Cablegate: Ambassador Visits Pepfar Sites in Southern Vietnam

Published: Tue 10 Jul 2007 09:50 AM
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1. (SBU) Summary: During a June 6-8 visit to the Cambodian
border provinces of Dak Nong, Binh Phuoc and Tay Ninh, the
Ambassador reviewed local efforts to combat HIV/AIDS and the
impact of projects funded by the President's Emergency Plan for
AIDS Relief. Officials at the Vietnam Youth Corps Drug
Rehabilitation Center in Dak Nong told the Ambassador that: (a)
80 percent of the Center's residents are from HCMC; (b) the
Center follows the HCMC five-year "rehabilitation" plan (versus
the national mandate of 24 months); and (c) 50 to 60 percent of
the residents are HIV-positive. Although roughly 250 of the
Center's residents have been released within the past year,
there is no system for tracking and following up these releasees
to ensure that they are well reintegrated into their
communities, do not relapse, and receive appropriate medical
care and counseling. In contrast, the PEPFAR-funded Life Gap
Outpatient Clinic in Tay Ninh located in Tay Ninh General
Hospital appeared to be relatively successful in providing
community-based services to the province's HIV/AIDS community.
However, its future is uncertain as the Vietnam Administration
for HIV/AIDS Control (VAAC) has proposed a "regional" approach
to AIDS control that may jeopardize future support to this site.
End Summary.
Drug Rehabilitation Center in Dak Nong
2. (SBU) During a June 6-8 visit to the provinces of Dak Nong,
Binh Phuoc and Tay Ninh along Vietnam's border withCambodia,
Ambassador Marine reviewed local efforts to combat HIV/AIDS and
the impact of projects funded by the President's Emergency Plan
for AIDS Relief (PEPFAR). Established in 2001, Educational,
Vocational, and Employment Center Number 5 (commonly referred to
as a 05/06 center) in Dak Nong serves male drug addicts and some
sex workers; the Dak Nong Center is one of 21 such centers in
and around HCMC housing drug addicts who are primarily from
HCMC. Following the model in HCMC's other drug-treatment
centers, the Center's program consists of a four to five month
detoxification course followed by training, educational and
vocational courses over four to five years. Eighty percent of
the Dak Nong center's addicts are from HCMC. The remaining
patients are from Dak Nong and neighboring provinces. Their
average ages range from 25 to 30. The Center has a capacity of
1,750 patients, but currently houses 1,347. As of June 2007,
235 residents have been released as part of a release program
that began in the second half of 2006. Administrators of the
facility reported that they plan to release 600 to 700 patients
this year. The Center is administered by Dak Nong Province, but
receives the VND equivalent of USD one million per year from the
Central Government to cover operational costs.
3. (SBU) According to Center administrators, between 50 and 60
percent of the center's patients are HIV-positive. The Center
offers a non-compulsory three-part HIV/AIDS program of
education, testing and voluntary counseling for its HIV-positive
inmates. The initiative is partially funded by the World Bank.
However, administrators said that the USD 14,000 in assistance
they receive is insufficient to provide anti-retroviral therapy
(ART) to participants with AIDS. Center patients infected with
opportunistic diseases are sent to local hospitals for
treatment. Center administrators reported that they do not keep
statistics on the number of HIV/AIDS deaths amongst Center
patients, as they are sent to other facilities once they exhibit
severe symptoms. They claimed not to have "readily available"
the number of patients who have been sent away for medical
4. (SBU) According to the administrators, after the four to five
year rehabilitation program is complete, patients have the
option of returning to their home provinces, or participating in
job programs at industrial complexes and enterprises with which
the Center has signed agreements. Continuing education at an
HCMC university is also an option if the Center patient meets
admission requirements.
5. (SBU) A Vietnam Youth Corp official based in HCMC claimed
that of 6,000 individuals released from HCMC's twenty-one 06
centers thus far, only 43 relapse cases have been recorded.
However, she acknowledged that follow-up programs are based on
voluntary participation in social work groups and
community-based centers. She could not provide information on
the number or percentage of releasees who participate in these
A Successful Local Program in Tay Ninh
6. (SBU) The PEPFAR-supported LIFE-GAP HIV/AIDS Out Patient
Clinic (OPC) in Tay Ninh General Hospital offers HIV/AIDS
counseling, testing, treatment, and peer education, clinic
Director Truong Thi Dung told the Ambassador. Its seven-member
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staff consists of doctors, nurses, a data manager and a
pharmacist. The program also has a doctor stationed at the
province's 06 center to refer patients who have shown some
success during the rehabilitation program to the OPC.
7. (SBU) The Tay Ninh OPC has been in operation since September
2004. However, in the center's first year of operation only 60
per cent of clients tested for HIV returned for their results.
Subsequently, a team from the Tay Ninh OPC was selected to
attend the Hanoi School of Public Health's Total Quality
Management (TQM) training in Hanoi. Upon completion of the
training, the number of clients returning for their confirmatory
tests increased to 95 per cent, which exceeded the clinic's goal
of 85 per cent. The Tay Ninh project is one of 23 similar
initiatives in Vietnam, and showcases the potential improvements
in HIV/AIDS healthcare after quality management training of
public health personnel.
8. (SBU) Since beginning operations in September 2004, the
clinic has served 411 HIV-positive clients. (Note: There are a
total of 1,466 HIV infected cases in Tay Ninh Province, of which
699 are AIDS cases. There have been 502 deaths out of 699 AIDS
patients in the province. End note.) For Fiscal Year 2007,
PEPFAR is providing USD 300,000 funds for the OPC program. In
addition, PEPFAR indirectly provides technical assistance
through the Hanoi School of Public Health and LIFE-GAP, a
Ministry of Health organization which was established to
coordinate, manage and monitor the CDC HIV/AIDS project. During
the Ambassador's visit on June 8, the OPC staff reported that
their current challenge is to obtain sufficient funding for all
its activities. Although ART is one of the program's
components, OPC staff explained that due to a lack of sufficient
funding, currently only 24 of the 80 ART candidates identified
by the clinic receive the treatment. The staff explained that
traditional/cultural barriers present an additional challenge to
AIDS testing and treatment, as patients tend to exhibit a
pessimism that limits their willingness to return for counseling
and treatment. The center staff added that stigmatization
dissuades many from getting tested in the first place.
9. (SBU) In his meetings with provincial government leaders as
well as his visits to the HIV/AIDS and drug treatment centers,
the Ambassador noted that government leadership on this issue
needs to be stronger. More attention needs to be paid to the
HIV/AIDS epidemic, not only in terms of funding, but also in
terms of changing public opinion and ending the stigmatization
of persons suffering from HIV/AIDS. People living with HIV/AIDS
need to be brought into the national dialogue on how best to
approach problems related to care and treatment of the disease.
He noted that the 06 centers must make HIV/AIDS prevention,
counseling and treatment programs an integral part of the
overall rehabilitation program. Furthermore, tracking and
follow-up programs to ensure the well-being of those released
from 06 centers must be better designed, as they are essential
for the prevention of drug abuse relapses as well as for
ensuring the safety and health of an HIV/AIDS high-risk group.
Provincial government officials assured the Ambassador that they
are fully committed to the fight against HIV/AIDS and to greater
efforts to minimize the stigma faced by persons living with
10. (SBU) Comment: Although the Tay Ninh project is successful,
its future is in doubt. PEPFAR and the Ministry of Health (MoH)
are engaged in negotiations regarding current HIV/AIDS
programming strategies. In order to have a more comprehensive
approach at the systems level, as well as to augment the efforts
to date, the Vietnam Administration for HIV/AIDS Control (VAAC)
has proposed to focus on a "regional" geographic approach as
opposed to a province-specific approach. The number of
VAAC/LIFE-GAP sites could be reduced and the Tay Ninh program
may be a casualty.
11. (SBU) Comment continued: The inability of the Dak Nong 06
Center to provide comprehensive data on the status of persons
released from the center is not unusual. In fact, it reflects a
broader problem that HCMC and other provincial governments face
in monitoring and ensuring the well being of former drug abusers
-- many of them HIV-positive -- once they are released into the
community. End Comment.
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