Cablegate: Hiv/Aids in Vietnam: Situation and Response

This record is a partial extract of the original cable. The full text of the original cable is not available.

080352Z Mar 05

ACTION SGAC-00

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FM AMEMBASSY HANOI
TO SECSTATE WASHDC 6882
INFO AMCONSUL HO CHI MINH CITY
CDC ATLANTA GA
DEPT OF HHS WASHDC

UNCLAS HANOI 000560

SIPDIS

SENSITIVE BUT UNCLASSIFIED

DEPT FOR S/GAC
DEPT PASS USAID FOR ANE/KUNDER AND ANE-SPO BRADY
DEPT PASS USAID FOR ANE/KENNEDY

CORRECTED COPY

E.O. 12958: N/A
TAGS: EAID ECON OSCI VM
SUBJECT: HIV/AIDS IN VIETNAM: SITUATION AND RESPONSE

REF: A) Hanoi 223 B) HCMC 132 C) Hanoi 536

1. (SBU) This cable contains sensitive information and
should not be posted on the internet. This cable is a
corrected copy of Hanoi 536.

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 others in
nearby Thailand and elsewhere 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, thus
intensifying stigma and discrimination, GVN leaders including
the President and Prime Minister have 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 the 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 in countering drug use or the
commercial sex trade 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 55 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 be synchronized
with the GVN's National Strategy. 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 Summary.

HIV/AIDS Situation in Vietnam
-----------------------------

7. (U) Vietnam's first case of HIV was identified in 1990
and its 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 seeking
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 or even
among 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. The 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
likely 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 four percent in 2003, but
approached or exceeded ten 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
CSW.

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 on MSM remains limited in Vietnam and they are
still largely un-acknowledged 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
married.

National Response: Improving
-----------------------------

13. (U) The GVN 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 to respond, 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) 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.

15. (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, harm reduction, care and
support, surveillance, monitoring and evaluation, access to
treatments, prevention of mother to child transmission
(PMTCT), STI management and treatment, blood supply safety,
and HIV/AIDS capacity building and international cooperation.

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) The government's 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 rehabilitation centers,
detaining repeat drug use offenders and CSW for treatment and
reeducation. 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 while other privately funded centers are either
managed by a city or corporately), 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. The HIV prevalence among
residents of centers in Haiphong in northern Vietnam 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 availability.

Healthcare Infrastructure and Support
-------------------------------------

20. (U) Operated by the Ministry of Health (MOH), 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, the Ministry of Labor, Invalids
and Social Affairs of Vietnam (MOLISA) operates a separate
healthcare system for residents of the 05/06 Rehabilitation
Centers.

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 (ARV) therapy.

Shortage of ARV Availability
----------------------------

22. (U) Access to ARV therapy and treatment of
opportunistic infections can dramatically reduce morbidity
and mortality in Vietnam. In early 2004, a World Health
Organization (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 other 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 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. (SBU) A lack of management and administrative systems
training among the nation's healthcare leadership in the MOH
and at all levels hinders the quick dispersal and utilization
of funds. Frequent reorganization of ministries and a
strict, hierarchical leadership structure 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 donor 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 the centers and for improved awareness and
understanding about HIV prevention and intervention for local
leaders and for center staff (Refs 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
five million USD to HIV/AIDS in 2004; direct international
support currently totals nearly ten times that amount.

29. (U) To date, USG programs (including United States
Agency for International Development, Center for Disease
Control, 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 six
provinces (Quang Ninh, Haiphong, Hanoi, 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, WHO, World Bank, the Ford
Foundation, Australia, Canada and Germany, and soon also the
Asian Development Bank. The United Nations HIV Theme Group
operates under the leadership of the United Nations
Development Program (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 underpinned the USAID framework:
increased national capacity to respond effectively to the
HIV/AIDS epidemic, improved prevention of HIV and other
sexually transmitted infections, and implementation of
appropriate care and support strategies to mitigate the
impact of the HIV epidemic.

32. (U) In October 2001, the U.S. CDC and the Vietnam's MOH
Global AIDS Program (GAP) signed a formal cooperative
agreement 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 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. In addition,
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
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 are
integrated and coordinated both across USG agencies and with
Vietnam's National Strategy and other international
organizations. Prevention programs include community
outreach, behavior change communication and prevention
interventions with HIV-infected people. In addition, support
is being 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
synchronized with the GVN's National Strategy and the Action
Plan focus 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
challenges.

Other External Assistance
-------------------------

37. (U) There are roughly 30 international non-governmental
organizations (INGOs), 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, Adventist Development and Relief Agency or ADRA),
general development (e.g., CARE, Family Health
International), 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 GVN won awards on Rounds I, II and III for
the Global Fund, with Round I including 12 million USD for
HIV/AIDS programs. The principal recipient is the MOH, and
to date, roughly 2.5 million USD have been disbursed to the
MOH. Global Fund support goes 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 ARV 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.

MARINE

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