Cablegate: Hiv/Aids: Ambassador Visits U.S. Government-

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

REF: Hanoi 2946

1. (SBU) Summary: During an October 29 trip to Haiphong,
the Ambassador visited three HIV/AIDS projects supported by
the President's Emergency Plan (EP) and met with city
officials. Haiphong is Vietnam's fourth most-populous city
and suffers from the country's second highest HIV incidence
rate. Senior city officials described a number of HIV/AIDS
awareness programs and public health measures they are
taking to deal with the disease and outlined their anti-
narcotics efforts. The director of a voluntary counseling
and testing center described efforts to identify HIV-
infected individuals, to refer them to care and also to
prevent the spread of the virus to others. Participants in
a support group for HIV-positive people identified as
particular priorities changing public attitudes towards
people living with HIV/AIDS and helping children of HIV-
positive people. Finally, the manager of a center for
injecting drug users (IDUs) described the center's efforts
at risk reduction for its clients. End Summary.

2. (SBU) The Ambassador visited Haiphong, Vietnam's fourth
largest city and a provincial-level administrative entity,
October 29 for meetings with local officials, community
leaders and religious workers (the Ambassador's discussions
with religious leaders will be reported septel). Haiphong
People's Committee Chairman Trinh Quan Su told the
Ambassador that he is "delighted" that Vietnam had been
chosen as part of the President's Emergency Plan (EP) and he
pledged the Haiphong authorities' "strong cooperation" with
the efforts of the United States and other donors to combat
HIV/AIDS. Provincial Department of Health Director Nguyen
Van Vy, also present at the meeting, elaborated on the
province's efforts to combat HIV/AIDS. He seconded the
Chairman's comments on foreign aid, saying that the health
authorities seek to "mobilize communities" in their effort
to fight HIV/AIDS and welcome USG assistance to Haiphong
NGOs which are carrying this out. Haiphong initiated
HIV/AIDS prevention efforts in 1989, which Vy said was "very
early" for Vietnam.

3. (SBU) The city's greatest HIV threat comes from injecting
drug users (IDUs), Vy continued. The province has "strong
leadership" on HIV prevention, and the People's Committee
has held three sessions solely to discuss prevention
measures. In addition, the Provincial Party Committee had
issued a resolution on HIV/AIDS prevention three years
before. Through government awareness efforts, 90 percent of
Haiphong residents are aware of the disease and 50 percent
know how to take preventive measures. The city is now
focusing on increasing HIV testing, strengthening safety
measures during healthcare activities (such as testing
donated blood), preventing mother-to-child transmission and
providing syringes to IDUs in order to reduce HIV
transmission. There are 6,300 individuals infected with HIV
in Haiphong, and 1,100 local residents have died of the
disease. The city has two facilities for treating the
disease, each with 50 beds. Vy claimed that, as a result of
the authorities' efforts, the rate of new cases is down 30
percent compared with previous years.

4. (SBU) Specifically addressing the spread of HIV/AIDS
through drug users, Haiphong public security director Nguyen
Binh Doan said that there are 4,000 IDUs in the Haiphong
area, and that Haiphong has two treatment centers -- one for
300 addicts and a second for 200. One third of the people
in these centers had entered voluntarily, Doan claimed.
(Note: These drug rehabilitation and treatment centers,
known as "06 centers," provide for the involuntary detention
and treatment of repeatedly identified addicts. The 06
centers are essentially the only drug rehabilitation
programs currently available in Vietnam. A large minority
of residents are "voluntarily" admitted by themselves or,
more commonly, by their families. End note.)

5. (SBU) The Ambassador said he welcomed cooperation with
the Haiphong authorities in prevention and treatment efforts
and noted that the President's Emergency Plan would
potentially allow them to expand activities. He urged the
authorities to lend their support to USG efforts to bring
medicines for AIDS treatment into Vietnam tariff-free,
noting that this would allow a 15 percent savings which
could be used in other efforts. Because being frank and
open about the disease is important, the Chairman should
speak out more publicly on AIDS, the Ambassador stressed.
In fact, during a meeting the day before, Prime Minister
Phan Van Khai had made a pledge to the Ambassador to raise
his voice on HIV/AIDS (reftel). On the subject of
rehabilitation centers, the USG shares the GVN's desire to
stop the use of illegal drugs. However, we have a
difference of opinion regarding the centers and are
presently not able to work with them for policy reasons.
Chairman Su closed the meeting by pledging to "personally
speak out" on the danger of HIV/AIDS.

6. (SBU) At a LIFE-GAP Voluntary HIV Counseling and Testing
Center (VCT), which is funded by the Centers for Disease
Control and Prevention (CDC) in a cooperative program with
the Vietnamese Ministry of Health (MOH), Project Director
Dr. Tran Thi Thanh Thuy identified the main activities that
the two-year-old program carries out. With a staff of eight
trained counselors and three laboratory technicians, the VCT
center has in its 23 months of operation counseled and
tested more than 5,000 clients at high risk for HIV. Using
a MOH-required standard test strategy requiring two visits,
90 percent of the center's clients returned for post-test
counseling and were also referred to additional services if
"indicated." Dr. Thuy explained that the center receives
clients through referral cards placed in health facilities
across the province and also gave additional cards to all
visitors to pass to their acquaintances. Currently serving
200 to 300 clients per month, the numbers of visitors tend
to be higher in the fall and winter, as well as after the
center conducts advertising campaigns. Of those who have
been tested, just over 22 percent were found to be HIV-
infected, indicating that the services, which are free and
anonymous (no name is reported to the Government), appear to
be attracting higher risk clients. Some 76 percent of the
positive tests were among drug users, but sexual
transmission appears to be rising, Dr. Thuy noted.

7. (SBU) In addition to the VCT center, the CDC-funded
program provides technical and financial support for an
HIV/AIDS outpatient clinic attached to the provincial
hospital; a community outreach program staffed by peer
educators who work in high-risk neighborhoods to provide
information, skills, condoms and referrals to IDUs and other
vulnerable populations; and a program to detect and prevent
mother-to-child transmission. This USG-funded project also
supports monitoring rates of sexually transmitted disease
infections among persons at high risk for HIV, tracks the
connection between tuberculosis and HIV in order to both
enhance identification of co-infection and better coordinate
the two provincial programs and distributes condoms to
persons with high HIV risk. Dr. Thuy noted that clients of
the VCT site preferred the Vietnamese-produced condoms to
the American condoms provided by the USAID Commodities Fund.
Clients complained that the American condoms have an
undesirable smell. The stigma against AIDS suffers remains
strong in Vietnam and it is sometimes difficult to recruit
employees to work in the project. In response to
Ambassador's question, Dr. Thuy said that, with more
funding, the center would like to expand its VCT and
community outreach activities to more of Haiphong's
districts, especially those in outlying areas.

8. (SBU) Mrs. Pham Thi Hue and four members of "Red Flame
Tree," a support group for HIV-positive people, described
for the Ambassador their efforts to raise awareness of
HIV/AIDS in Vietnam. Mrs. Hue gives talks at schools and
businesses, and said she was planning a trip to HCMC to
speak at an Adidas factory the following day. Ha Minh Thao,
Hue's husband and a continuing drug user, noted he has
spoken to IDUs about HIV/AIDS. Most people have a basic
idea about AIDS, Hue said, but "people are surprised to find
out that someone who looks like me" is HIV-positive.
Although the group has the support of local leaders and some
funding from CARE, members have little or no access to
medicines to treat the disease, Hue said.

9. (SBU) Hue and the other members of the group told the
Ambassador that people living with HIV/AIDS in Vietnam need
both "spiritual support" from the public and help in caring
for their children. Support from Vietnam's leaders would be
very useful in this. Children with HIV/AIDS in particular
often suffer as they are left by their parents, who either
shun them or who have themselves died of the disease. Mrs.
Hue noted that her own son (who is not HIV-positive) is
unable to attend preschool, although she is attempting to
meet with teachers and parents to explain his condition and
is hopeful that he will be able to begin soon. The group
had recently organized a festival for children who are HIV-
positive and assisted families to purchase materials to help
children with their schoolwork. This "deeds, not words"
assistance is most welcome by people living with HIV/AIDS
and their families, Hue said.

10. (SBU) The Ambassador's final HIV/AIDS-related site visit
in Haiphong was to the Seagull Club, a drop-in and outreach
center for IDUs partially funded by USAID through Family
Health International (FHI). Dr. Hoang Thi Tuyet Minh,
Manager of the Seagull Club, explained that the club focuses
on HIV risk reduction though consultancy activities, medical
checks, peer-to-peer counseling, supplying condoms and by
providing and exchanging hypodermic needles. (Note:
Syringe and needle access is legal in Vietnam without
prescription, and, in this program, the needles are provided
by the provincial health department. No USG funds are used
to procure or supply syringes or needles. End note.)

11. (SBU) Dr. Minh said that the club is known as a place
where IDUs can relax, with a large number of visitors also
coming to acquire needles. She added that the club also
attempts to spread knowledge about HIV/AIDS and makes
referrals to the LIFE-GAP VCT center. Approximately 60
percent of the club's clients are HIV-positive. In response
to the Ambassador's question about the moral hazard of
providing needles to IDUs, Dr. Minh explained that the club
has a "hierarchy of harm reduction." This prioritizes the
encouragement of people not to use drugs, but, for those who
are unable to stop injecting, the program also includes
teaching methods of protecting injectors from acquiring HIV
or transmitting HIV to others. Dr. Minh said she does not
know how many IDUs continue to share needles, but
acknowledged that an estimate of ten percent by Mr. Thao of
Red Flame Tree may be accurate. Rates may be higher in
distant areas and among groups that are harder to reach,
such as prostitutes, she said.

12. (SBU) In response to the Ambassador's question, Dr. Minh
said that, if the club had more funds available, it would
like to carry out a drug substitution (methadone) program to
help eliminate injecting and, ideally, drug use overall.
They would also like to help people released from 06 centers
to identify long-term jobs. The treatment these centers
provide is by itself not enough, because a lack of new
opportunities and the low price of heroin lead almost all
former addicts to relapse. Only one of the 5,000 IDUs
reached by the club had successfully quit drugs. FHI staff
member Vuong Thi Huong Thu noted that the program has been
effective in reducing HIV, as indicated in a recent FHI
survey that showed the HIV infection rate among IDUs to be
decreasing. However, both drug use and HIV incidence are
moving from urban to rural areas through seasonal laborers,
she added.

13. (SBU) Comment: Haiphong's authorities showed a positive
commitment to treating people living with HIV/AIDS in their
city, and we hope we can use their positive example to
encourage other leaders in northern Vietnam. Nonetheless,
our visits to the three organizations show an overall effort
that is barely keeping its collective head above water. It
appears that these groups could be further expanded or
duplicated to meet very immediate needs. As more
President's Emergency Plan money hopefully becomes
available, we will be in a position to help improve on these
existing efforts, as well as replicate them in other, less-
prepared provinces in Vietnam. End Comment.


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