HANOI — As preparations start for the international conference AIDS 2012 later this month, in Washington, D.C., specialists in Vietnam are discussing ways to develop their own expertise as donor money becomes increasingly thin.
Vietnam’s first case of HIV was recorded in Ho Chi Minh City in the early 1990s. For the next 10 years, the most clinicians could do was provide diagnosis.
But with help from international organizations, over time diagnosing the disease was no longer like giving a death sentence.
With training and resources from several global agencies, Vietnamese doctors started administering life-saving anti-retroviral drugs in 2005. Clinicians say, after treatment, patients regain their health, can go back to work and lead a nearly normal life.
Vietnam HIV/AIDS, proactive approach
But as a middle-income country, Vietnam can no longer rely on external support.
"All activities for treatment in Vietnam get support from the projects supported by the outside. But after some period, the projects finish. So Vietnamese must stand on their own," said Dr. Nguyen Van Kinh, leading researcher on HIV/AIDS in Vietnam.
Kinh says that is part of the reason why health specialists in the country created the Vietnam Clinical HIV/AIDS Society, known as VCHAS. It was set up with support from the U.S. Centers for Disease Control through the Harvard Medical School AIDS Initiative, as part of the U.S. President’s Emergency Plan for AIDS Relief.
Kinh is president of the society, which held its first meeting last month. It has been hailed as one of the first professional medical organizations in Vietnam of any kind, and Kinh has high hopes for its future.
"VCHAS has three functions. First, networking and sharing experience and treatment. Second, improve the capacity of the physician, technician working on HIV/AIDS treatment," explained Kinh. "And, third, we try to share experience with other countries and international organizations."
Historically in Vietnam the HIV/AIDS epidemic has been concentrated among injecting drug users, but medical advisors say this is now shifting to sexual transmission. An emerging key population at higher risk of catching the disease is men who have sex with men, where the rate of infection is nearly 17 percent.
Vietnam UNAIDS Director Eamonn Murphy says part of the challenge in reaching these men is cultural taboos, says Eamonn Murphy.
"In many parts of Vietnam they act like this does not exist. I mean, come on, no country in the world does not have MSM [Men who have Sex with Men] ... I have been in provinces where they say, 'Oh, we do not have any of those, go to Ho Chi Minh City," he recalled.
Murphy says discrimination against people living with HIV/AIDS is not uncommon. People still move home because of the way their neighbors react to their HIV status. And, children can be denied access to schools because their parents have HIV, even if the children themselves do not.
Stigma is also known to affect medical professionals working with HIV/AIDS patients. Dr. Pham Thanh Thuy, a leading specialist in the disease from Hanoi’s Bach Mai hospital, says there is sometimes reluctance among public health professionals in other fields to treat HIV/AIDS patients because of a lack of knowledge.
But part of the work planned by VCHAS will be to provide training to other hospital departments so medical staff can understand more about the disease.
"With this training we get people to understand HIV. It can help them to decrease the discrimination and it can help them to help us treat HIV-infected patients if they need care other than HIV treatment. I mean care and treatment for non HIV-methods, the things [health issues] that anyone can have," stated Thuy.
As donors prepare to disengage, Vietnam has recognized that urgent action is needed to pay for treatment and prevention. The government has stepped up funding from its budget to pay for drugs necessary for treatment. But that is not enough, according to UNAIDS’ Murphy.
He says there needs to be major reprioritization of resources to fill the gap. Part of that could come from scrapping the country’s controversial rehabilitation centers for drug users.
"These detention centers, huge white elephant, waste of money. They do not achieve the outcomes that anyone is looking for," said Murphy. "Either in terms of either social order control or public health."
The centers met international condemnation after a report last year by Human Rights Watch accused them of forced labor. Murphy says, although there are fewer drug users in the centers now, they still cost money and it would be better if the resources were used for public health.
He says the government recognizes there are more effective ways of dealing with heroin dependence and has set a target of 80,000 people on methadone by 2015, up from the current 10,000.
Founders are hopeful VCHAS will encourage medical professionals to feel proud of their hard work in a sector that is neither popular nor lucrative and will also generate home-grown research in Vietnam.
Dr. Thuy says Vietnam has come a long way in tackling discrimination, but there is still more to be done. Although VCHAS is still very new, she hopes that the organization will help clinicians treat people who take part in so-called "social evils" as patients and provide treatment whenever and wherever they need it.