A delegation from Viet Nam visited the drug quality control division of a Thai factory that manufactures antiretroviral medicines. L to R: Dr Chu Quoc An, Head of Delegation, Mr Bang from Viet Nam Social Security, Mr Tien from Drug Administration of Viet Nam, Dr Nhan from Viet Nam Administration for AIDS Control Credit: UNAIDS/Bich.N

Mr Dong, a 37-year-old man from Hanoi, has been living with HIV for a number of years. He is in good health thanks to the antiretroviral treatment that is provided free of charge in Viet Nam and is a leading member of the Viet Nam Network of People Living with HIV (VNP+).

But Mr Dong, as well as many other colleagues in the Network, is worried. He knows that the donors who pay for nearly all of Viet Nam’s HIV treatment programme will soon leave. Who will pay for his antiretroviral (ARV) medicines in the future?

“The first-line of antiretrorival treatment I am currently on costs about US$ 98 per person per year. That is with imported generic medicines,” explains Mr Dong. “I can afford it for now if treatment is no longer free. But I don’t know until when I can stay this healthy and keep my job, while antiretrorival treatment is life-long. That is not to mention that treatment cost could be much higher if I have to shift to second-line treatment or buy non-generic drugs,” he noted.

At the end of 2012, Viet Nam was providing antiretroviral treatment for nearly 60% of all people in need, according to the Viet Nam Administration for HIV/AIDS Control (VAAC). However, 97% of the funds for antiretroviral medicines come from external funding, which is expected to significantly decrease after 2015.

This is the result of Viet Nam’s recent achievement of middle-income country status and the prolonged economic downturn in donor countries. The Government of Viet Nam is increasing its national budget allocations to the HIV response, but much more slowly than the expected decrease in donor support. Current projections of the amount of funding required to purchase antiretroviral medicines for all in need indicate there will be a significant gap by 2016.

Deputy Prime Minister Nguyen Xuan Phuc has called on VAAC to address this potential funding crisis, and VAAC has initiated the development of a “National Plan to Ensure the Sustainable Supply of ARVs Beyond 2015”, in collaboration with development partners, including UNAIDS.

South-south learning and political leadership is key

Collecting evidence and good practice from countries in the region was identified by VAAC as essential to inform the development of the plan. In April 2013, UNAIDS supported a study visit by a multi-sectoral Government delegation to Thailand.

The delegation learned how Thailand, as a middle-income country, is providing universal access to antiretrovirals and all HIV-related tests free-of-charge, financed by the state budget and provided to all in need through national health insurance schemes. They also learned how Thailand has issued compulsory licenses for two kinds of ARVs and centralized procurement and supply chain management of ARVs to keep costs down while also ensuring the Thais have access to high-quality first-line and second-line drugs.

“We learned a lot about how Thailand went through a long process to achieve universal coverage of healthcare for all Thai people and antiretroviral treatment for those in need, and about their challenges,” said Dr Chu Quoc An, head of the Viet Nam delegation. “Yet, the most important lesson learned is that strong political leadership at the highest levels has been Thailand’s key to success.”

Positive outlook

Delegates agreed that leadership, determination and a strong multi-sectoral coordination will be critical for Viet Nam to adapt and adopt lessons learned from Thailand. As the study tour emphasized, adequate time is also needed to enable plans to come to fruition.

“I believe Viet Nam can do it,” said Steve Kraus, UNAIDS Regional Director for Asia and the Pacific. “We can see how the country is accelerating progress towards national targets and international commitments on HIV treatment. We can see the determination is there. UNAIDS is committed to continue supporting this South-South cooperation, and to assist Viet Nam in its quest to ensure life-long treatment for all in need.”

For Mr Dong, the progress towards a sustainable plan for treatment is encouraging, but concerted action is critical. “I am excited to hear about VAAC’s development of the ARVs sustainability plan and the engagement of many sectors,” he said. “I hope National Assembly and Government leaders will pay more attention to this issue so the plan can soon become a reality, for the benefits of people living with HIV and the wider community.”

People who use drugs in a 05 centre in Tien Lang district, Hai Phong City, Viet Nam.
Credit: UNAIDS

The life of a female sex worker in Viet Nam is filled with fear—fear of HIV, fear of violence, fear of stigma, and most of all, fear of the law enforcement services. A study conducted by the government of Viet Nam in 2012 on sex work and migration found that 50% of female sex workers report being afraid of the police. Up until a few months ago, arrest could lead to years of confinement in an administrative detention centre known as the ‘05’.

However, very recently, the National Assembly of Viet Nam passed a new Law on the Handling of Administrative Sanctions which effectively ends the practice of detaining sex workers in ‘05’ centres. The Law also allows drug users who are subject to compulsory treatment in drug detoxification centres to have court hearings on their cases and legal representation at the court.

“I found it like a dream coming true when I heard the news,” said Khanh, a leader of the Peaceful Place self-help group for female sex workers in Ha Noi, Viet Nam. “I used to use drugs and sell sex. I spent six terms in detention centres. I know how hard it is to stay in there and I know [detention] centres do not help you to stay away from drugs or stop selling sex.”

Khanh was one of the community representatives who were able to share their life experiences and their needs with members of the drafting committee of the new law in early 2011 during a community consultation workshop organized with support from UNAIDS.

During the development of the law, government officials and National Assembly members also sought concerted policy advocacy and technical assistance by United Nations agencies—including UNAIDS, UNDP, UNICEF, UNODC, WHO and UNFPA under the framework of the One UN Initiative in Viet Nam.

“I highly appreciate the United Nations’ concerted support to the Ministry of Justice for the development of the Law on the Handling of Administrative Sanctions,” said Vice Minister of Justice Nguyen The Lien, Vice Chairperson of the Law’s drafting committee. “The United Nations has strong comparative advantage in providing legal support to Viet Nam because the United Nations always respects the country’s ownership and leadership in legislation development,” he added.

Following the law’s passage, UNAIDS and other UN agencies are providing support to the development of enabling regulations and the alignment of existing policies that are required for the Administrative Sanctions Law to be put into practice.

The Ministry of Labour, Invalids and Social Affairs (MOLISA), which is responsible for prevention and control of drug use and sex work, is organizing a national policy dialogue that aims to ensure coherent implementation of the law’s new provisions on sex work. The Ministry is also working on a ‘renovation plan’ to introduce alternatives to drug detoxification in detention centres. These include open, user-friendly and voluntary drug treatment centres operating under a ‘community-based’ treatment approach—a treatment model offering social and occupational services, including psychological support and aftercare along with drug treatment services such as detoxification, opioid substitution therapy and relapse prevention.

“By closing administrative detention centres for sex workers and changing compulsory closed drug detoxification centres into open, community-based drug treatment services can greatly help scale-up HIV prevention services for people who are at higher risk of HIV in Viet Nam. This will increase the efficiency of the national response to HIV,” said Tony Lisle, UNAIDS country coordinator for Viet Nam.

According to 2011 HIV sentinel surveillance, HIV prevalence among men who inject drugs and female sex workers was 13.4% and 3% respectively. Another in-depth study estimated that HIV prevalence was 48% among men who inject drugs in Ho Chi Minh City, and 20% among sex workers in Hanoi, the capital of Viet Nam.

“I highly commend the Government and National Assembly for this very important [action]. It will bring tangible benefits to the lives of many Vietnamese,” said Ms Pratibha Mehta, United Nations Resident Coordinator in Viet Nam. “The United Nations hopes that the National Assembly will also review the administrative detention centres for drug users from a similar perspective,” she added.

The Vietnamese law was explored in depth, together with other best practices in the region, during the second regional consultation on compulsory centres for drug users in Asia and the Pacific held from 1-3 October in Kuala Lumpur, Malaysia.

Organized by UNODC, UN Economic Social Commission for Asia and the Pacific and UNAIDS and hosted by the National Anti-Drugs Agency of the Government of Malaysia, the consultation brought together senior officials from Viet Nam, Malaysia and seven other countries from east and south-east Asia. Participants shared practical expertise on how countries may look at moving forwards within their legal frameworks towards expansion of voluntary, community-based treatment programmes as an alternative to the compulsory detention model.

At the closing of the consultation, the nine attending countries agreed to further decrease the numbers of operating compulsory detention centres and decrease the number of people being detained in such centres, at a rate to be determined by the country. “We are delighted at the strong demonstration of interest by the countries of the region to move—albeit at different speeds—towards the goal of voluntary, community-based treatment,” said Gary Lewis, UNODC Regional Representative for East Asia and the Pacific said. “This represents a major step forward,” he added.

In March 2012, 12 United Nations agencies and entities issued a landmark joint statement calling upon its Member States to close compulsory drug detention and rehabilitation centres, highlighting concerns associated with the centres, including increased vulnerability to HIV and tuberculosis infection as well as insufficient legal safeguards and judicial review.

Dr. Nguyen Thanh Long, Director General of the Viet Nam Authority for AIDS Control discussed gender mainstreaming in the next National Strategy on HIV

Nguyen Thi Hien, from Viet Nam’s northern province of Bac Ninh, contracted HIV from her husband. “My husband told me when we started our relationship that he had sex with sex workers and injected drugs in the past, but I did not know then what the implications were for me,” she said.

Ms Nguyen Thi, now a peer educator of the Bright Futures network of people living with HIV, said most of the women she meets are widows of men who injected drugs and who only found out their HIV status after their husbands died of an AIDS-related illness.

According to the Viet Nam Authority for AIDS Control (VAAC), in 2010 women accounted for up to 30% of the total registered HIV infections in Viet Nam, while before 2005 women made up less than 15%.

The epidemic in Viet Nam is still mainly concentrated among men who inject drugs. However, this change in the ratio of newly reported HIV cases may reflect an increase in HIV transmission from men with high risk behaviours to their wives or regular female sexual partners in Viet Nam.

The Government of Viet Nam has made firm commitments to develop a comprehensive response to HIV, as well as to prioritize gender equality within the country’s socio-economic development strategy.

To support this, the government and major stakeholders, including civil society and people living with HIV, came together to discuss ways to improve the gender responsiveness of the 2011-2020 National Strategy on HIV/AIDS Prevention and Control. “We need to mainstream gender issues in each of the three pillars of the next strategy including HIV prevention, treatment and care, and impact mitigation,” said Dr Nguyen Thanh Long, Director General of the Viet Nam Authority for AIDS Control (VAAC).

Technical experts from UN Women and UNAIDS joined the discussions on 14-17 March. Participants identified areas of the national HIV response that should better respond to the specific needs of women and men at higher risk of infection. These include men and women who inject drugs, female and male sex workers and women whose intimate partners engage in high-risk behaviour. One area to explore is how the rapid scale up of methadone maintenance therapy—a priority for the next phase of the HIV response—could offer opportunities to better protect the HIV-negative sexual partners of drug users; for example, by providing people taking methadone with services to prevent sexual transmission of HIV.

“I have seen good signals of an engendered HIV strategy for Viet Nam,” said Suzette Mitchell, UN Women Country Representative. “Viet Nam has strong political commitment to address gender issues; and civil society is very engaged, providing many good ideas for gender mainstreaming in the strategy,” she added.

A 2010 United Nations-supported analysis of the current strategy for Viet Nam’s HIV response highlighted the need for more data to better understand the gender dynamics of the epidemic. In particular, the analysis identified a need for more information on how economic reform and social changes have different impacts on men and women and make them vulnerable to HIV.

“Gender issues need to be specifically addressed in the baseline analysis for the strategy and gender sensitive indicators need to be developed,” stressed Dr Long.

With intensified action to place gender issues at the centre of the national AIDS strategy, Viet Nam joins increasing efforts across Asia-Pacific to address this aspect of the AIDS response in the region.

 “Viet Nam is showing extraordinary leadership on this issue,” said Jane Wilson, UNAIDS Gender Advisor from the UNAIDS Regional Support Team. “The agreement to engender the National Strategic Plan will have significant impact in making the AIDS response more effective and is an example of progressive action in the region on gender.” 

Secretary-General Ban and Viet Nam Deputy Prime Minister H.E. Truong Vinh Trong talking to people living with HIV on Methadone for drug dependence and antiretroviral treatment at Tu Liem health care centre. 29 October 2010. Credit: UN Viet Nam/Doan Bao Chau

United Nations Secretary-General Ban Ki-moon visited a “one-stop shop” health centre for HIV services in Hanoi, Viet Nam on 29 October together with H.E. Mr Truong Vinh Trong, Deputy Prime Minster and chairman of the National Committee on AIDS, H.E. Nguyen Quoc Trieu, Minster of Health, H.E. Nguyen Thi Kim Ngan, Minister of Labour – Invalids and Social Affairs, and H.E. Le The Tiem Vice Minister of Public Security and delegates of the United Nations Country Team.

The HIV epidemic in Viet Nam is concentrated among key populations at higher risk. While HIV prevalence among adults aged 15-49 is estimated at 0.44%, prevalence is significantly higher among men who have sex with men, people who inject drugs and sex workers in the country.  For example, HIV prevalence among people who inject drug is about 30%, and in some provinces nearing 50%.
Viet Nam’s HIV response has benefited from the increase in political commitment in recent years. During the visit to the Health Centre, the Deputy Prime Minister, H.E. Truong Vinh Trong highlighted that “Viet Nam is considering turning the national response to HIV into a National Target Programme. This will help ensure the sustainability of the response to HIV and the achievement of the Millennium Development Goal on HIV.”

The Tu Liem District Health Centre in Hanoi provides HIV-related services, including HIV counselling and testing, and peer education to key populations at higher risk. The centre also distributes condoms, clean needle and syringes. Recently a government programme was started to provide methadone maintenance therapy, as part of a role out of methadone clinics across the country.

“This health centre is not only preventing the further spread of HIV. You are not just reducing deaths from AIDS in Viet Nam. You are achieving much more,” said Secretary-General Ban to the staff working at the Tu Liem District Health Centre. “You are giving life to people who will contribute to the development and success of Viet Nam.”

Secretary-General Ban also spoke to people living with HIV who were receiving methadone for drug dependence treatment as well as antiretroviral treatment. Many at the centre told the Secretary-General how methadone has changed their lives.

Secretary-General Ban thanked the participants for speaking out on behalf of people living with HIV and he also stressed the importance of addressing issues such as stigma and discrimination to enable people to access HIV services with dignity.

“Viet Nam has significantly scaled up its response to HIV in recent years and has experienced significant progress. I urge the international community to stand by the commitments made to this country to ensure a sustained response to the epidemic and not withdraw their funding,” concluded Mr Murphy, UNAIDS Country Director, speaking on behalf on the UN Country Team.

Leaders in Vietnam’s AIDS response urged to optimize resources and focus HIV interventions for key populations at higher risk to help achieve targets for universal access. 

The delegation met with Deputy Prime Minister Truong Vinh Trong. Credit: UNAIDS

A UN high-level delegation headed by the UN Secretary General’s Special Envoy for HIV/AIDS in Asia and the Pacific, Dr Nafis Sadik and Special Advisor to the UNAIDS Executive Director, Mr JVR Prasada Rao visited Vietnam this week to discuss its AIDS response with key stakeholders—including Deputy Prime Minister Truong Vinh Trong, Chairman of the National Committee for AIDS, Drugs and Sex Work Prevention and Control. 

The UN high-level mission to Vietnam is part of a regional assessment across countries in Asia and the Pacific taking place over 2009-2010 to improve the effectiveness of AIDS responses in the region. 

The HIV epidemic in Vietnam is concentrated among key populations at higher risk. While HIV prevalence among adults aged 15-49 is estimated at 0.44%, prevalence is significantly higher among men who have sex with men, intravenous drug users and sex workers in the country. 

Development and provision of a standard package of HIV prevention, treatment, care and support services for key populations of higher risk are among the priority actions recommended by the UN delegation for the country. 

The delegation met with People Living with HIV in Hai Phong City. Credit: UNAIDS

Vietnam has seen recent progress in its response to HIV. The country has scaled up needle and syringe programmes over the past two years. In 2009 drug use was decriminalized which has helped create a more supportive environment for harm reduction interventions. The total increase in the number of clean needles and syringes distributed went from two million in 2006 to 24 million in 2009. 

A recent study found that 94.6% of male intravenous drug users reported using sterile injecting equipment the last time they injected and HIV prevalence among the drug using population has declined from a high level of 29.4% in 2002 to 18.5% in 2009. 

“I am impressed with the strong commitment and leadership showed by Deputy Prime Minister Truong Vinh Trong and leaders of the relevant ministries in addressing HIV,” said Dr Sadik. “This is essential to make policy change happen to scale up access to HIV services.” 

“Vietnam should calculate the financial resources needed to support a comprehensive response to HIV up to 2015 and aim to provide at least one third of the total amount from government budgets to ensure the sustainability of the national response,” Mr Prasada said, underlining the delegation’s recommendations. 

The UN delegation discussed the national response to HIV with a wide range of stakeholders including National Committee members, donors, local and international civil society organizations, provincial HIV authorities, people living with HIV, people at higher risk of HIV infection and the Joint UN team on HIV in Vietnam. 

Civil society representatives underlined the need for increased and sustained resources. “There are two districts in our Hai Phong City still not covered by HIV interventions and people living with HIV there are suffering from stigma, discrimination and lack of access to services,” said Ms. Doan Thi Khuyen, member of a self-help group in their meeting with the delegation. 

“I would like you to advise HIV authorities to provide more resources so that services are available in all districts,” she proposed. 

The delegation will make recommendations for Vietnam to achieve its universal access targets and the AIDS-related MDG, identify the main gaps and barriers and actions to achieve them, and the financial resources and technical assistance needed.

“This is a unique experience with the UN I’ve never seen elsewhere,” said Lisa Sherburne, an HIV specialist with Save the Children. Credit: UN

Pham Xuan Tung talks eagerly and takes notes for his group during a biology lesson on HIV transmission and the replication of the virus in blood cells. This new type of highly interactive class is something Tung, a student at Hoang Quoc Viet upper secondary school in Dong Trieu District, Quang Ninh Province, clearly enjoys.

The class is based on a new, integrated reproductive health and HIV prevention curriculum for secondary school students being developed and piloted by the Ministry of Education and Training (MOET), with support from UNICEF, UNFPA, UNESCO and Save the Children in Viet Nam. Many students in Quang Ninh Province, Quang Tri Province and Ho Chi Minh City are following the new pilot curriculum.

A comprehensive national HIV prevention curriculum

Many students in Quang Ninh Province, Quang Tri Province and Ho Chi Minh City are following the new pilot curriculum. Credit: UN

“I have seen a positive change in the participation of students in my class. The new teaching and learning method allows room for every student to speak up, and they are much more responsive,” said Tung’s teacher Truong Thi Hoa.

The new curriculum for secondary schools nationwide draws on UN-supported work in schools, including healthy living and life skills programmes, reproductive health and HIV prevention initiatives, and pre-service training for teachers. Integrating the areas into core lessons and extra-curricular activities, it includes special training for parents so they can better discuss HIV and reproductive health issues with their children – subjects that can be particularly sensitive and difficult to address.

“This is a unique experience with the UN I’ve never seen elsewhere,” said Lisa Sherburne, an HIV specialist with Save the Children. “It allows more resources, more cohesive actions and a more powerful voice for the Viet Nam education sector.”

The changes are all aimed at integrating HIV prevention into the next national curriculum framework and new textbooks to be developed by the ministry and approved by the National Assembly in 2015.

However, many challenges remain. The ministry needs strong political leadership and greater capacity for planning and coordination, sufficient resources, teachers with better capacity, and effective intra-ministry and multisectoral coordination.

“Our biggest challenge is how to facilitate the close collaboration among departments in the ministry and among ministries related to the education sector response to HIV,” says La Quy Don, vice director of MOET’s Department of Student Affairs.

For Eamonn Murphy, UNAIDS Viet Nam Country Director, this is also a top priority.  “We are committed to providing joint support for policy-making, enhanced coordination and implementation of several key aspects of the education sector’s response to HIV.”

Empowering young people to protect themselves against HIV is a key priority area in UNAIDS Outcome Framework 2009-11.

Preventing people living with HIV from dying of tuberculosis is one of the 10 priority areas outlined in the UNAIDS Outcome Framework for the period 2009-2011. Credit: UNAIDS/P.Virot

The 18th Stop TB Partnership Coordinating Board meeting is being held from 4 – 5 May 2010 in Hanoi, Viet Nam. The meeting will bring together UNAIDS and the Stop TB Partnership to strengthen their joint response to HIV/TB co-infection and to agree on a compact intended to halve TB deaths in people living with HIV by 2015.

‘One in four AIDS deaths is linked to tuberculosis. This compact represents an important milestone in ensuring that no person living with HIV dies of TB, a preventable and curable condition’ noted UNAIDS Deputy Director, Programme Paul De Lay

Every three minutes a person living with HIV dies of tuberculosis. Mortality rates have escalated (to an estimated 500,000 a year) over the past 10 years. The emergence of drug resistant strains of TB is a particularly lethal threat in populations with high rates of HIV infection.

Preventing people living with HIV from dying of tuberculosis is one of the 10 priority areas outlined in the UNAIDS Outcome Framework for the period 2009-2011. UNAIDS hopes to achieve this goal by ensuring an effective integrated delivery of services for HIV and tuberculosis as well as nutritional support in all settings.

Universal access and MDG targets for HIV and TB will be difficult, if not impossible, to achieve without greater attention to marginalized and vulnerable groups, such as prisoners, drug users, women, and migrants, and the strengthening of a human rights approach to ensure equitable access and risk-reduction.

A wide variety of participants are expected to attend the meeting, including Ministers of Health of Viet Nam, South Africa and Myanmar, the Regional Director of the World Health Organization Western Pacific Region as well as high-level representatives from UNAIDS, the Stop TB Partnership and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Discussions will range from an overview of the TB epidemic in Viet Nam and the Western Pacific Region to a review of progress in the development of new TB drugs, diagnostics and vaccines.

The Board meeting is also meant to be a follow-up from the Beijing Ministerial Meeting held in April 2009 where ministers from countries with high burden of multi-drug-resistant tuberculosis (MDR-TB) and extremely drug-resistant tuberculosis (XDR-TB) met to address the disease’s alarming threat. The 18th Stop TB Partnership Coordinating Board meeting will review the progress made by countries since Beijing and recommend further actions to overcome bottlenecks and accelerate action.

The Stop TB Partnership is a leading public-private global health partnership, established in 2001, with the aim of eliminating tuberculosis as a public health problem and, ultimately, to obtain a world free of TB. It comprises a network of more than 900 international organizations, countries, donors from the public and private sectors, governmental and nongovernmental organizations and individuals.

The Viet Nam Network of People Living with HIV (VNP+) was legally registered early November and officially launched on 24 November 2009, with the support of the Joint UN Team on HIV in Viet Nam.

VNP+ represents the combined strength of 150 self-help groups and alliances of People Living with HIV from various parts of Viet Nam, and ensures their meaningful involvement in the national response to AIDS.

“Networks of people living with HIV are highly effective mechanisms for building partnerships and advocating for Universal Access to Prevention, Treatment, Care and Support,” said Ms Jan Beagle, UNAIDS Deputy Executive Director Management and External Relations who attended the network launching ceremony in Hanoi.

“I would therefore like to congratulate the government of Viet Nam for ensuring that people living with HIV are fully involved at every stage of the national response to HIV,” she added.

Registered as a local NGO under the name of Action Center for People Living with HIV, VNP+ is also mandated to provide training and create job opportunities for People Living with HIV and those affected by HIV; conduct information and communication activities on HIV/AIDS and promote research and prevention, care and treatment programs.

“The network will act to empower those living with and affected by HIV to overcome stigma and discrimination and contribute to the national response,” stated VNP+ representative Do Dang Dong, asserting “we look forward to a close partnership with the government, other civil society and with international organizations to best perform our role.”

The Joint UN Team on HIV and other partners particularly PEPFAR, have provided technical and financial support to VNP+ since its establishment in 2008. Earlier this year, the Joint UN Team supported the network with training on results based project management, policy advocacy skills and organization of regular information sharing meetings and its annual review meeting.

The UNAIDS Programme Coordinating Board delegation attended the launch of VNP+ during their field visit to Viet Nam in 23-24 November.

Besides visiting UN supported projects and programmes on the ground, the delegation also met with government leaders, including the Chair of the National Committee on AIDS, Drugs and Prostitution Prevention and Control H.E. Deputy Prime Minister Truong Vinh Trong.

UNAIDS Executive Director Michel Sidibé praised Viet Nam’s efforts to reach its universal access goals in a meeting with Viet Nam’s Deputy Prime Minister H.E. Mr Truong Vinh Trong in Paris.

UNAIDS Executive Director Michel Sidibé praised Viet Nam’s efforts to reach its universal access goals in a meeting with Viet Nam’s Deputy Prime Minister H.E. Mr Truong Vinh Trong in Paris. The meeting took place on 28 April during a study visit to the Netherlands and France.

The two leaders discussed specific measures to reach Viet Nam’s universal access goals, including strengthening multisectoral coordination in the AIDS response, the intensification of comprehensive prevention and harm reduction programmes with inclusion of substitution therapies and new approaches to address sex work.

The Deputy Prime Minister in endorsing Mr Sidibé’s bold priorities stated that, “Viet Nam is doing its best to make sure its people are protected from HIV.”

Study visit to review experience in the area of drugs and sex work prevention and management

Mr Truong Vinh Trong also shared the findings of the Viet Nam delegation’s study visits to the Netherlands and France during which they reviewed policy, practice and experience in the area of drugs and sex work prevention and management.

Mr Sidibé commended the leadership of Mr Trong in taking senior leaders from the Viet Nam National Committee on AIDS, Drugs and Prostitution on the research visit. Members of the high-level government delegation included Mr Le The Tiem, Vice Minister, Ministry of Public Security; Mr Bui Hong Linh, Vice Minister, Ministry of Labour, Invalids and Social Affairs; and Professor Trinh Quan Huan, Vice Minister, Ministry of Health.

The visit included meetings with Dutch and French Ministers and officials from the Health and Foreign Affairs ministries and visits to facilities that provide services for people living with HIV and programmes for people who inject drugs, sex workers as well as research institutes and a prison. Mr Trong explained that senior members of the National Committee accompanied him on the visit to ensure that lessons learned would be incorporated in Viet Nam’s national response to AIDS.

Progress towards universal access

Although the country faces challenges to meet its universal access targets, Viet Nam has made significant progress in some areas. Expansion of coverage and access to quality HIV treatment and care have been considerably improved in those areas with high HIV prevalence since the targets were set in 2006. There has been a 50% increase in the number of eligible pregnant women receiving antiretroviral treatment, and a six-fold increase in access to antiretroviral treatment. Methadone pilot sites started operation in two provinces in 2008.

The UNAIDS Executive Director was invited by the Deputy Prime Minister to attend the opening of the conference on the commemoration of 20 years of Viet Nam’s response to HIV to be held in Hanoi in 2010.

Viet Nam’s rapid economic development and growth over the last decade has resulted in increased levels of mobility both within the country and across its borders.

Viet Nam’s rapid economic development and growth over the last decade has resulted in increased levels of mobility both within the country and across its borders. Large infrastructure and development projects coupled with industrial growth have encouraged young people and workers from all over the country to move to major cities and provinces.

However, in areas of rapid economic development and increasing internal migration, factors such as separation from family and communities and harsh working conditions contribute to an increased vulnerability of migrants and mobile populations to HIV and other sexually transmitted infections as they engage in unsafe behaviours such as unprotected sex and injecting drug use.

Additionally, as HIV prevention and health care services are not specifically targeted towards migrants and mobile populations these groups tend to have poorer access to such services. This is especially true for migrants and mobile people who are often not registered as residents in the area where they work.

The migrant population includes female sex workers, migrant workers on construction sites, industrial and exporting zones and workers at river ports and bus stations.

Since its designation as an Industrial and Processing Zone in 2002, Can Tho province, in the south western region of the country, has stood out as a magnet destination for migrant workers as it is the largest city in the Mekong River Delta. The number of HIV cases in Can Tho has also increased at least ten fold, from 73 in 1997 to 733 in 2006.

In 2004, the Canada South East Asia Regional HIV/AIDS Programme initiated a project with the Can Tho Department of Labour, Invalids and Social Affairs and the Can Tho Trade Union to undertake HIV prevention activities with migrants working as casual labourers, truck drivers and sex workers. The project established the Far Away From Home Club, which aims to provide a supportive and empowering environment for sex workers and other migrant workers in Can Tho City.

It is estimated that there are 1100–1600 female sex workers in Can Tho province, of whom 400–500 are street-based sex workers; the same authorities place the number of people who inject drugs between 2200–2500.

Peer education

The Club empowers members of mobile populations such as sex workers and internal migrants by providing life-skills training focusing on HIV and other sexually transmitted infections, on AIDS, public speaking skills, gender and sexuality, stigma and discrimination.

A core team of 10 peer educators (five sex workers and five migrant workers) have supported over 60 Far Away From Home Club members; they have received and shared information and skills that reduce their likelihood of exposure to HIV. These members return to their social networks and informally share their knowledge with their peers.

One of the main achievements of the project has been to ensure the confidentiality of all of those who seek help and support from the group. The assurance of complete anonymity and confidentiality has encouraged more sex workers and migrant workers to access health services through the referral of the Club members and peer educators. In particular, referrals were made to a variety of clinics that provide confidential and accessible services for mobile populations, including treatment of sexually transmitted infections voluntary counselling and testing, and general health check-ups.

The club touches the lives of hundreds of migrants and mobile people every month through their engagement of the private sector in workplace interventions or its outreach activities at hotspots for direct and indirect sex workers.

Involving migrants and mobile populations and empowering them to advocate for access to HIV services for their peers has been crucial to the success of the programme. Furthermore, its ethical soundness, relevance and effectiveness have made the project a successful component of the HIV prevention strategies and a reference work targeting migrants and mobile populations.