Cablegate: Hiv Infection Rates Climbing in Hcmc -- Nearing

This record is a partial extract of the original cable. The full text of the original cable is not available.




E. O. 12958: N/A

1. Summary: On a visit to Ho Chi Minh City, Staffdel McCormick
from the House Committee on International Relations met with local
government officials and NGO partners involved in the city's fight
against HIV/AIDS. Current estimates indicate that the infection
rate in Vietnam is approaching one percent, a key measure of
whether the disease is about to breakout into the general
population. Damning statistics highlight the growing problem:
0.9% of pregnant women at the city's primary maternity hospital
test HIV positive as do 3.4% of HCMC's military recruits. The
staff delegation visited a USAID-funded anonymous testing and
counseling center that opened in 2001, which only attracts two to
three clients per day. Follow-on care available to individuals
infected with HIV is extremely limited in Vietnam and infection is
effectively a death sentence. End Summary.

Fear Epidemic Poised to Enter General Population
--------------------------------------------- ---
2. On January 3, 2004, a staffdel led by James McCormick, Staff
Director of the House International Relations Committee's (HIRC)
Subcommittee on Asia and the Pacific, met with officials from the
Ho Chi Minh City AIDS Committee. Staffdel members attending were:
John Walker Roberts, Deputy Chief of Staff, HIRC; Peter Yeo,
Minority Deputy Chief of Staff, HIRC; and, Douglas Anderson,
Counsel, HIRC Subcommittee on Asia and the Pacific. The AIDS
committee, which is comprised of representatives of several city
departments, is the last of its kind in Vietnam. In mid-2003 the
GVN restructured its response to the HIV/AIDS epidemic and
replaced all other provincial level HIV/AIDS Committees with the
Ministry of Health as the lead agency at both the provincial and
national level. In HCMC, however, the AIDS Committee has been able
to reach across departments for a more coordinated approach.

3. A detailed briefing by Dr. Tran Thinh, Project Coordinator of
the city's AIDS Committee, highlighted the growing HIV/AIDS
problem in the city. According to the committee's statistics,
0.9% of pregnant women at the city's primary maternity hospital
test HIV positive, as do 3.4% of the city's new military recruits.
This is more than double the national average. In the city's
primary treatment center for TB and Lung disease, 1216 patients
were HIV positive or sick with full-blown AIDS. This number has
increased every year and was only 165 in the year 2000. Dr. Thinh
noted that trends of infection showed that the new cases were
getting younger, and the disease was increasingly common among
women. He stated that the highest prevalence for HIV was among
intravenous drug users (heroin), but was increasing among
commercial sex workers. The big news, however, was that Thinh
stated that the disease is apparently making the jump from high-
risk groups to the population at large. Both Dr. Thinh and NGOs
say that the infection rate is probably between one half and one
percent of the overall population in Vietnam, and higher in Ho Chi
Minh City. A one percent infection rate is the point at which the
spread is considered a "generalized" as opposed to a concentrated
epidemic. Every testing category, from military recruits to
pediatric patients and from sex workers to pregnant women, is
marked by an increase in prevalence.

No Treatment for HIV/AIDS
4. Dr. Thinh provided a window on the grim fate faced by those
that develop AIDS in HCMC. Basically, anti-retroviral drugs are
not available to the general population. They are simply too
expensive. According to Dr. Thinh, the only anti-retroviral
therapies subsidized by the government are limited to health-care
providers exposed in the course of their duties. The health care
system is only providing treatment of opportunistic infections
associated with AIDS and palliative care.

5. In Dr. Thinh's words, he is "fighting a war with no soldiers,
no supplies, and no strategy." Trained healthcare workers are in
short supply and the most effective therapies are in even shorter
supply. The nation spends only six cents per capita per year on
HIV/AIDS, according to Dr. Thinh. As for strategy, the HCMC AIDS
Committee seems to understand that careful planning and
coordinated action are key to countering the spread of the
disease. At this point, however, he noted that it is difficult
for HCMC to take action without more policy guidance and material
assistance from the central government. Just the same, he said
that even with the city's resource constraints, it was placing
particular emphasis on testing and education, beyond the simple
scare messages found on billboards nationwide. He indicated the
city was starting to provide some information to fifth graders
(twelve year olds), since a lot of at-risk students left school
after that. Part of the overall effort is a USAID-funded
anonymous testing center. In addition, USAID will be funding a new
HIV/AIDS prevention program for high risk groups in HCMC.

USAID Funds Anonymous Testing - 28% Positive
6. Following Dr. Thinh's briefing, the staffdel met with program
staff at the USAID-funded Anonymous Testing Site (ATS) in Binh
Thanh District. The ATS opened in November 2001 with funding and
technical assistance from the University of California at San
Francisco. Currently, the ATS receives approximately 30,000 USD
per year from USAID via Family Health International (FHI). The
ATS program, located above a `Condom Caf' on a busy street in a
mixed commercial/residential area, is modeled after HIV testing in
the U.S. This model affords clients anonymity in the testing
process and professional counseling, both before and after the

7. The center currently sees only about 80-100 individuals every
month. Most are in their twenties, and men outnumber women two to
one. Most admit to at least one high-risk activity such as IV
drug use, participation in the commercial sex trade, or
unprotected sex. Of those that walk in the door, 90% decide to
have the test that day and 84% of those tested actually return for
the results. Approximately 28% of ATS clients test positive for
HIV. Post-test counseling for ATS clients includes counseling on
future behavior and medical referral.

8. The first floor of the building that houses the ATS is a
`Condom Caf.' In addition to the typical fare of coffee and pop
music, this caf's employees, all the beneficiaries of HIV/AIDS
peer educator training, dispense literature on risky behavior as
well as condoms. The caf, reportedly popular with local youth,
was founded by a French NGO but has since passed to the control of
district health officials who operate and fund it.

9. The ATS program staff stated that they would like to expand
the center's services to include U.S.-style support groups for
those that test positive for HIV. They also talked about the
value of expanding the advertising campaign to increase the number
of individuals taking advantage of the center's testing services.
According to an American physician working with the ATS, an
estimated 50-75% of Vietnamese infected with HIV are unaware of
their status.

10. Comment: Without effective drug therapies available to the
general population and without testing in meaningful numbers, the
committee must find new resources, build capacity, and redouble
its public awareness campaigns if it is to make any kind of

11. Staffdel McCormick did not have an opportunity to clear this
cable before their departure.


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