Giang (HCMC PAC) 
told us patients were not allowed to die at the centers because 
they had no crematoria to dispose of the bodies.