Search

 

Cablegate: Vietnam's First Hiv/Aids Law: Transforming National

VZCZCXRO2609
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB
DE RUEHHI #2822/01 3120050
ZNR UUUUU ZZH
R 080050Z NOV 06
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 3941
INFO RUEHHM/AMCONSUL HO CHI MINH 2118
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3034
RUEHKO/AMEMBASSY TOKYO 5625
RUEHHK/AMCONSUL HONG KONG 1046
RUEHGZ/AMCONSUL GUANGZHOU 0743
RUEHCN/AMCONSUL CHENGDU 0275
RUESLE/AMCONSUL SHANGHAI 0021
RUEHSH/AMCONSUL SHENYANG 0331
RUEHHK/AMCONSUL HONG KONG 1047
RUEHIN/AIT TAIPEI 1424
RUEHOR/AMEMBASSY GABORONE 0021
RUEHAB/AMEMBASSY ABIDJAN 0017
RUEHDS/AMEMBASSY ADDIS ABABA 0030
RUEHGE/AMEMBASSY GEORGETOWN 0007
RUEHPU/AMEMBASSY PORT AU PRINCE 0014
RUEHNR/AMEMBASSY NAIROBI 0024
RUEHTO/AMEMBASSY MAPUTO 0013
RUEHWD/AMEMBASSY WINDHOEK 0011
RUEHUJA/AMEMBASSY ABUJA 0023
RUEHLGB/AMEMBASSY KIGALI 0031
RUEHSA/AMEMBASSY PRETORIA 0056
RUEHDR/AMEMBASSY DAR ES SALAAM 0020
RUEHKM/AMEMBASSY KAMPALA 0010
RUEHLS/AMEMBASSY LUSAKA 0013
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 06 HANOI 002822

SIPDIS

SIPDIS

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

E.O. 12958: N/A
TAGS: ELAB PGOV PINR PROP SOCI TBIO KHIV VM

SUBJECT: VIETNAM'S FIRST HIV/AIDS LAW: TRANSFORMING NATIONAL
APPROACHES AND ATTITUDES


HANOI 00002822 001.2 OF 006


SENSITIVE BUT UNCLASSIFIED

1. (SBU) Summary: On June 29, 2006, the National Assembly of
Vietnam passed the Law on HIV/AIDS Prevention and Control. The
legislation, the first on this subject, goes into effect on January
1, 2007. While details are still under discussion, this bold and
comprehensive new Law demonstrates Vietnam's serious commitment to
combating the disease and mobilizing all sectors of the country,
including provincial leadership, community- and faith-based
organizations, and international groups. Protection of rights for
people living with HIV/AIDS (PLWHAs), substitution therapy for drug
abusers, insurance and anti-retroviral drug benefits are among the
key issues addressed in the law. The unusually open debate and
discussion conducted during the past year on the Law's measures,
through seminars, media outlets and National Assembly hearings,
offer a rare opportunity for civil society involvement in the
lawmaking process, which is usually tightly controlled by the
Communist Party. As the fifteenth focus country under the
President's Emergency Plan for AIDS Relief, Vietnam will continue to
receive strong USG support and funding as it continues to construct
laws, regulations and policies dealing with HIV/AIDS. End Summary.

Vietnam's First HIV/AIDS Law: Key Provisions
--------------------------------------------

2. (SBU) On June 29, 2006, the National Assembly of Vietnam passed
the long-awaited Law on HIV/AIDS Prevention and Control, the first
of its kind in the country. Earlier that month, Deputy Prime
Minister Pham Gia Khiem pledged to "hammer out bolder and more
effective measures" at the High Level Meeting of the United Nations
General Assembly on HIV/AIDS. The comprehensive measure goes into
effect on January 1, 2007, overriding a myriad of administrative
ordinances and decrees issued by the Government of Vietnam (GVN) in
the past decade. The Law includes a total of six chapters and fifty
articles that will affect an estimated 280,000 PLWHAs in Vietnam,
including 10,000 children. The estimated number of reported (or
known) cases of HIV/AIDS is expected to rise to 310,000 by 2010.

3. (SBU) A recurring theme throughout the Law is the emphasis on
the rights of PLWHAs and the need to combat stigma and
discrimination. According to the Law, PLWHAs have the right to
refuse medical examination and treatment, but must notify their
spouse or fiance and health workers directly dealing with their care
and treatment of their positive status. Privacy rights are clearly
outlined, particularly in the workplace with regards to promotion
and termination; employers cannot require HIV tests. Testing will
only be compulsory when a court dictates it. Even rights to burial
and cremation (significant in a Taoist-based society) and admittance
to schools are explicitly mentioned with enforcement provisions.

4. (SBU) Another key focus in the Law is the inclusion of
prevention measures for high risk groups (sex workers and injecting
drug users) including the use of condoms, safe-injecting practices,

HANOI 00002822 002.2 OF 006


and expanding the treatment of addiction to illegal drugs through
the use of medication-assisted therapies (e.g., methadone,
naltrexone, etc). A key component is mainstream drug substitution
therapy with a full range of comprehensive addictions counseling and
supportive interventions. Provisions on blood transfusions,
diagnostic bio-products, sterilization, disinfection and benefits of
volunteers in vaccine trials are also outlined in detail.

5. (SBU) Prevention of mother-to-child transmission is another
priority, with commitment to assist babies born to HIV mothers with
substitutions for breast milk. Medical establishments are clearly
identified as responsible for HIV/AIDS treatment and implementing
preventive measures against mother-to-child transmission. National
mobilization in fighting AIDS, not restricted to officials and
organizations only, are touted, urging awareness and action from
local leaders at the hamlet, village and clan levels. Additional
emphasis on public awareness, prevention education and general
messaging on stigma are prominent in the Law. Free anti-retroviral
drugs (ARV) will be provided to those exposed by occupational
accidents or medical procedures, pregnant women, abandoned orphans
and children under the age of six. Those who hold medical insurance
are now covered for HIV/AIDS examinations and treatment.

How the Law Evolved
-------------------

6. (SBU) National Assembly deputies debated the draft Law in two
major sessions in February and May 2006. Intense discussion focused
on the right of infected patients to privacy and refusal of medical
treatment. The debate over who would receive free ARV drugs and who
would not, through the provision of health insurance, was also a key
point of debate. Discussion about building separate schools for
HIV-positive children was met with vehement opposition from
representatives in the southern provinces of Ho Chi Minh City and
Long An. Some legislators argued that a proposal to have all fees
for examinations and treatments paid by insurance would be
discrimination for those who do not have insurance.

7. (SBU) According to the Law's key drafter, Ministry of Health
(MOH) Deputy Director of Health Legislation Nguyen Huy Quang,
existing laws in Cambodia, the Philippines, Australia and Japan
influenced Vietnam's draft. The main focus of the Law remains on
the rights of PLWHAs, prevention interventions and the critical need
to involve all levels of authority, down to the commune-level (even
though the overall directive comes from the Communist Party's
central authorities). Quang also insisted that Vietnam's Law is
clearer than that of Cambodia and the Philippines on prevention
interventions and the rights of PLWHAs, although both were used as
models. Quang acknowledged the real challenge is that "regulations
do not change people overnight" and that the Law is a work in
progress, ready for adjustment and revision as needed. Supporting
PLWHA clubs and organizations is an important statement the GVN is
attempting to make to the public about stigma and discrimination,

HANOI 00002822 003.2 OF 006


even allowing the establishment of a State-sanctioned national
association for PLWHA.

8. (SBU) The USG began supporting work on the development of an
HIV/AIDS Law in Vietnam in 2002 through a USAID grant to the POLICY
Project, which has since been renamed the Health Policy Initiative
(HPI). Funding is now supported by the President's Emergency Fund
for AIDS Relief (PEPFAR). The HPI was instrumental in providing
technical assistance to the GVN drafting team and eventually direct
support to the National Assembly in revising the draft Law, which
passed with a number of heavily debated gains for HIV advocates.
The Mission's interagency PEPFAR team has provided the MOH direct
feedback on the draft Law, thereby encouraging legislation that
addresses comprehensive concerns, particularly on stigma and the use
of methadone in medication-assisted therapy for illicit drug users.


9. (SBU) According to HPI Advisor David Stephens, the new Law could
be stronger but it is a good base to start, particularly because of
the intensive consultative process that went into drafting the Law,
which sought opinions from international organizations, the Women's
and Youth Unions (quasi-governmental mass organizations), provincial
officials and PLWHAs. It provided an opportunity for "ownership" of
the Law by different segments of civil society that are usually not
afforded such a voice. Frank, vigorous and sometimes contentious
debates on testing and privacy heralded a rare forum in Vietnam, a
society where laws are usually drafted behind closed doors.

Vietnam's Long Road: Dealing with HIV/AIDS
-------------------------------------------

10. (SBU) The first case of AIDS in Vietnam was detected in 1991
when a 24-year-old woman in Ho Chi Minh City discovered her status
during a routine blood test required for immigration to Australia.
By February 1995, 2,280 cases were detected throughout the country.
Now, the prevalence rate in the general population is estimated at
0.53 percent, with high-risk groups including sex workers and
injecting drug users a growing concern, and the epidemic has spread
to all 64 provinces and major cities in Vietnam. A Communist Party
Directive dated March 11, 1995, did little more than note the
formation of a National AIDS Committee consisting of eighteen
members of government agencies and mass organizations under the
chairmanship of the Deputy Prime Minister. The Directive called for
a "healthy, faithful life avoiding drugs and prostitution," which
are "social evils" to be countered with strong police surveillance
and sentences.

11. (SBU) The Ordinance on the Prevention and Control of HIV/AIDS
followed in April 1995, containing definitions of HIV and vague
references to protecting PLWHAs from discrimination, encouraging
family members of those infected to provide care and moral support,
but no legal protections. The ordinance gave doctors the authority
to test a patient for HIV during a routine medical examination and

HANOI 00002822 004.2 OF 006


require the patient to notify the spouse. Doctors also reserved the
right to inform other family members, employers and affiliated
organizations. People infected with HIV were also prohibited from
working in "some sectors" which were never clearly defined. Dr.
Stephens of HPI calls the 1995 Ordinance a "measure without teeth"
as it failed to provide transparent legal guidelines and address the
protection of the rights of PLWHAs, confidentiality and privacy
issues. Since 2003, HPI has been working hard to provide input to
shape key portions of the Law through the Institute of Health Policy
under the direction of the Ministry of Health.

12. (SBU) Like many countries, Vietnam was initially unprepared to
deal with the onslaught of AIDS. By 2004, the GVN had constructed a
National Strategic Plan on HIV/AIDS Prevention (2004-2010),
including a supplementary Vision to 2020. For the first time, the
GVN laid out guidelines and measures for a national response to
combat the disease through a multi-pronged approach enlisting the
Ministries of Education and Training; Culture and Information;
Public Security; Labor; Invalids and Social Affairs; Health;
Finance; and even Planning and Investment. The GVN opened its arms
to international cooperation and set a goal to reduce the national
prevalence rate in the general population below 0.3 percent by 2010.
Another goal was to ensure that 70 percent of HIV patients receive
ARV by 2010. The Strategic Plan included specific commitments to
negotiating the reduction of ARV's prices, establishing satellite
treatment quarters of regional hospitals and implementing voluntary
counseling and testing programs in all provinces by 2010. The
Supplementary Vision to 2020 committed prevention activities for a
"gradual reduction in the absolute number of people infected" by the
year 2020.

13. (SBU) In June 2004, Vietnam became the fifteenth PEPFAR focus
country. Nearly USD 80 million have been allocated under the EP thus
far and another USD 59 million are slated for FY07. With over thirty
international and local partners and sub-grantees that make up the
PEPFAR family in Vietnam, a wide-ranging network of programs to
provide ARV medicines, HIV care, prevention and treatment have been
in place for the past two years with plans for expansion in FY07 to
additional partners and provinces with focused programs.

A Concrete Pledge and Moving Forward
------------------------------------

14. (SBU) Vietnam made a critical decision to take its commitments
to a deeper level in December 2005 when the Central Committee of the
Communist Party Secretariat instructed local Party committees to
tackle HIV/AIDS as an "urgent and long-term duty." The directive
cited local prevention plans to combat prostitution and drug abuse,
along with public efforts directed at youth, sex workers and
homosexuals. The Party Central Committee's Commissions for Science
and Education, and Ideology and Culture, and the United Nations
Development Program (UNDP) also jointly agreed to implement a
three-year plan with USD 2 million from UNDP and the Swedish

HANOI 00002822 005.2 OF 006


International Development Cooperation Agency (SIDA) and USD 250,000
from the GVN in the three pilot provinces of Lang Son, Khanh Hoa and
An Giang. The project objective was to establish guidelines and
policies to create a legal basis for multi-sector HIV/AIDS
prevention and gender equality. Under the project, HIV/AIDS would
be included in socio-economic development plans, and a new method
for contact with HIV/AIDS patients would be applied in the pilot
provinces.

15. (SBU) In November 2005, Vice President Truong My Hoa
highlighted the impact of stigma on PLWHAs at a meeting organized by
UNDP and SIDA with 50 members of the Bright Futures Group, a PLWHA
network organization founded in 2003 with over 500 members currently
nationwide. The Vice President stated that the government would
"reaffirm the highest political commitment of the Party, State and
Vietnamese people in reducing stigma and discrimination." Another
mark of progress was the inclusion of PLWHA groups and international
organizations in the discussion to develop a national law on
HIV/AIDS, an unusual nod towards civil society involvement. Coupled
with the HIV/AIDS Law is the draft Law on Associations currently,
which has long been under debate in Vietnam and seeks to establish
regulations for Vietnamese and foreign organizations to convene,
including groups to promote HIV/AIDS networks. The latest version of
the Law on Associations was pulled from the National Assembly's 2006
work plan; when it will be considered is unclear.

Steps Toward Implementation and Beyond
--------------------------------------

16. (SBU) Since the issuance of the HIV/AIDS Law in June 2006, the
GVN has been busy working out the details on implementation in
January, 2007. The MOH held a series of seminars in August in
northern, central and southern regions to explain the Law to
provincial leaders, lawyers, media representatives, PLWHAs and
community groups. HPI continues its work with MOH on the Law's
implementing decrees and regulations, debating how detailed they
should be and the need to build in flexibility to deal with a
changing environment. PEPFAR Vietnam's FY07 draft budget supports
plans for HPI to continue to work with the GVN, local PLWHA groups
and individuals to examine and assist with the implementation of the
HIV/AIDS Law at the provincial level.

17. (SBU) Mobilizing the state-owned media in a strong public
affairs campaign is also an essential component of the Law's
implementation. Deputy Director of the Central Party Committee's
Commission for Science and Education Pham Manh Hung, held a press
briefing on September 28 urging the media to report more effectively
on HIV/AIDS. He emphasized that the disease does not equate to a
"social evil" and called on provincial and city officials to step up
local plans to fight stigma. Human interest pieces in the
State-controlled Vietnam News Agency and Voice of Vietnam radio
about discrimination and stigma faced by PLWHAs have significantly
increased in recent months. Post's Public Affairs Section has

HANOI 00002822 006.2 OF 006


intensified efforts to educate the public about HIV/AIDS and tell
our story of the President's Emergency Plan through press releases
and seminars. Joining forces with an online newspaper, Post also
successfully organized Vietnam's first, live web chat on HIV/AIDS in
May with a panel consisting of a PEPFAR team member, PLWHAs and
health experts. A letter to the editor submitted by the Ambassador
that congratulated the media's more balanced focus and attention on
HIV/AIDS, and PLWHAs in particular, was recently published in the
Vietnam News.

18. (SBU) One of the most significant by-products of the HIV/AIDS
lawmaking process has been the engagement of civil society and
community groups, which continues as plans for implementation of the
Law unfold. The Center for Consultation on Legal and Policy on
Health and HIV/AIDS under the Vietnam Lawyers' Association is
currently training lawyers and PLWHAs in provinces with the highest
infection rates. Faith-based organizations and religious groups are
also receiving open encouragement from the GVN to join the fight
against HIV/AIDS. In April, Buddhist clerics convened in HCMC for a
conference to share experience in providing support to PLWHAs.
Through PEPFAR funding, a number of pagodas in Hanoi, Hue and HCMC
provide face-to-face and telephone consultations for tens of
thousands of people. Clerics have also held more than thirty
training courses for monks and nuns, provided free medical checkups
and treatment to over 8,000 patients, and organized memorial
services and worship for hundreds of families whose loved ones have
died from AIDS.

19. (SBU) Before implementation of the Law on January 1, 2007, the
GVN must release details of the legal measures. This includes a
list of occupations requiring HIV testing before recruitment,
regulations on care and treatment of women during pregnancy
delivery, regulations on monitoring sexually transmitted diseases
and the responsibility of medical establishments, procedures for HIV
testing, and steps for HIV education in schools as MOET develops
content for teachers' manuals on sex education. Issues such as
reproductive technology, standards for voluntary testing centers, as
well as counseling and prevention among discordant couples (couples
where one member is HIV-positive while the other is HIV-negative)
are also areas that will require further attention by policymakers
in the future.

MARINE

© Scoop Media

 
 
 
World Headlines

 

OECD: COVID-19 Crisis Puts Migration And Progress On Integration At Risk, Says

Watch the live webcast of the press conference Migration flows have increased over the past decade and some progress has been made to improve the integration of immigrants in the host countries. But some of these gains may be erased by the COVID-19 pandemic ... More>>


Pacific Media Watch: How Pacific Environmental Defenders Are Coping With The Covid Pandemic

SPECIAL REPORT: By Sri Krishnamurthi of Pacific Media Watch Pacific Climate Warriors - creative action to trigger better responses to climate crisis. Image: ... More>>

Reporters Without Borders: Julian Assange’s Extradition Hearing Marred By Barriers To Open Justice

After monitoring four weeks of evidence in the US extradition proceedings against Wikileaks publisher Julian Assange, Reporters Without Borders (RSF) reiterates concern regarding the targeting of Assange for his contributions to journalism, and calls ... More>>

OHCHR: Stranded Migrants Need Safe And Dignified Return – UN Migrant Workers Committee

The UN Committee on Migrant Workers has today called on governments to take immediate action to address the inhumane conditions of migrant workers who are stranded in detention camps and ensure they can have an orderly, safe and dignified return to ... More>>