News from Vietnam
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REPRODUCTIVE HEALTH and HIV/AIDS from VIETNAM will be presented in this section
30 November 2024
Vietnam makes great progress in fight against HIV/AIDS
Vietnam has made notable strides in combating HIV/AIDS, with key milestones such as reducing new HIV infections and AIDS patients, lowering AIDS-related deaths, and curbing disease progression, Deputy Prime Minister Le Thanh Long has affirmed.
Speaking at a November 29 hybrid meeting organised by the Ministry of Health to mark World AIDS Day (December 1), Long, who is also Chairman of the National Committee for AIDS, Drugs, and Prostitution Prevention and Control, emphasised that this event calls on every individual, organisation, community, and nation to join hands, share responsibility, and demonstrate resilience to protect the health of themselves and their communities. He reaffirmed Vietnam’s commitment to creating a society free from stigma and discrimination toward people living with HIV.
According to the official, the Vietnamese Government has remained committed to prioritising resources, developing synchronous policies, and implementing effective measures for HIV/AIDS prevention and control.
However, Long acknowledged that challenges remain and the HIV/AIDS epidemic continues to threaten public health and socio-economic development, while stigma and discrimination against people living with HIV persist.
To meet the goal of ending AIDS in Vietnam by 2030, he uDeputy Prime Minister Le Thanh Long has affirmed.rged ministries, central agencies, local authorities, and socio-political organisations to integrate HIV/AIDS prevention and control into broader economic and social development plans. He also called for the continued implementation of Party guidelines and State policies, along with increased investment and financial support for prevention efforts.
The health sector was tasked with mobilising and efficiently utilising all resources while leveraging advancements from the Fourth Industrial Revolution to combat HIV/AIDS. Efforts should prioritise high-risk areas and focus on specialised prevention and control measures.
“The health sector must ensure easy access to HIV/AIDS prevention services for the public, involve private healthcare providers in treatment, enhance professional capacities, and offer appropriate incentives for persons engaging in anti-HIV/AIDS work,” Long stressed.
He also expressed gratitude to international partners, urging them to continue supporting Vietnam with financial resources and technical expertise, and in the adoption of global best practices.
Minister of Health Dao Hong Lan highlighted Vietnam’s remarkable progress over nearly 35 years of implementing the anti-HIV/AIDS programme, which has positioned the country as a regional and global leader in HIV/AIDS prevention and control.
“Vietnam has implemented comprehensive strategies, providing services that range from prevention to testing and treatment, while significantly expanding programme coverage,” she said. By 2024, approximately 48,000 individuals are expected to receive opioid substitution therapy, and 70,000 access pre-exposure prophylaxis (PrEP).
In 2023, Vietnam led the Asia-Pacific region in PrEP treatment, preventing HIV transmissions in 97% of users. Each year, HIV testing and counseling programmes reach over 2 million people, with approximately 11,000 new cases detected.
Currently, around 183,000 HIV carriers in Vietnam are receiving antiretroviral (ARV) therapy, with over 97% achieving undetectable viral loads. This places Vietnam among the global leaders in HIV treatment quality.
Eamonn Murphy, UNAIDS Regional Director for Asia-Pacific, Eastern Europe, and Central Asia, emphasised that now is a critical moment for Vietnam to intensify its HIV response and achieve its national goals.
US Ambassador Marc E. Knapper hailed Vietnam as a global model for other nations, highlighting its leadership in maintaining a robust HIV/AIDS prevention and response strategy.
21 May 2024
If anyone asks, I just keep silent: the impact of stigma on Vietnamese women living with HIV
A recent study details how gender-based stereotypes and culturally defined roles negatively impact how Vietnamese women living with HIV engage with healthcare, their coping strategies and their support systems.
According to Dr Lin Chunqing and colleagues, women living with HIV in Vietnam avoid sharing their status, isolate from family and friends, and internalise the guilt and shame associated with their condition. This can lead to delays in accessing healthcare, reduced employment opportunities and less ability to fulfil traditional family-caring roles. But the study also highlights women’s resilience, determination and the support they get from family and peers.
HIV stigma continues to be an obstacle to HIV treatment and care. Women and girls – who comprise a large proportion of people living with HIV worldwide – are more likely to experience HIV-related stigma and more susceptible to internalising those experiences. In other words, they may turn social narratives, perceptions and labels about HIV and people living with HIV into personal views and self-perceptions. This process of internalising stigma can lead to developing anxiety and depression, and leaving healthcare needs unmet.
In Vietnam, behaviours that can lead to HIV acquisition such as injecting drug use and sex work are perceived as social misconduct, immoral or criminal behaviours, and are defined as ‘social evils’ by the country’s constitution.
Women in Vietnam face significant disparities in economic and employment opportunities, with lower rates of workforce participation and access to paid work. They navigate a religiously diverse but predominantly patriarchal culture, that places a lot of emphasis on women’s modesty, purity, and virtue.
These cultural and religious beliefs can affect how women with HIV understand themselves. For example, Buddhist beliefs about karma can sometimes lead to perceptions that HIV is a result of wrongdoing in a previous life. Confucian concepts of hierarchy, which traditionally see women as supportive caregivers, can restrict their sense of autonomy. Taoist ideas of harmony can lead to a subtle acceptance of life adversities and a less proactive approach to facing challenges.
With this background in mind, the new study aims to understand the intersecting burden of stigma, gender inequality and cultural beliefs for women in Vietnam.
In 2021 and 2022, researchers conducted in-depth interviews with 30 women living with HIV recruited through HIV clinics and community organisations in Hanoi, the capital city. Interviewees were all cisgender women and Kinh (the majority ethnic group). The researchers acknowledge that a limitation of their study is that it does not represent the experiences of rural women, ethnic minority women or transgender women.
Half of the interviewees were between 36 and 45 years old, 80% had some middle or high school education, and 70% had irregular or unstable employment. Two-thirds reported acquiring HIV through sex, less than half (43%) were married, one-third had a husband or partner living with HIV and most had either one (60%) or two (30%) children at the time of the interview.
Overall, women reported a reduction in HIV-related stigma and discrimination in Vietnam over the last two decades, potentially related to advances in the country’s HIV response. Nonetheless, cultural beliefs and gender biases still have a significant role in shaping attitudes and behaviours towards women living with HIV, as detailed below.
Gender-differentiated stigma
Women reported gender-based stereotypes and assumptions about their HIV status being linked to non-monogamous relationships or sex work, whilst men’s HIV was thought to be related to drug use. There were cultural expectations of female virtuosity, while men’s risk-taking behaviour tended to be accepted.
“If men use drugs, their family has money, there are multiple reasons why they should be accepted. But I am a woman, if I get in trouble, people will say terrible things about me. For example, she did bad things and got the disease, so now she must face the consequences”.
They also reported double standards of Vietnamese patriarchal culture that meant a husband was often encouraged to leave a marriage if her wife got HIV first, whilst the wife was more likely to maintain a marriage if it happened the other way around. Even when women contracted HIV from their partners, they faced stigma and social isolation rather than sympathy.
Women living with HIV tended to experience more directly discriminatory behaviours than their male peers. There was a general sense that women are emotionally and physically weaker, and wouldn’t retaliate in the same way as men:
“That’s why even though people do discriminate, they dare not behave [with men] they way they do to [women with HIV]”.
Gender roles and family responsibility
In Vietnamese culture, women are often expected to assume multiple family roles. They are meant to care for both her and the husband’s family, handling household chores and looking after the children, whilst men are expected to provide the main source of income and are not expected to get involved in domestic tasks.
Many of the women interviewed felt disappointment and faced discrimination from their families if HIV-related health issues prevented them from fulfilling these traditional roles. Some were threatened with being outed, resulting in many of them avoiding family contact to protect their privacy and wellbeing.
“A few people from my husband family know about it (my HIV). I’m still threatened in terms of how I raise my child. If I didn’t let my daughter visit (my husband’s family) there, they would tell everyone that I am HIV positive, and tell everyone to keep away from me.”
Modern Vietnamese society expects women to be both family caretakers and financial breadwinners, but there are widespread assumptions about the health of people living with HIV being impaired. Many interviewees had internalised this idea – and also the guilt and shame associated with their perceived failure to carry out their family role.
“I don’t have a voice in the family. The truth is that my health is not good, I can’t do anything for my family…Sometimes there is discrimination from my family, but I don’t blame them, although sometimes I feel self-pity, I really do…I can’t take care of my family, and my younger sister has to do it instead of me”.
Healthcare seeking challenges
Stigma in healthcare settings remained the biggest challenge for women living with HIV in Vietnam, who experienced avoidance, segregation, suboptimal care and breaches of confidentiality.
“I brought the referral letter and my medical record…,which has an HIV sign on the cover. Then I gave it to the nurse who stood outside the reception greeting patients…And she suddenly said out loud ‘Oh you got HIV, right?’ Then all the people waiting right next to me…stood a few meters away from me. They were afraid to come close.”
Taboos surrounding their sexuality, and fear of being recognised or their status being shared with their community, impacted women’s decision-making around HIV care, with some travelling longer distances to avoid local spaces.
Internalised stigma based on misunderstandings of HIV made women cautious and hesitant to access care:
“Disease is disease. HIV is more than a disease, (it is) contagious. And the transmission happens just not in (sexual) relationship. I even lost confidence going to the beauty salon now. I do not have the confidence even go to hospital now”.
This reluctance to engage with healthcare could lead to misunderstandings and misinformation about treatment, leading to delays in seeking care.
Coping strategies and support systems
Understanding the prejudice and discrimination towards people living with HIV, women saw non-disclosure as the simplest way to maintain their relationships, secure employment and avoid stigma. Keeping their HIV status secret led women to isolate themselves and avoid taking medication in front of others.
Despite challenges, resilience and determination were also key to maintaining good health and having active and healthy lifestyles. In participants’ words, it takes a lot of work to live “like a normal person” and be “very useful to society”.
“To be honest, I’m already determined. My life, no matter how hard it is, I will bear it on my own. So I just kept quiet. If anyone asks, I just keep silent. That’s all”.
Several participants described getting support from family members and also found comfort from peers, in groups of women living with HIV. These spaces helped them meet multiple needs, share personal matters, exchange resources and information, and motivate each other to overcome obstacles. Participants accompanied each other to healthcare appointments and looked after each other at times of ill health.
“I have developed more connections. I have gained more knowledge…We have been together for ten years. Honestly, I feel closer to them than to my blood relatives”.
Conclusion
The links between culture, gender norms and stigma exacerbate the challenges faced by women living with HIV in Vietnam. Their vulnerabilities must be addressed through a multi-layered approach.
Culturally rooted programmes with religious elements like mindfulness, balance and meditation may help support women in coping with stress induced by stigma and gender-based bias. Additionally, vocational training and money lending programmes have the potential to enhance financial stability and personal autonomy.
Interventions engaging partners and family members – who can be both a source of stigma and support – may facilitate changes in gender-based family norms, encourage shared caregiving and promote health-seeking behaviour.
Lastly, changes are required at community and policy levels to dispel HIV misinformation, develop empathic views about people living with HIV and reinforce gender equity policies.
The researchers say that such an approach may lead progress towards gender equity and better health outcomes for women living with HIV in Vietnam.
14 July 2022
Boosting PrEP access for key populations in rural Vietnam: The story of Tay Ninh Pride
Tay Ninh Pride is a local social enterprise organization in Tay Ninh Province, Vietnam. Established in 2016 by 15 members of the lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) community, Tay Ninh Pride works to develop a support network for LGBTQI people throughout the province by advocating for their rights and providing access to HIV services, including HIV counseling, testing, commodities, and antiretroviral therapy (ART). In 2018, Tay Ninh Pride began providing the LGBTQI community with referrals for pre-exposure prophylaxis (PrEP) at provincial public health facilities.
However, since PrEP became available in Tay Ninh Province, uptake among LGBTQI individuals has been low. Recognizing the need to increase PrEP enrollment, Tay Ninh Pride began working with LGBTQI community members in March 2021 to understand the challenges and motivators they encountered around PrEP access and use. Through discussions with the community, Tay Ninh Pride found that the timing of PrEP administration at public facilities and the fear of being identified as HIV positive were major concerns. The discussions also revealed that a community-led PrEP clinic would address many LGBTQI community members’ concerns about seeking PrEP services in the province.
The community-led clinic model includes providers who are members of the LGBTQI community or have received gender sensitivity and anti-discrimination training. Clinics like these provide a stigma-free environment for LGBTQI people to openly discuss their health concerns. The model also provides the flexibility to book an appointment with a provider, which is not currently feasible with public health facilities across the country. People seeking services at public health facilities only receive an appointment ticket upon their arrival and then must wait to be seen by clinic staff. The inability to book appointments in advance, high demand for services, and high client load at public facilities leads to lengthy wait times for most services.
Community-led PrEP clinic launch
After several months of collaboration with EpiC Vietnam, the Provincial Department of Health, and the Provincial Center for Disease Control, Tay Ninh Pride opened the Tay Ninh Pride Pharmacy and Clinic on May 5, 2022. One hundred community members from Tay Ninh Province and nearby regions attended the event. It provided an opportunity to inform the public, including the LGBTQI community, about the clinic’s offerings, which include judgement-free options to access PrEP services. In addition to PrEP services, the clinic offers quick HIV testing, gender-based violence screening, and sample collection for hepatitis B and C, kidney function, and sexually transmitted infection (STI) testing. Located in a popular gathering spot for members of the LGBTQI community, the clinic is designed and decorated to be welcoming. The clinic is also associated with local laboratories to provide fast and convenient service for test results. In its first two months of operation, Tay Ninh Pride Pharmacy and Clinic successfully enrolled 35 clients for PrEP — 30 new clients and five clients that transferred from other clinics. From May to September 2022, Tay Ninh Pride expects to enroll at least 60 people on PrEP and deliver HIV testing services to 120 clients.
1 December 2021
HIV/AIDS remains burden on Vietnam
HIV/AIDS is still a burden on Vietnam with about 12,000 new cases diagnosed and about 2,000 deaths each year.
To date, about 212,769 people are living with HIV in Vietnam. Since the beginning of this year, 10,925 people have been found positive to the virus, 84.8 percent of whom are male, while 1,528 have died of the syndrome, bringing the total deaths so far to 108,849.
Unsafe sexual activities remain the main method of HIV transmission in the country with 79.1 percent of new cases this year. MSM (men who have sex with men) is becoming a major risk of HIV transmission in Vietnam.
Currently, Vietnam has about 1,300 facilities providing HIV testing and consultation services, along with 201 labs qualified to confirm HIV testing results in 63 cities and provinces across the nation. So far, 1.7 million people have received HIV testing and consultations, of whom about 12,000 have been confirmed to be positive to the virus.
Meanwhile, HIV self-testing has been conducted in 33 cities and provinces covered by the US President’s Emergency Plan For AIDS Relief (PEPFAR) and projects funded by the Global Fund.
There are 478 HIV treatment facilities, including 270 accepting health insurance. At the same time, about 161,000 people living with HIV are undertaking treatment, of whom, over 85,000 are taking antiretroviral drug (ARV) which is covered by health insurance.
Meanwhile, the Methadone treatment programme has been conducted in 341 treatment facilities nationwide, benefiting 52,000 patients. As of October this year, more than 1,100 patients in three localities piloting the programme had been allowed to take Methadone home. At the same time, over 800 patients have received Buprenorphine treatment in eight cities and provinces.
Thanks to efforts by localities across the nation to diversify communications activities on HIV/AIDS through websites and social media networks such as Facebook and Tiktok, so far, 89 percent of people living with HIV have known their HIV status, while 76 percent of people with diagnosed HIV infection have received sustained ARV therapy, and 96 percent of people receiving ARV therapy have reported viral suppression./.
1 October 2021
USAID’s HIV Program Provides Mental Health Support
Vietnam has endured months of strict social distancing and lockdowns in major cities and provinces to limit the spread of COVID-19. When social distancing began in April, staff and clients of HIV programs reported increased stress and anxiety associated with lost income, social isolation and fears of infection.
To help clients of HIV services stay informed on how to access medications and take care of their health, USAID’s Enhanced Community HIV Link Southern project launched a series of positive talks called “My Dear, Just Breathe!” with a range of speakers including frontline physicians, influencers, and wellness coaches.
Clients raised a variety of topics and questions on the COVID situation, vaccination, preventive behaviors, HIV medication (ARV and PrEP) enrollment and prescription refills during lockdown, nutrition, and physical and mental health wellbeing. Six episodes were aired with each garnering more than 1000 views.
6 April 2021
Addicts in Điện Biên get better access to methadone treatment
Opioid addicts will be able to pick up several days supply of methadone for use at home after an event that was held yesterday in the northern mountainous province of Điện Biên.
The event was held by the Việt Nam Administration of HIV/AIDS Control (VAAC) under the Ministry of Health (MoH), the World Health Organization (WHO) in Việt Nam and the provincial Department of Health.
The MoH said methadone has been used to treat opioid addicts in Việt Nam since 2008.
Currently, more than 52,000 people receiving methadone treatment in 330 treatment facilities in all 63 provinces and cities.
The coverage of the programme has reached 28 per cent of the total number of addicts, with the six-month period for medicine adherence rate at 83 per cent, above the world average of is 80 per cent.
Điện Biên Province has recorded more than 9,000 drug addicts and currently, more than 2,400 are undergoing methadone treatment at the province’s 35 methadone dispensing facilities.
Hoàng Đình Cảnh, deputy director of the VAAC, said after more than 12 years of implementation, the treatment of opioid addiction with methadone has revealed a number of limitations.
They included low access to treatment and very different regional adherence to treatment. The rate of treatment dropout accounts for more than 50 per cent, mostly in mountainous provinces.
One of the main reasons leading to discontinuation of treatment is patients having to receive treatment at a medical facility.
To tackle the problem, different countries around the world have allowed some patients to bring methadone to use at home.
Providing patients with methadone for many days will reduce travel time, travel-related costs and create favourable conditions for patients to access, maintain and comply with treatment.
This helps to improve treatment for patients, improve quality of life and increase patient and family satisfaction with methadone treatment facilities.
Cảnh said Điện Biên was one of three localities, along with Lai Châu and Hải Phòng City, to run the pilot programme, because Điện Biên was a mountainous province which is difficult to travel in.
Many patients have to travel tens of kilometres to get to treatment facilities for their daily medicine. Methadone dispensing points have been deployed in some commune health stations but still cannot meet the needs of patients because the villages are too far away and the roads to medical facilities and dispensers are very high in mountainous areas.
This is also a very active locality that has achieved good results in methadone treatment in recent years.
The successful pilot implementation of this programme in the three localities would serve as the basis for a nationwide expansion, he said.
11 March 2021
160,000 people living with HIV/AIDS set to receive ARV treatment
Việt Nam hopes to provide anti-retroviral (ARV) treatment to about 160,000 people living with HIV/AIDS this year, said Deputy Prime Minister Vũ Đức Đam.
Đam, who is also chairman of the National Committee for AIDS, Drug and Prostitution Prevention and Control, has called on ministries and agencies to improve the legal framework and issue detailed instructions to better implement the amended law on HIV/AIDS Prevention and Control that was approved by National Assembly last year.
He asked for diverse measures to be used for HIV/AIDS prevention and control and increasing the provision of preventive treatment for people in high-risk groups.
The Deputy PM said he expected more HIV/AIDS patients would be able to access ARV treatment with the medical costs covered by the public health insurance fund.
According to statistics from the Ministry of Health, since the first HIV/AIDS case was detected in Việt Nam in 1990, until now, more than 102,000 people in the country have died of AIDS and about 250,000 HIV patients are still alive, but only 210,000 know their HIV status.
Việt Nam has a rate of HIV-infected people receiving antiretroviral (ARV) treatment with a viral load below the inhibitory threshold reaching 96 per cent, meaning that they have undetectable levels of HIV in their bodies and they pose no risk of HIV transmission to their sexual partners who are negative to HIV.
Over the past 10 years, Việt Nam has kept the community HIV infection rate below 0.3 per cent.
According to the United States Agency for International Development (USAID), since 2000 the country has deployed preventive measures to stop 400,000 people from being infected with HIV while 150,000 received treatment that prevented death from AIDS.
In 2014, Việt Nam became the first country in Asia to adopt the 90-90-90 targets set by the Joint United Nations Programme on HIV/AIDS, under which by 2020, 90 per cent of those living with HIV would know their HIV status; 90 per cent of people who know their status are in HIV treatment, and 90 per cent of all patients in treatment would have undetectable levels of HIV in their bodies.
Only the third target was achieved by the year 2020.
Việt Nam is known as one of four countries with the best HIV/AIDS treatment in the world along with Germany, the UK and Switzerland, Health Minister Nguyễn Thanh Long said when he introduced to the National Assembly the draft of amendments to Law on HIV/AIDS Prevention and Control last year.
At a recent meeting highlighting key tasks in HIV/AIDS, drug and prostitution prevention and control this year, Đam emphasised the need to increase public understanding and awareness over the issues.
He called on press and media agencies to support communication campaigns.
Regarding drug crime prevention and control, he asked the ministries of security, defence and finance to step up the fight on drug crimes, particularly in border areas.
17 April 2020
Community networks extend arms to connect people to medicine in Viet Nam
When the Vietnamese Government introduced social distancing mid-March 2020 to respond to COVID-19, Binh Nam (not his real name), already on distance learning from his college since February, lost his part-time job at a small company. He decided to leave Ho Chi Minh City, which had a cluster of confirmed COVID-19 cases, to settle back in his home town, about 300 kilometres away.
“Going home seemed like the best option for me at the time,” Mr Nam said.
He arrived at his parents’ home just before buses shuttling people back and forth across the provinces stopped. With stricter lockdown measures taking effect in early April, he realized he was in a bind. He would run out of HIV treatment.
“I considered going to a local HIV clinic, but feared my HIV status would be disclosed,” he said. “I also could not buy antiretroviral medicine at private clinics because that would clear out my savings.”
And he definitely did not want to ask his parents, because they didn’t know he was living with HIV.
“I felt desperate,” he said. As a last resort, Mr Nam texted a man who runs a social media channel on HIV information, education and counselling that he follows.
Upon learning of Mr Nam’s situation, Nguyen Anh Phong, a representative of the Viet Nam Network of People Living with HIV (VNP+) in the south of Viet Nam and co-founder of the Lending a Helping Hand Fund, mobilized some funds to get him an antiretroviral therapy refill.
“This was among the first calls for help that made us notice more and more people were stuck in their home province with a limited amount of antiretroviral medicine,” Mr Phong said.
He and his VNP+ peers decided to form a group on one of the most popular social media chatting platforms in Viet Nam to find ways to connect people and help them collect medicine at clinics other than their own. More than 150 community members joined the group across the country.
Community feedback filtered back to the Viet Nam Authority for HIV/AIDS Control (VAAC) at the right time as it was drawing up emergency contingency plans. It was dealing with a hospital closed because of a temporary COVID-19 quarantine in Hanoi, so people couldn’t access HIV services or treatment. And with so many people stranded in the provinces, something had to be done.
VAAC issued new guidelines on HIV care and treatment during the pandemic developed with technical support from the United States President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations.
“We invited the Viet Nam Network of People Living with HIV to join our technical discussions and to give us feedback because they know the challenges faced by people living with HIV,” said Phan Thi Thu Huong, VAAC Deputy Director in charge of HIV care and treatment.
The guidelines allow for multimonth antiretroviral therapy refills for all people on HIV treatment and for the provision of pre-exposure prophylaxis and tuberculosis medicines.
Provinces have been assigned focal points and hotline numbers for people who experience unusual symptoms.
More importantly, the standard referral requirements were eased in order to allow clients temporary access to alternative HIV clinics for antiretroviral therapy refills. VAAC also proactively resolved procurement challenges in order to avoid stock-outs, so Mr Nam and others could access HIV clinics of their choice for refills.
Viet Nam’s HIV epidemic is concentrated mostly among gay men and other men who have sex with men, transgender women, people who inject drugs and female sex workers and their intimate partners, with a rising HIV prevalence among gay men and other men who have sex with men .
“I believe that by joining hands, we can help all people get their refills so that no one misses their treatment because of COVID-19,” said Mr Phong.
Working hand in hand and getting results is what communities do best, according to Marie-Odile Emond, the UNAIDS Country Director for Viet Nam. “These networks are pillars of peer support and resilience and now more than ever they’re like an extended arm of the public health sector,” she said.
30 November 2018
Vietnam launches national program for pre-exposure prophylaxis for HIV
PATH, USAID, and Vietnam’s Ministry of Health launch PrEP program to substantially reduce new HIV infections as total PrEP service enrollment passes 2,000.
On the eve of the 30th World AIDS Day, Vietnam’s Ministry of Health (MOH), the United States Agency for International Development (USAID), and global health non-profit organization PATH, announced the nationwide launch of pre-exposure prophylaxis (PrEP) services for HIV prevention in Vietnam.
PrEP allows people who do not have HIV but are at substantial risk of infection to prevent HIV by taking a pill every day, as part of a combination HIV prevention strategy.
If a HIV-negative person uses PrEP, their chance of contracting HIV through unsafe sex or injection drug use decreases, as the medication will work to prevent the virus from establishing a permanent infection. PrEP is extremely effective when taken correctly, and is proven to reduce the risk of HIV infection by 92 percent or more.
Since 2015, the World Health Organization has strongly recommended PrEP as an additional prevention choice for people at substantial risk of HIV.
“International guidance, plus the in-country evidence generated from pilot programs led by the MOH and implemented by the USAID/PATH Healthy Markets project and UNAIDS, shows that PrEP is an effective method for HIV prevention for those most at risk of HIV. This is why Vietnam has established and will implement the national plan for PrEP for 2018-2020, making PrEP available for at least 7,300 people in at least 11 provinces by 2020,” stated Associate Professor Phan Thi Thu Huong, the vice director of Vietnam Administration for HIV/AIDS Control (VAAC). This important step makes Vietnam the second country in Asia, after Thailand, to roll out PrEP nationwide. “We will take good care of PrEP users by providing them with sufficient information about the prevention of sexually transmitted infections including HIV, and will also aim to negotiate with PrEP providers to reduce the treatment cost so people who are in need can more easily access PrEP.”
VAAC, USAID, and PATH launched pilot PrEP services (Prepped for PrEP—P4P) in 2017 through the USAID/PATH Healthy Markets project.
The USAID/PATH Healthy Markets project has worked with community groups led by people at risk of HIV, provincial MOH leaders, commercial sector partners, and private and public outpatient clinics to provide PrEP for 1,967 people at high risk of contracting HIV—men who have sex with men (MSM), transgender women (TGW), and the HIV-negative partners of people living with HIV who are not viral load suppressed—in Ho Chi Minh City and Hanoi.
PrEP was also made available through a pilot project run by UNAIDS.
“The launch of PrEP through P4P in June 2017 made a critically important HIV prevention tool available to those most at risk in Ho Chi Minh City and Hanoi,” said Dr. Kimberly Green, chief of party for Healthy Markets. “This pilot was only possible due to a strong partnership between civil society organizations, social enterprises, and private clinics led by MSM, TGW and people living with HIV, along with local health leaders, public outpatient clinics, and commercial partners including Gilead Sciences, Reliv/Mylan, and Abbott.
The national scale-up of PrEP is essential to dramatically bending down the curve of new HIV infections in Vietnam.”
Guests at the launch also heard from community leaders, PrEP providers and users, and private sector partners who participated in a symbolic commitment to the future of PrEP in Vietnam, along with leaders of the VAAC, provincial Centers for Disease Control, USAID, and PATH.
“Since 2017, we’ve enrolled 635 people on PrEP at our clinic,” shared Dr Tran Le Viet Thanh, from G-link Clinic. “The retention rate—people that continue to take PrEP over time—is high, as we support people to integrate the medication regimen into their daily lives.
I have no doubt that PrEP is already saving a lot of lives in Vietnam and so I am very happy to see it will be available to many more people who need it, very soon.”
“I’ve been on PrEP for nearly a year. I feel very happy and secure with this wonderful choice,” said Tuan, an office worker in Ho Chi Minh City. “Many of my friends are jealous because PrEP isn’t available yet where they live—they will be very happy to hear about the national expansion of the service! I hope a lot more people will now consider and try PrEP to protect themselves and their loved ones.”
The USAID/PATH Healthy Markets project has also worked with the World Health Organization, UNAIDS and PEPFAR partners to support the VAAC to develop a comprehensive package of national policies, guidelines, and training materials that will support the scale up of PrEP. Roll-out will begin in nine provinces in 2019 before expanding to eleven provinces in 2020.
“The nationwide launch of PrEP in Vietnam has been a long-standing goal of PEPFAR and USAID,” said Mary Tarnowka, U.S. Consul General.
“We are extremely appreciative of the Ministry of Health’s commitment to this truly catalytic approach to HIV prevention, and its ability to lead the way in HIV innovation. By working together with USAID to introduce and now roll-out PrEP nationwide, the 2030 HIV elimination goals are one step closer.”
The national launch of PrEP services in Vietnam was hosted by VAAC, in coordination with USAID, and PATH. Through PEPFAR, the U.S. Government works closely with the MOH; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and others to develop a long-term, sustainable program to support the Vietnamese government to scale up activities for HIV prevention, treatment, and eradication.
16 May 2018
Vietnam and LGBT rights: Making strides
Vietnam has seen a radical change in lesbian, gay, bi-sexual and transgender (LGBT) rights over the last decade as the State has made significant steps to protect rights and equality.
Just more than a decade ago, homosexuality wasn’t accepted widely. There was stigma and discrimination against LGBT people because of their sexual orientation or gender identity.
Things have changed.
Lawmakers slam anti-LGBT discrimination
Public attention turned to homosexuality and the LGBT community in 2012 when Minister of Justice Ha Hung Cuong became the first senior Vietnamese government official to publicly call for the end of prejudice against homosexual people and mentioned the once-taboo subject of same-sex marriage.
“Personally, I think that the recognition or non-recognition of same-sex marriage should be based on very basic studies, credible assessment of impacts on many social and legal aspects, such as personal freedom, compatibility with cultural practices of Vietnamese families and society, and sensitivity and social consequences of the regulations,” stated Cuong in an online public dialogue in July that year.
He further emphasised the need to protect the rights of gay couples. “The country should adopt a legal mechanism to protect their rights in terms of legal personality, property or children of cohabiting couples.”
For many LGBT people, the minister’s words were a bold step forwards, paving the way for their search for marriage equality, given that the previous Law on Marriage and Family specifically outlawed gay marriage.
The LGBT community did not have to wait long for the next supporter to step up.
“In the angle of human rights, gay people also have the right to live, eat, wear, love, and pursue happiness,” Vice Minister of Health Nguyen Viet Tien said publicly a few months later.
“In terms of citizenship, they have the right to work, study, receive medical check-ups and treatment, and register birth, death and marriage… in line with rights and obligations with the State and society.”
The ban made many homosexuals afraid to come out due to fear of discrimination from families, friends and colleagues and being abandoned, he stressed, calling for the legal recognition of same-sex marriage as it is a human right.
New rules spark hope and motivation
Also in 2012, the Ministry of Justice (MoJ) activated a review of the Marriage and Family Law which, for the first time in Vietnamese history, brought up legal consideration of same-sex marriage.
The ministry asked all government agencies for opinions about revising the law again in an official letter sent in May, 2012, concerned that the community of gays and lesbians was expanding in the country but many lived together without registering a marriage.
“From the perspective of individual rights, marriage between people of the same sex should be recognised,” the letter said.
“The cohabitation of same-sex couples is a real social phenomenon, which results in binding relations and issues concerning property ownership and child custody.”
“The current law may not legalise their marriage but there must be a legal framework to address these issues.”
The MoJ launched a number of policy dialogues with LGBT groups during the formation of the bill.
It also engaged several organisations, including the Institute for Studies and Society, Economy and Environment (iSEE) and the Women’s Union, in civil society consultation to get insight and relevant expertise in the LGBT community and related issues, and to assess impacts of the bill on the society.
“We worked with the Ministry of Justice in many consultation workshops on this bill… We really appreciated the effort of the government in protecting the rights of LGBT people… and to show its acceptance of alternative lifestyle,” Le Phan Anh Thu, iSEE’s Acting Coordinator of LGBT Rights Programme told Vietnam News Agency.
The draft bill was submitted to the Vietnamese National Assembly for debate in 2013, making Vietnam the first country in Asia where the topic was discussed at parliamentary level.
June 19, 2014 was a special day for LGBT people.
After two years of discussion, the NA passed the revised law, with no clause prohibiting marriage between people of the same sex. The new law allowed same-sex couples to co-habit and have wedding ceremonies, but they are not considered a legal family.
Though the act does not recognise gay marriage, an activist called it “quite amazing change in such a short span of time,” given that the LGBT social movement was said to have only started a decade ago.
Despite some disappointments about the outcome, many others felt optimistic. “It may be not completely there yet… but it is good to know it’s moving forward,” said H.H.T, an LGBT activist.
“The new law has positive effects on advocacy to change public awareness as it sends a message that same-sex marriage is not a bad thing.”
“Some were upset, but in return, many others have become more deeply engaged into the community’s activities because they understand if they do not advocate for their own rights, then nobody can,” he added.
“This might be a baby step towards equal marriage, but was an important one that brought us hope and motivation,” Anh Thu added.
“Practically, same-sex couples still are not protected by law but on the other hand, lifting the ban on same-sex marriage reflected a huge change in the mindset of policy makers.”
“LGBT people now can be more confident to not only present their visibility but also to talk about their rights to access services, such as education, legal and medical services”.
Vietnam well ahead in Asia
Vietnam grabbed big attention again in November 2015 when lawmakers took a major step by voting to pass the amended Civil Code that legalises sex reassignment surgery.
Previously, sex reassignment in Vietnam was limited to only those without complete sex organs and those with both male and female sex organs. Now anyone can have sex change surgery and can legally register under a new name and new gender.
The LGBT community is excited for more big changes in the next few years as the new Law on Gender Change is being crafted by the Ministry of Health (MoH) to protect the rights of transgender people.
The law is set to be submitted to parliament for review in 2019 at the latest.
“The bill stipulates how to identify a person whose gender identity is different from his/her assigned sex at birth through psychological evaluations… After that, doctors are allowed to perform medical interventions, such as hormone therapy or breast and genital surgeries,” said Nguyen Huy Quang, director of the MoH’s department of legal affairs.
“If passed, the bill will provide a basic and humane legal framework… for transgender people to live true to themselves and set their bodies free,” he said.
“It’s a work in progress and I am pleased to see the efforts that are going in to considering the different aspects of the bill on protecting the rights of transgender people in healthcare,” Ambassador of Canada to Vietnam Ping Kitnikone told Vietnam News Agency.
“The support of the MoH as well as iSEE clearly shows that the LGBT issue is becoming more and more salient in Vietnam, and that more and more officials and individuals are beginning to see the importance of empowering this community.”
According to H.H.T, his activist peers in the region are impressed with what Vietnam has achieved so far, referring to those from the Asian countries where gay marriage remains outlawed.
“This makes Vietnam one of the leaders in the region”, H.H.T said.
“During our interactions with fellow activists, Vietnam is always being referred to as a beacon of hope with regards LGBT rights in ASEAN,” said Ryan V. Silverio, Regional Coordinator of ASEAN Sexual Orientation and Gender Identity/Expression Caucus (ASC), a regional organisation of LGBT human rights activists in Southeast Asia.
“The revision of the civil code and the Vietnamese government’s openness to LGBT organisations in crafting a new law on gender recognition was positively welcomed by activists.”
If Vietnam adopts the bill, the country will become the sixth in Asia and the second in Southeast Asia to have specific legislation on gender reassignment.
Anh Thu was convinced that it (the adoption of bill) reflects the government’s consistent view – LGBT rights are basic human rights.
“So protecting them is the right thing to do.”
20 June 2017
Vietnam has built an LGBT friendly medical centre
Vietnam has built an LGBT-friendly medical centre so the community can have safe access to health care, sexual health information and counselling.
The centre is working towards improving access to health care to trans people especially, as it is currently illegal for people to access hormone of surgery in the country.
Although the country has put laws in place to decriminalise this, they will not take full force until 2019 at the earliest.
As well as decriminalising hormone and surgery treatment, the legislation has introduced more protections for trans people.
The centre will be providing free STI testing as well as providing this extra level of care to trans people,
It will also provide care for those diagnosed with HIV by working with other facilities who may be better equipped.
Based in Ho Chi Minh City, it has been set up by the Men’s Health Centre and G -Link, who promote health care within the LGBT community.
Doctors at the clinic have said that it will greatly improve the care of LGBT people, especially trans people who may be self-prescribing hormones.
Dr Trà Anh Duy is a doctor at Bình Dân Hospital in the same region as the new clinic explained that the clinic was crucial as some trans people “can overdose or use substandard hormones”, he also fears that these hormones might not be administered “in a hygienic way.”
One 24-year-old trans woman said that the community was often scared of seeking medical help in the country because they feared being judged.
She explained that she and friends she knew had bought hormones from Thailand but had bad side effects.
She said: “I could easily buy hormones from people who had visited Thailand for sex-change surgery. Hormones and that kind of surgery are still not available in Việt Nam.
“My friends, who had gone through gender transition, had problems from overdoses because they did not go to a doctor, but just listened to advice from friends.
“They had vomiting and spinal pain, and at times felt dizzy. Others even had bleeding after returning to Vietnam from Thailand where they had sex-change surgery.”
1 March 2017
Viet Nam embraces zero HIV-related discrimination in health car
A demonstration project aiming at reducing HIV related discrimination in healthcare settings is underway in Ho Chi Minh City, as part of the broader effort of the Viet Nam Administration for AIDS Control (VAAC) to intensify anti- discrimination efforts toward ending AIDS by 2030, with support from UNAIDS.
Removing unnecessary fear of HIV among health workers
Inspired by the global movement, Viet Nam embarked on a new initiative in late 2016 to further reduce HIV-related discrimination in healthcare settings. Under the overall guidance of the Viet Nam Administration for AIDS Control (VAAC) and with support from UNAIDS, Ho Chi Minh City spearheaded the adaptation of a HIV-related discrimination survey tool and piloted a survey among health workers and service users in three health facilities in the city.
“We chose both general hospitals and HIV specialized health facilities for conducting this survey,” said Dr. Tieu Thi Thu Van, Director of Ho Chi Minh City Provincial AIDS Centre. “It provides us with scientific evidence of the level of HIV-related stigma and discrimination in health facilities that will inform interventions to create change among health workers. This demonstration project is therefore rather important.”
It is clear from the survey that discrimination related to HIV still exists in healthcare settings. 40% of the respondents who are HIV positive reported having experienced discrimination in health facilities. On the other hand, many health workers (about 70% of all respondents) applied over self- protection measures when taking care of people living with HIV due to their worry of getting HIV infection.
Informed by the results of this survey in late 2016, Ho Chi Minh AIDS Centre is working with the three health facilities to build staff HIV related stigma and discrimination knowledge and enhance their professional skills. A training toolkit has been adapted for Viet Nam based on the findings of this survey, and the training of trainers is underway from 28 February to 3 March 2017 for selected staff of the three health facilities and representatives of people living with and people at higher risk of HIV. Participants at the training of trainer workshop will also discuss plans for rolling out the training and development of a code of conducts related to zero HIV discrimination for their health facilities, as well as the role of community in the project implementation.
Discrimination-free health care for ending AIDS
“HIV-related discrimination in healthcare settings is a major barrier for Viet Nam to maximize HIV service uptake and achieve the 90-90-90 treatment target, so the country can firmly move toward ending AIDS by 2030,” said Mr. Ali Safarnejad, UNAIDS Viet Nam Acting Country Director.
“This is particularly important as Viet Nam is transitioning HIV services from donor financing to social health insurance funds whereby HIV services will be provided mostly at general hospitals and not specialized HIV clinics,” added Mr. Safarnejad.
The agenda on zero discrimination in health care, jointly initiated by UNAIDS and the World Health Organization’s Global Health Workforce Alliance nurtures respect for equality and aims to ensure healthy lives for all.
According to the global agenda, a national action plan on zero discrimination in healthcare settings should embrace seven priorities. Some of these priorities are very relevant for the response to HIV-related stigma and discrimination in Viet Nam, such as providing timely and quality healthcare regardless of HIV or other health status, or because of selling sex and using drugs; respecting patient’s privacy and confidentiality; prohibiting mandatory testing or coercive practices; and, ensuring participation of the affected communities.
Partnership for success
The initiative has been developed and implemented in close consultation with representatives of the Viet Nam Network of People Living with HIV (VNP+) while also engaging members of other HIV key affected populations.
“Reducing HIV-related discrimination is not only the task of health workers. We the people living with HIV also have to take part,” said Nguyen Anh Phong, VNP+ Steering Committee representative in southern Viet Nam. “We will work closely with the three health facilities to find appropriate solutions to address the existing discrimination that suits both health workers and community, so as to mobilize community participation in this effort.”
Participation of people living with HIV and key populations from conceptualization of the initiative, adaptation of the tool kit, conducting the survey, the training of trainers and training sessions at health facilities, as well as monitoring progress at health facilities is key to ensuring the project delivers expected results.
“We will conduct an assessment at the end of this pilot project. I hope lessons learned from this pilot will help further improve the methodology of measuring HIV-related discrimination in healthcare settings and intervention approaches, so we can expand the practice nation-wide,” said Dr. Hoang Dinh Canh, VAAC Vice Director.
22 november 2016
PrEP in HCMC
UNAIDS in collaboration with the Center for Applied Research on Men and Health (CARMAH) and with an agreement of the Viet Nam Administration for AIDS Control (VAAC) and the HCMC Provincial AIDS Center (PAC), plans to implement a PrEP demonstration project among MSM community in HCMC. Linked to the community-based testing pilot that UNAIDS is also conducting in the city, the PrEP project will see 200 high-risk,HIV-negative MSM enrolled on PrEP, and maintained for a duration of 18 months. During the project, those enrolled will be monitored for adherence, tolerance for the medication, and tested for HIV. The evidence generated will demonstrate the feasibility of implementing PrEP in community settings in Viet Nam, and form the foundation of advocacy for adoption of PrEP as an additional measure of HIV prevention for MSM. It will also demonstrate the willingness of MSM to self-pay for PrEP after 12 months.
25 November 2015
Vietnam passes landmark law recognizing transgender people
Ban on gender reassignment surgery has also been lifted
Vietnam has passed a landmark law legally recognizing transgender people and lifting a ban on gender reassignment surgery.
More than 80% of lawmakers Tuesday (24 November) voted in favor of the law change, which will come into effect on 17 January 2017.
Under the new legislation, those who have undergone gender reassignment surgery can change their gender marker and will be given the ‘personal rights in accordance with their new sex,’ the state-controlled VnExpress website reported.
The National Assembly said the law was an attempt to ‘meet the demands of a part of society… in accordance with international practice, without countering the nation’s traditions.’
There are an estimated 270,000 transgender people in the communist country, many of whom travel to nearby Thailand for operations.
‘According to a survey in 2014, four in every five transgender people in Vietnam desire to have [sex reassignment surgery]. Of these 11% had undergone the surgery, mostly made outside of Vietnam,’ said Luong Minh Ngoc, director of Institute for Studies on Society, Economy and Environment.
‘Transgender person can now perform sex change with affordability and safety in Vietnam. It is also an important step forward in recognizing the existence and equality of transgender people to live as themselves.’
Homosexuality and gender dysphoria are still taboo in the Vietnam but in recent years the country has become leader in LGBTI rights in the region.
A ban on gay marriage was lifted earlier this year but same-sex unions remain unrecognized by the law.
26 November 2015
58% of Married Women in Vietnam Have Been the Victims of Domestic Violence: Report
Though the scourge of sexual harassment is well documented in Vietnam (to the point where Hanoi has considered launching gender-specific busses), its ugly cousin, domestic violence, is an even more serious problem, according to a joint United Nations and Vietnamese government report.
At a meeting in Hanoi on November 21 organized by White Ribbon, an Australian campaign to end men’s violence against women, officials learned that 58% of married women “are victims of either or both kind of violence, which causes them heavy physical and mental damage,” reports Voice of Vietnam.
According to Pratibha Mehta, UN Resident Coordinator and UN Development Program (UNDP) Resident Representative in Vietnam, most victims kept quite in the wake of abuse. “87 percent of victims did not seek help due to the lack of available services. Many were also too afraid to speak up due to the fear of stigma, discrimination and further harassment,” she said at the meeting.
To help reduce domestic violence, White Ribbon is working with Vietnamese authorities to raise awareness about domestic abuse. The program focuses on garnering men’s support in stopping and speaking out about violence.
At the conference, Nguyen Thuy Hien, deputy director of the Hanoi-based Women and Development Center, said that having men speak out against the issue is a linchpin for turning the tide.
“The ending of violence against women and girls cannot succeed without the participation of men and boys.”
Nguyen Bao Thanh Nghi, a sociology professor at Ho Chi Minh City Open University, said that while there have been domestic campaigns to address the issue in the past, “they often die prematurely and fail to create systematic and widespread changes,” since they are unable to get male support.
Hopefully, the Vietnamese government will begin to take action on this important issue as it has recently done with sexual harassment.