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Cablegate: Ambassador's Engages Vietnamese Leadership On Health Issues

VZCZCXRO9553
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1464/01 2261738
ZNR UUUUU ZZH
R 141738Z AUG 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6111
INFO RUEHHM/AMCONSUL HO CHI MINH 3542
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 04 HANOI 001464

SIPDIS


SENSITIVE
SIPDIS

STATE FOR O/GAC, EAP/MLS, EAP/EP
STATE PASS TO USAID FOR ANE AND GH
STATE PASS TO HHS/OGHA (WSTIEGER, CHICKEY)
BANGKOK FOR USAID (TBEANS, LBRADSHAW AND BSLATER)

E.O. 12958: N/A
TAGS: KHIV KFLU TBIO PREL PGOV SOCI VM
SUBJECT: AMBASSADOR'S ENGAGES VIETNAMESE LEADERSHIP ON HEALTH ISSUES


HANOI 00001464 001.2 OF 004

1. (SBU) Summary: As part of his series of farewell calls on
Vietnamese leaders, Ambassador Marine met separately with Deputy
Prime Minister (DPM) Truong Vinh Trong and former Minister of Health
(MOH) Tran Thi Trung Chien to discuss health issues, particularly
HIV/AIDS. Ambassador Marine pushed the Government of Vietnam (GVN)
to better coordinate its internal efforts to combat HIV/AIDS,
perhaps under the supervision of the office of the DPM, and to work
more closely with donors. In both conversations, the Ambassador
stressed the need to upgrade prevention efforts, de-stigmatize
HIV/AIDS, utilize medicine (methadone) assisted treatment to limit
the spread of the disease among intravenous drug users, and bring
those living with HIV/AIDS into the policy making process.
Vietnam's recently enacted HIV/AIDS legislation represented a good
first step, but the GVN now needed to focus on implementation. On
avian influenza, Ambassador Marine emphasized the need to continue
to share clinical samples. End Summary.

2. (SBU) On August 10, Ambassador Marine met separately with Deputy
Prime Minister (DPM) Truong Vinh Trong and former Minister of Health
(MOH) Tran Thi Trung Chien as farewell calls before departing Hanoi.
This was the Ambassador's first time to meet DPM Trong, who was
recently re-elected to an additional term in that position. Trong's
portfolio includes health issues, and the Ambassador and
representatives of other donors had been interested in seeing Trong
for some time to discuss coordination in fighting HIV/AIDS. Madame
Chien had left her position as Minister of Health earlier the week
of the meeting and has been replaced by Nguyen Quoc Trieu.

DEPUTY PRIME MINISTER TRONG ON HIV/AIDS
---------------------------------------

3. (SBU) The Ambassador began his meeting with DPM Trong by telling
the DPM that he would like to follow up on an April letter he and
UNDP Resident Coordinator John Hendra had sent to the DPM. In that
letter, the Ambassador and Hendra urged the GVN to improve its
multi-sectoral response to the HIV/AIDS problem in Vietnam, which
the Ambassador stated poses a long-term threat to Vietnam's economic
health. The "plain truth" is that we are not winning the fight
against HIV/AIDS with 100 new HIV/AIDS infections every day in
Vietnam, he stressed.

4. (SBU) The Ambassador advocated that the Office of Government and
the DPM play a central supervisory and management role that cuts
across ministerial lines, and suggested an ongoing dialogue on
HIV/AIDS between the donors and the GVN, to include meetings with
the DPM and other senior GVN officials. The USG and other donors
have made significant contributions to the battle against HIV/AIDS
in Vietnam, including USD 65 million from the USG in 2007. However,
GVN ministries must find more effective ways to coordinate with one
another and with donors in the fight against HIV/AIDS. As HIV/AIDS
involves much more than simply health issues, the Ministry of Health
(MOH) cannot succeed in fighting HIV/AIDS on its own; other GVN
ministries must be involved.

5. (SBU) The Ambassador suggested that the National Committee for
Drugs, Prostitution and AIDS Prevention and Control could coordinate
GVN HIV/AIDS activities, particularly a broader multi-sectoral
response that cut across ministerial lines. However, this committee
did not meet often enough and had no mechanism for day-to-day
operations.

6. (SBU) The Ambassador focused on several specific areas that need
attention. First, the GVN needed to expand the program of using
medicine (methadone) to replace drugs for intravenous drug users,
who form a major vector in Vietnam for the spread of HIV/AIDS. The
GVN also needed to develop ways to include people living with
HIV/AIDS into the policy-making process as these people know the
disease and its impact best. The GVN and the donors must create an
inclusive and transparent process to develop a set of cost norms for
donors and their partners, including NGOs, to be adopted across all
areas of health care delivery.

7. (SBU) Stigma and discrimination also remain major impediments in
the fight against HIV/AIDS. Many Vietnamese continue to associate
HIV/AIDS with the "social evils" of drug use and commercial sex
work. The resulting stigma causes people to avoid testing and
possible help. The Ambassador encouraged high-ranking GVN
officials, including the DPM, to publicly demonstrate support for
people at risk or living with HIV/AIDS to help them live as fully

HANOI 00001464 002.2 OF 004


integrated members of society. The law passed by the National
Assembly last year was an important first step, but the GVN now must
implement this law comprehensively.

8. (SBU) DPM Trong responded first by thanking the Ambassador for
his participation in many important events in the bilateral
relationship during his three year tenure, including successful
visits by Prime Minister Phan Van Khai and President Nguyen Minh
Triet to the United States and by President Bush and Secretary Rice
to Vietnam. "I have two children and many grandchildren living in Ho
Chi Minh City and they were happy to welcome President Bush to their
city," he said.

9. (SBU) DPM Trong stated that he was confident that the friendship
and solidarity between the United States and Vietnam would continue
to strengthen. The DPM singled out Vietnam's accession to the WTO
and the U.S. Congress' granting of Permanent Normal Trade Relations
as milestones in the relationship.

10. (SBU) As for HIV/AIDS, the DPM praised the significant
assistance from the USG to Vietnam, but noted that he shared the
Ambassador's concerns on the status of the HIV/AIDS epidemic in
Vietnam. Prior to meeting with the Ambassador, the DPM chaired a
session that morning strengthening GVN efforts at preventing illegal
drugs from entering Vietnam. On August 17, he will host a
conference looking at heroin replacement medication. Noting that
HIV/AIDS is a pandemic requiring urgent attention, the DPM stated
that he would meet with the next U.S. Ambassador to discuss how to
coordinate efforts and planned to host a meeting to "exchange
experiences" with the donor community.

11. (SBU) The Ambassador responded that he would relay the DPM's
comments to Ambassador Michalak for follow up.

LAW ENFORCEMENT
---------------

12. (SBU) The Ambassador concluded the meeting by highlighting the
DPM's focus on anti-corruption efforts and improving the rule of
law. He then urged the DPM to consider how the USG and GVN could
deepen law enforcement cooperation, with a focus on
counter-terrorism, anti-money laundering and anti-narcotics efforts.
The DPM stated that he looked forward to discussing these issues
with Ambassador Michalak.

MADAME CHIEN'S NEW POSITION
---------------------------

13. (SBU) Madame Tran Thi Trung Chien stated that she recently had
been selected to chair the "Vietnam HIV/AIDS Prevention
Association". This organization consists of members from State
agencies and from non-governmental organizations, though it does not
yet have a final charter. The organization operates under a
delegation of authority from the MOH, which had been tasked by the
Prime Minister to create a support fund for Vietnamese HIV/AIDS
patients. Madame Chien noted the organization's difficulties in
funding for infrastructure and highlighted the need for
international assistance.

EVOLVING VIETNAMESE HEALTH CONCERNS
-----------------------------------

14. (SBU) Ambassador Marine noted evolving Vietnamese health
concerns as the country modernizes, including the impacts of
smoking, pollution, motorbike/auto safety and diet. To counter
these rising issues, Vietnam must continue its health sector
reforms, particularly the development of relevant regulations and a
comprehensive insurance regime.

AVIAN INFLUENZA
---------------

15. (SBU) Ambassador Marine noted Vietnam's world-class surveillance
and early response strategy for human and animal attacks of avian
influenza. However, recent events show that the virus has not
disappeared and the GVN must maintain its vigilance. (Note: In the
past two weeks, Vietnam reported the deaths of two people infected
with the H5N1 virus.) As the virus changes, it may become more
dangerous. Thus, the prompt sharing of clinical samples remains
crucial to leverage U.S. and World Heath Organization resources

HANOI 00001464 003.2 OF 004


--not just of recent cases of H5N1 infection, but also of seasonal
influenza. Ambassador Marine urged increased communication and
cooperation between animal and health sectors, particularly in
pandemic preparation and response.

16. (SBU) Madame Chien said that she recently met with Ambassador
John Lange, U.S. Special Representative on Avian and Pandemic
Influenza, at an APEC Health Ministers' meeting in Sydney and agreed
with the importance of sharing samples to develop vaccines.

HIV/AIDS AND PEPFAR
-------------------

17. (SBU) Madame Chien thanked the Ambassador for U.S. support to
the Vietnamese health care sector, particularly the PEPFAR program,
which she called the "signature symbol" of American assistance.
Through cooperation with its U.S. partners, the GVN has improved
Vietnamese health and safety capacity toward world standards.

18. (SBU) This week, the MOH, Vietnam Administration for AIDS
Control (VAAC) approved a plan starting in September to train
HIV/AIDS patients to provide care and support for other HIV/AIDS
patients. Income from this work will allow the people living with
HIV/AIDS to better afford treatment and will increase social
integration. Madame Chien also stated that she has been in
discussions with VAAC to develop a year-long university based
clinical training program for nurses to specialize in HIV/AIDS care
and treatment.

19. (SBU) Ambassador Marine agreed with Madame Chien's
characterization of the U.S.-Vietnam partnership to combat HIV/AIDS.
Turning to the specifics of PEPFAR, Ambassador Marine stated that
this year's PEPFAR budget for Vietnam would reach USD 65 million
with USD 88 million tentatively budgeted for next year. The
Ambassador did not anticipate future increases and noted that both
sides now need to focus on how to use these funds most effectively
and how to increase cooperation within the GVN, bilaterally and
between all donors.

20. (SBU) Ambassador Marine underscored the need to involve people
living with HIV/AIDS in how to deal with the disease and noted the
potential of the health training plan described by Madame Chien.
The response to HIV/AIDS must be multi-sectoral, with cooperation
among many ministries, as the disease is not simply a health issue.

21. (SBU) Ambassador Marine called the new HIV/AIDS law an important
landmark in Vietnam's successful response to HIV/AIDS and detailed
his recent visit to a clinic in Ho Chi Minh City where lawyers use
the new law to provide assistance to HIV/AIDS patients. However,
the GVN must ensure the full implementation of the law so its terms
are not simply words on paper, he warned.

22. (SBU) The Ambassador noted the need to focus on prevention of
HIV/AIDS. As the number of new cases climbs, the GVN will be
required to provide long-term support to these victims at great
expense. Ambassador Marine emphasized the value of medicine
assisted treatment for limiting HIV/AIDS among intravenous drug
users. The Ambassador noted that he raised the pilot methadone
project during his recent meeting with the Prime Minister and urged
its expansion to prevent 06 center residents and other drug users
from relapsing.

23. (SBU) Ambassador Marine stated that testing and counseling were
critical for at risk populations and urged the GVN to speed up
availability of rapid testing, while improving current testing and
counseling procedures.

24. (SBU) Finally, the GVN must raise the profile of alcohol abuse
as a factor increasing the risk of HIV/AIDS exposure, particularly
in the context of other changes in Vietnamese society - an
increasingly migratory population, young people engaging in sexual
activity prior to marriage - that together raise the chances of
contracting HIV/AIDS.

VIETNAMESE HEALTH CARE SECTOR
-----------------------------

25. (SBU) Madame Chien highlighted the status of the Vietnamese
health care sector, noting that during her tenure the MOH focused on
four areas; better preventive care, improved health care for the

HANOI 00001464 004.2 OF 004


poor, children's issues, and increased access to health care for
disadvantaged people. According to Madame Chien, 52 million
Vietnamese currently have State health insurance to access to basic
health services, though the country lags in providing high-tech
care.

26. (SBU) The MOH is revising the 10 year-old hospital care
regulations, which will be sent to the Prime Minister soon for
approval. The revisions will create a fund for patient services (but
not for health care worker salaries). This fall, the MOH will
submit a draft law on health insurance and recently submitted a
proposal to upgrade the district health care system. However, while
MOH requested 8.3 trillion dong (approximately USD 520 million) for
the 2008 budget, the GVN has only approved 300 billion dong
(approximately USD 1.9 million) to date. The Prime Minister recently
approved a Master Plan on health care system design stretching out
to 2020 that will focus on preventive medicine, examination and
treatment, human resources, and drug and medical equipment, along
with the improvement of local and district health systems,
particularly in distant regions.

MARINE

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