Cablegate: Hiv/Aids in Vietnam: Situation and Response

Published: Fri 4 Mar 2005 10:24 AM
This record is a partial extract of the original cable. The full text of the original cable is not available.
E.O. 12958: N/A
REF: A) Hanoi 000223 B) HCMC 000132
1. (SBU) SENSITIVE: Please do not post on internet.
2. (SBU) Summary: In June 2004, Vietnam was selected as the
fifteenth focus country under the President's Emergency Plan
for AIDS Relief (Emergency Plan). While HIV/AIDS in Vietnam
is a relatively recent phenomenon compared with nearby
Thailand and others in the region, the epidemic in Vietnam is
rapidly increasing and expanding, driven largely by a co-
existing epidemic in injection heroin use and a growing
commercial sex industry. Its growing prevalence among young
adults threatens the future development of the country
socially and economically. With the Ministry of Health (MOH)
estimate of overall population prevalence still fairly low at
0.44 percent and with the epidemic concentrated among the
most at-risk populations such as intravenous drug users and
commercial sex workers, Vietnam still has an opportunity to
stem the spread of HIV/AIDS into the general population.
3. (U) The Government of Vietnam (GVN) has shown
considerable commitment in its HIV response. It initiated a
National AIDS Committee in 1987 even before the first case of
HIV was reported in Vietnam, and initiated a sentinel
surveillance system in 1994, which has expanded from eight to
forty provinces. The GVN also responded with a strong
campaign against drug use, prostitution and crime. While
policy and public perception initially linked HIV/AIDS with
the `social evils' of drug use and prostitution, intensifying
stigma and discrimination, GVN leadership including the
President and Prime Minister has gradually begun to address
and change those views. In 2004, the Prime Minister also
approved a National Strategic Plan on HIV/AIDS Prevention,
providing guidance for a comprehensive national response. At
a December 2004 conference, the Prime Minister acknowledged
that HIV/AIDS prevention and control must be considered as a
social development priority and proclaimed 2005 as the
Focused Year for HIV/AIDS Prevention and Control.
4. (SBU) Vietnam faces numerous challenges in coping with the
new epidemic. Besides the shortage of health care units and
staff trained in HIV diagnosis, treatment and care, and the
persistent stigma and discrimination against people infected
and affected by HIV/AIDS, Vietnam lacks adequate coordinated
national and local leadership across sectors, increasing its
vulnerability to the growing impact of this disease. One of
the strategies some provinces have followed in controlling
drug use and prostitution is to detain repeat offenders in
rehabilitation centers. These centers now hold nearly 60,000
people, among whom there is a very high HIV prevalence and a
high rate of infectious diseases among HIV-infected persons.
However, their effectiveness is limited.
5. (U) In order to mount an effective response to the
epidemic, Vietnam will require increasing levels of resources
committed to HIV/AIDS programs. It currently commits about
USD five million and relies heavily on international
assistance, which was nearly USD 30 million in 2004 and is
expected to rise substantially in 2005.
6. (U) The Emergency Plan will inject considerable additional
funding that will consolidate and expand U.S. agency-
supported HIV/AIDS prevention and care activities as well as
to initiate treatment programs in Vietnam. USG HIV/AIDS
activities under the Emergency Plan will also synchronize
with the GVN's National Strategy and Action Plan Areas. The
Emergency Plan will emphasize closer coordination with other
donors and over 30 international organizations to achieve the
most efficient and comprehensive mechanisms to meet current
needs and challenges. As a result of these efforts, the
United States hopes to intensify the GVN'S efforts to control
the spread of HIV/AIDS into the general population and
prevent the erosion of the country's economic gains. End
HIV/AIDS Situation in Vietnam
7. (U) Vietnam's first case of HIV was identified in 1990
and the first AIDS case was reported in 1993. Many experts
describe the HIV situation in Vietnam as `explosive,' as
numbers of infections increased from near zero to an
estimated 215,000 in just over a decade. According to the
Ministry of Health (MOH), all 64 provinces in Vietnam had
reported HIV cases by the end of August 2004. Very little
effective HIV treatment exists in Vietnam, and the use of
antiretroviral therapy regimens is limited. Because of
relatively low general population testing due to fear, stigma
and discrimination, most people with HIV in Vietnam do not
even know they are infected. Without effective
interventions, the national prevalence rate is projected by
MOH to rise to over 0.5 percent this year.
Prevalence and Surveillance: Drug Users and Sex Workers
--------------------------------------------- -----------
8. (U) The HIV epidemic in Vietnam is still considered in a
"concentrated" phase by WHO criteria, with overall population
prevalence estimated at 0.44 percent in 2004. (Note: U.N.
AIDS (UNAIDS) and the World Health Organization criteria for
a "concentrated" epidemic is a prevalence rate below 1
percent for adults aged 15-49. End Note.) However, there
are great differences in prevalence between provinces. In
those provinces with the highest HIV prevalence - including
all major urban areas - HIV prevalence for women presenting
for antenatal care (ANC) already approaches or exceeds 1
percent. (Note: ANC women are used as a proxy for general
population prevalence in Vietnam. End Note.) A recent survey
estimated that one in every 75 families in Vietnam has a
family member infected with HIV. These GVN estimates may
still underestimate the situation because surveillance is not
conducted routinely among the general population and certain
high-risk groups.
9. (U) Data regarding HIV prevalence in Vietnam is primarily
obtained through HIV Sentinel Surveillance (HIV SS) conducted
annually in 40 provinces for six sentinel populations:
intravenous drug users (IDU), female commercial sex workers
(CSW), antenatal women, sexually transmitted infection (STI)
clinic patients, tuberculosis patients, and military
recruits. The vast majority of HIV infections are in young
people less than 30 years old, with 55 percent of reported
HIV cases between the ages of 20 and 29. Unlike other focus
countries under the Emergency Plan, available data indicate
that the epidemic is primarily concentrated among those
groups who practice high-risk behaviors, including the IDU
population and secondarily among sex workers. These groups
and the sex worker clients are the key drivers of the
epidemic in Vietnam. Recent studies of these two sentinel
groups suggest further rapid spread is likely to occur into
the general population.
10. (U) To date, at least 60 percent of reported HIV/AIDS
cases have been in IDU. IDU in Vietnam are young, with a
mean age of less than 20 in Quang Ninh province and 21 years
in Hanoi. Nationwide, it is estimated that 30 percent of all
drug users are infected. However, 2003 GVN estimates showed
over 50 percent and as many as 75 percent of drug users are
believed to be infected in the larger urban settings
including the northern provinces and Ho Chi Minh City.
11. (U) A growing sex worker industry (street-based as well
as bar-, restaurant- and karaoke-based) has also played an
important role in HIV transmission. HIV sentinel data show
increasing prevalence rates in female CSW in several of the
40 provinces. More and more sex workers are also injecting
drugs. Behavioral surveillance and qualitative studies
indicate injection drug use is occurring increasingly among
women and that female IDU, frequently turn to sex work for
financial support. In a recent study of street-based sex
workers, 50 percent reported drug use (mainly heroin
injection) and 45 percent were HIV positive. Overall HIV
prevalence in female CSW was 4 percent in 2003, but
approached or exceeded 10 percent in certain urban areas
rates. Male CSW are increasingly common, but no data exist on
them. There are also no surveillance data on the clients of
12. (U) Two additional important populations not yet
included in the sentinel surveillance system are blood donors
and men who have sex with men (MSM). Studies of blood donors
indicated two of 10,000 donors screened positive for HIV.
Information remains limited for MSM in Vietnam and they are
still widely unrecognized by the government. However, a 2001
survey of 219 MSM in HCMC found MSM reported multiple sex
partners, did not use condoms consistently and were often
National Response: Improving
13. (U) The government of Vietnam has recently demonstrated
a much greater commitment in fighting HIV. A National HIV
sentinel surveillance was initiated in 1994 and has expanded
into 40 provinces. In 2001, the government initially
responded to the growing crime, drug and HIV epidemic with a
Three Reductions Campaign focusing on reducing drug use,
prostitution and crime. More recently, in 2004, the Prime
Minister signed a strong national HIV control strategy
committing responses across multiple sectors. In August
2004, President Tran Duc Luong met with and praised doctors
and nurses caring for HIV patients, and in a landmark event
for changing public perception, openly met with a group of
young people living with HIV/AIDS (PLWHA). The Prime
Minister further signaled Vietnam's focus on fighting
HIV/AIDS by convening a year-end National HIV Conference in
December 2004. At the conference, he spoke of the
seriousness of the problem and noted the issues of weak
sexuality and HIV/AIDS education for young people, the
expansion of commercial sex and the persistence of stigma and
discrimination. Calling on the entire political and social
system, the Prime Minister acknowledged that HIV/AIDS
prevention and control must be considered as a social
development priority and proclaimed 2005 as the Focused Year
for HIV/AIDS Prevention and Control.
National HIV/AIDS Strategy
14. (U) In March 2004, the GVN released the National
Strategic Plan on HIV/AIDS Prevention for 2004-2010 with a
Vision to 2020. The strategy provides a comprehensive
national response to the epidemic, calling for mobilization
of government, party and community level organizations across
multiple sectors. The strategy takes an active stance to
reducing drug-related HIV transmission and calls for efforts
to diminish HIV/AIDS-related stigma, including de-linking
HIV/AIDS from "social evils" such as drug use and
prostitution. The strategy calls for nine action plans to be
developed; these plans will constitute operational HIV/AIDS
policy and the government is currently negotiating with
national and international stakeholders to develop these
documents. The action plans will cover the following areas:
behavior change communication (BCC), harm reduction, care and
support, surveillance, monitoring and evaluation, access to
treatments, prevention of mother to child transmission
(PMTCT), (STI) Sexually Transmitted Infection management and
treatment, blood supply safety and HIV/AIDS capacity building
and international cooperation.
15. (U) Two things changed in 2000. First, the national
coordinating authority shifted to a new body, the National
Committee for AIDS, Drug and Prostitution Prevention and
Control. This committee is chaired by a Deputy Prime
Minister, and includes 18 member ministries of the government
and a number of other sectors, socio-political organizations
and federations and central institutions. Also in 2000, the
National AIDS Bureau (renamed the National AIDS Standing
Bureau, NASB) returned to MOH. Then in 2003, the National
AIDS Standing Bureau was dismantled in favor of relegating
coordination of HIV/AIDS activities and assistance to the
Department of Preventive Medicine and AIDS Control of the
AIDS Division within MOH.
Stigma and Discrimination
16. (U) Stigma and discrimination continue to pose a major
challenge to fighting the HIV epidemic and must be addressed
to enable people to seek health services and get the support
needed. Stigma intensifies the impact of HIV/AIDS at a
variety of levels. At the national and provincial levels
stigma encourages prejudice in the allocation of resources
and support mechanisms, while at the household and community
levels stigma reduces or removes informal support structures
that ordinarily provide support to families to cope with
health or economic instabilities. Discrimination against
PLWHA and people affected by HIV/AIDS, especially families,
is still common. HIV stigma and discrimination are compounded
by the fact that many PLWHA are also members of marginalized
groups such as IDU, CSW and MSM.
17. (U) Policies classifying people living with HIV/AIDS as
practitioners of "social evils" and a threat to society have
stigmatized those infected, while simultaneously impeding any
constructive public dialogue on the issue and hindering the
development of more effective prevention and treatment
programs. Policy and program activities designed to delink
HIVAIDS from the stigma of social evils have begun to be more
openly discussed as an essential feature of an effective
response in the country. As a further signal of the
Government's commitment to persons with or affected by
HIV/AIDS, in January 2005, the Prime Minister released
instructions to delink HIV/AIDS from social evils, and
censuring discrimination against persons with HIV/AIDS.
Drug and Prostitution Prevention and Control
18. (U) The national drug control policy of Vietnam has
remained consistent over the past decade, combining strict
law enforcement, socio-economic development and mass
education. Since 1997, policy implementation has fallen to
the Vietnam Standing Committee for Drug Control within the
Ministry of Public Security. Law enforcement approaches
dominate. No laws proscribe selling needles or syringes,
although most pharmacists do not sell sterile equipment to
presumed IDU. Government rehabilitation centers, also known
as 05/06 centers (05 centers house FSW, 06 centers house
IDU), constitute the provincial government programmatic
response to IDU and sex workers.
Rehabilitation Centers
19. (U) Government of Vietnam policy on rehabilitation for
IDU prescribes detoxification and community-based education
as first steps in treatment. Some local governments also
reacted to escalating crime by building social labor and
rehabilitation centers, detaining repeat drug use offenders
and CSW for treatment and re-education. These centers
include a large population at risk of acquiring or
transmitting HIV. Currently, there are 114 rehabilitation
centers in the country (84 of which are state-owned), with
more under construction. The total number of residents in
05/06 centers nationwide is nearly 60,000, with approximately
28,000 residing in the eighteen 05/06 centers in the Ho Chi
Minh City area alone. Overall, an estimated 50 percent of
residents in the rehabilitation centers in Ho Chi Minh City
are HIV-infected, with the prevalence ranging from 20 to 70
percent in a given center. HIV prevalence among residents of
centers in Haiphong is 80 percent. An estimated one quarter
of all living HIV cases are currently housed in the
rehabilitation centers, with very limited health care or drug
Healthcare Infrastructure and Support
20. (U) Operated by the Ministry of Health, the nation's
health care system is vertical, originating in the Central
Government and extending down through the provincial,
district and commune levels. Since 1988, the government has
allowed private medical practice that has contributed to
increasing access to health care services and choice in
providers. The majority of general health care is
administered at the provincial level. However, most
provincial AIDS committees lack an adequate number of trained
staff in public and allied health professions. A separate
health care system exists within the Ministry of Defense
(MOD) for active military, their families, and retirees and,
in many cases, civilians who for various reasons do not have
access to the MOH facilities. This system has its own medical
school and training. In addition, with one or two exceptions
where MOH provides services, MOLISA operates a separate
healthcare system for residents of the 05/06 Rehabilitation
Key Challenges
21. (U) Vietnam has a comparatively strong general public
health infrastructure and a leadership that is increasingly
engaged in addressing the HIV/AIDS epidemic. However, many
challenges remain. These include the shortage of a health
care workforce trained in HIV diagnosis, treatment and care,
the continued stigma and discrimination against people with
or affected by HIV/AIDS and inadequate coordinated leadership
across agencies and ministries. Along with strengthening
continued prevention efforts, Vietnam must also address the
growing need and demand for HIV treatment through
antiretroviral therapy.
Shortage of ARV Availability
22. (U) Access to antiretroviral therapy and treatment of
opportunistic infections can dramatically reduce morbidity
and mortality in Vietnam. In early 2004, a WHO task force
visited Vietnam to assess the nation's viability to enter the
WHO 3 by 5 Program (three million people on ARV treatment by
2005). The WHO team estimated that in January 2004, less than
100 people had access to ARV treatments. Many barriers
contribute to the lack of widespread availability of ARV in
Vietnam: the high cost of the drugs produced or purchased in
Vietnam and imported from abroad; limited coordination within
the MOH and with others sectors; limited coordination of
partners for care and treatment (including ARV procurement);
the high level of stigma and discrimination, particularly
within the health care system; and an absence of human
resources development and training plans.
Insufficient Clinical Care and Management
23. (U) There is an absence of policies and programs that
include training for health care workers and persons infected
and affected by HIV. Also lacking are affordable quality
care and clinical management with the full range of treatment
options from the provincial level to ward level; low numbers
of clinically qualified staff and poor remuneration and
incentives for staff motivation; and understaffed health
management units.
24. (U) The number of health care providers in Vietnam
trained in basic diagnosis and treatment of HIV/AIDS totals
about 350-400 professionals trained by USG, USG partners, and
other international NGOs. However, far fewer physicians have
been trained to provide anti-retroviral (ARV) therapy and
they practice primarily in four provinces: Hanoi, HCMC, Quang
Ninh and Hai Phong. Each province has an AIDS Division, but
few full-time specialized workers in AIDS prevention. Health
care provision in the military, 05/06 Centers and the public
health sector are also overseen by different Ministries.
Consistency in service provision is necessary if there is to
be an effective response.
Persistent Stigma and Discrimination
25. (U) Although there has been important progress, stigma
and discrimination about HIV still exist in society, and in
the key areas of employment, education and health services.
Relatively low HIV prevalence and ten years of public
campaigns associating HIV/AIDS with drug use, crime and sex
work have led to powerful stigma and discrimination,
including in the healthcare sector; efforts to improve the
legal framework for rights-based advocacy of PLWHA will prove
fruitful only if those rights are enforced. Until recently,
government policy defined HIV/AIDS as a social evil. The GVN
stance has recently changed and leaders have gradually begun
to address social perceptions of persons with or affected by
HIV/AIDS, and the Prime Minister's recent instructions have
officially defined the change in policy.
Weak Coordinated Leadership
26. (U) A lack of management and administrative systems
training among the nation's healthcare leadership in the MOH
and at all levels may hinder the quick dispersal and
utilization of funds. Frequent reorganization of ministries
and a strict, hierarchical leadership structure are likely to
inhibit the ability of government officials to lead decision-
making and policy formulation initiatives. While the Prime
Minister has recently acknowledged that an effective HIV
response requires active leadership across all ministries and
agencies, the National Committee for AIDS, Drug and
Prostitution Prevention and Control, which has national
coordinating authority, has not demonstrated much public
leadership. Interministerial cooperation and coordination
was further diminished by the GVN's decision to dismantle the
independent National AIDS Standing Bureau and subsume overall
responsibility for all HIV/AIDS programs and coordination
under the Department of Preventive Medicine and AIDS Control
of the AIDS Division within MOH.
Rehabilitation Center Concern
27. (U) A significant proportion of HIV-infected persons
and most at risk populations are currently in rehabilitation
centers. Strategies to ensure access to treatment and
continuing treatment regimens both for those transitioning
from centers and those sent into centers must be addressed in
the community. The GVN is concerned with the high rate of
infectious diseases among HIV-infected persons in the centers
and has raised the need for increased training and investment
in and improved awareness and understanding about HIV
prevention and intervention for local leaders and for center
staff. (Ref A and B)
Foreign Assistance
28. (U) As with any developing nation, Vietnam has limited
financial resources committed to HIV/AIDS activities and thus
depends heavily on international support. The GVN committed
nearly $6 million USD to HIV/AIDS in 2004; direct
international support currently totals several times that
29. (U) To date, USG programs (including USAID, CDC,
Department of Labor and Department of Defense) have provided
technical and financial support to Vietnam to develop HIV
prevention, treatment, and care programs in 33 provinces
throughout Vietnam - with particular focus in 6 provinces
(Quang Ninh, Hai Phong, Ha Noi, HCM City, An Giang and Can
Tho). Based on the nature of the epidemic in Vietnam, USG
interventions target the most at risk populations in the
country, and simultaneously build a network of care and
treatment services for those who are infected. U.S.
assistance for HIV/AIDS activities in Vietnam totaled
approximately USD 18 million in 2004 and will be
approximately USD 25 million in 2005. In addition to this
direct assistance, the United States is also a significant
contributor to the Global Fund, which has provided Vietnam
with further funding support.
30. (U) Other large bilateral donors or NGOs providing HIV
assistance include Great Britain (DFID), WHO, World Bank, the
Ford Foundation, Australia (AusAID), Canada, and Germany
(Kfw), and soon also the Asian Development Bank. The United
Nations HIV Theme Group is under the leadership of the UNDP
representative. In addition, there is an active effort to
coordinate strategy and activities among organizations
through the UNAIDS coordinator. International support
outside of U.S. assistance totaled about USD 30 million in
2004 and will increase substantially in 2005.
USG HIV/AIDS Activities
31. (U) USAID began funding HIV/AIDS activities in Vietnam
in 1999. In 2002, USAID developed a framework to support the
national HIV/AIDS program from 2003-2008, with the main
objectives to contain the spread of HIV/AIDS and to mitigate
the impact on those infected and affected by HIV/AIDS. Three
intermediate results underpin the USAID framework: increased
national capacity to respond effectively to the HIV/AIDS
epidemic, improved prevention of HIV and other sexually
transmitted infection, and implementation of appropriate care
and support strategies to mitigate the impact of the HIV
32. (U) In October 2001, a formal cooperative agreement
between the U.S. Centers for Disease Control and Prevention
and the Vietnam MOH initiated Global AIDS Program (GAP)
activities was signed for HIV prevention and control
activities and capacity building in 40 provinces and ten
national institutes. To manage these activities, the GVN
developed a new government coordinating office, the LIFE-GAP
Project Office, overseen by a 12-member Steering Board under
the direction of a Vice Minister of Health.
33. (U) USG has also supported HIV prevention initiatives
in the workplace through SMARTWork (Strategically Managing
AIDS Responses Together) Vietnam, a joint initiative of the
U.S. Department of Labor (DOL) and the Ministry of Labor,
Invalids and Social Affairs of Vietnam (MOLISA). Launched in
January 2003, SMARTWork fosters workplace HIV prevention
education and policies to prevent discrimination in the
workplace against employees affected by HIV/AIDS.
34. (U) The U.S. Department of Defense, through the U.S.
Pacific Command (PACOM), has funded HIV/AIDS training courses
at its Regional Training Center (RTC) in Bangkok, Thailand
since September 2004. Vietnamese military medical providers
have attended RTC courses on HIV/AIDS prevention, laboratory
diagnosis, counseling and policy development. Finally PACOM
has begun renovating laboratory facilities at the Military
Institute of Hygiene and Epidemiology.
The Emergency Plan
35. (U) In June 2004, Vietnam was selected as the fifteenth
focus country under the President's Emergency Plan for AIDS
Relief (Emergency Plan). This selection injected
considerable additional funding to consolidate and expand
upon U.S. agency supported HIV/AIDS prevention and care
activities as well as to initiate treatment programs.
Together, these programs target the most at-risk populations
and will be integrated and coordinated both across USG
agencies and with Vietnam's National Strategy and other
international organizations. Prevention programs will
include community outreach, behavior change communication and
prevention interventions with HIV-infected people. In
addition, support will be provided for certain general
population prevention activities in focus provinces,
including prevention of mother to child transmission (PMTCT),
blood safety and safe injection, and messages on abstinence,
delay of sexual debut and being faithful to one partner. In
the area of treatment, USG support will include safe and
effective antiretroviral drugs for adults and children,
laboratory equipment and tests related to HIV treatment, and
the development of drug procurement, management and drug
distribution systems. Care activities include a broad
spectrum of activities involving HIV-infected persons such as
HIV counseling and testing, palliative clinical and community-
based care, provision of drugs to prevent or treat
opportunistic infections and certain treatment interventions
for injection drug users.
36. (U) USG HIV/AIDS activities under the Emergency Plan are
intended to synchronize with the GVN's National Strategy and
Action Plan areas. The Emergency Plan further aims to
cultivate strong local leadership and sustainable activities
through diverse partnerships with the GVN across multiple
ministries and agencies, mass organizations like the Vietnam
Women's Union and the Vietnam Youth Union, faith-based
organizations, local non-governmental organizations and
community-based organizations. The USG strategy also
emphasizes close coordination with other donors and
international organizations to achieve the most efficient and
comprehensive mechanisms to meet current needs and
Other External Assistance
37. (U) There are roughly 30 international non-governmental
organizations (INGOs), over five government-sanctioned
technical local non-governmental organizations (LNGOs), seven
UN organizations, five major bilateral agencies and the
Global Fund concentrating resources on HIV/AIDS programs in
Vietnam. International organizations include faith-based
(e.g. World Vision, ADRA), general development (e.g. CARE,
FHI), and specialized consulting firms (e.g. Abt.
Associates). Local non-government organizations include
specialized research organizations, program design and
implementation organizations, and community-based
organizations. The Government of Vietnam won awards on Rounds
I, II and III for the Global Fund, with Round I including $12
million for HIV/AIDS programs. The principal recipient is
the MOH, and to date, roughly $2.5 million have been
disbursed to the MOH. Global Fund support will go to
prevention, care and treatment programs directed by the MOH
in 20 provinces.
38. (SBU) Comment: Vietnam has a unique opportunity to
mount an effective response to its growing HIV/AIDS epidemic.
In the last year, the approval of the National AIDS Strategy
and the Prime Minister's declaration of HIV/AIDS as a top
priority for the GVN have been important steps forward in the
fight against HIV/AIDS. Among the key challenges and
opportunities Vietnam now faces in its national HIV response
are: the lack of sufficient human resources to implement the
National AIDS Program; the limited antiretroviral treatment
currently available to AIDS patients; and the participation
of and consensus among different ministries and sectors.
Coordinated inter-ministerial leadership will ensure that
prevention measures mobilize all relevant sectors and
organizations, and that strategy and resources for care and
treatment are coordinated and managed efficiently and
effectively. It is also essential for the implementation of
and coordination among the many activities and programs
supported by international assistance. Consistent public
messages and supporting legal reform will also be necessary
to eliminate enduring stigma and discrimination against
PLWHA. End of comment.
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