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Cablegate: Pepfar Spending in Hcmc Money Well-Spent

VZCZCXRO1891
RR RUEHDT RUEHPB
DE RUEHHM #1107/01 3021246
ZNR UUUUU ZZH
R 291246Z OCT 07
FM AMCONSUL HO CHI MINH CITY
TO RUEHC/SECSTATE WASHDC 3290
INFO RUEHHI/AMEMBASSY HANOI 2270
RUCNARF/ASEAN REGIONAL FORUM COLLECTIVE
RUEHHM/AMCONSUL HO CHI MINH CITY 3503

UNCLAS SECTION 01 OF 02 HO CHI MINH CITY 001107

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/BCLTV, EAP/RSP, OES/IHA AND S/GAC
STATE PASS TO HHS FOR OGHA

E.O. 12958: N/A
TAGS: ECON KHIV TBIO PREL PGOV SOCI OTRA OVIP VM
SUBJECT: PEPFAR SPENDING IN HCMC MONEY WELL-SPENT


HO CHI MIN 00001107 001.2 OF 002


1. (SBU) SUMMARY: U.S. Senate Committee on Foreign Relations
staff members Shannon Smith and Jennifer Simon concluded their
President's Emergency Plan for AIDs Relief (PEPFAR) assessment
visit to Vietnam with a stop in Ho Chi Minh City (HCMC) on
October 11-12. HCMC officials, medical staff, and NGO partners
leading the city's fight against HIV/AIDS reported significant
progress in prevention of mother to child transmission (PMTCT),
care and treatment of the HIV-affected, and community outreach,
while treatment of incarcerated and released-but-relapsed
injection drug users (IDUs) remains problematic. Overall, the
staffers assessed that PEPFAR spending in HCMC is money
well-spent, and the well-reasoned, capacity-building nature of
future projects proposed by HCMC HIV health workers (e.g.
sexually transmitted infection (STI) clinic and TB diagnosis
capability) suggests forthcoming allocations will not be
misspent. End Summary.

View from the Top
-----------------
2. (SBU) Vice Chairman of the HCMC AIDS Committee Dr. Le
Truong Giang outlined PEPFAR-supported accomplishments, as well
as challenges and future priorities in the fight against HIV in
HCMC. Giang noted that model programs, such as Community Care
and Support Centers (CCSC) that provide a range of services
(e.g. Out Patient Clinics (OPC), Voluntary Counseling and
Testing (VCT) and Peer Education (PE)) at one location, were
developed in HCMC and then spread to other provinces. About
20,000 patients are currently receiving some form of care and
treatment, including 7,000 on anti-retroviral (ARV) therapy - up
from 100 in 2005 when PEPFAR funding began in Vietnam. PMTCT
programs now operate in all of HCMC's 24 districts, benefiting
130,000 pregnant women yearly, many of whom are from outlying
provinces without PMTCT programs. One growing challenge is the
successful reintegration into society of the 10,000 IDUs
released to date from drug rehabilitation centers (a number
projected to grow to 20,000 by 2009), many of whom relapse.
Although the GVN is still formulating a strategy to mitigate the
high relapse rate, following MOH approval, the Committee plans
three PEPFAR-supported methadone clinics to treat relapsed
returnees. In response to StaffDel questions regarding what
proportion of those in need are covered by existing programs,
Giang estimated that coverage rates for PMTCT were 95 percent,
nearly 100 percent for care and treatment, but much lower for
the HIV-infected in prisons and rehabilitation centers.
(Comment: Local CDC staff present thought these estimates high.
End comment.)

Fewer Mothers Infecting Children
--------------------------------
3. (SBU) Director Dr. Vu Thi Nhung of Hung Vung Hospital, HCMC's
principal ObGyn facility described the hospital's PMTCT program,
after which the StaffDel toured the facility. The percentage of
HIV positive pregnant women peaked at 1.0 percent in 2005, but
has held steady at 0.8 percent (121 of 14,892 cases) since 2006.
The current mother-to-child transmission rate is 6.5 percent,
down from an estimated high of 35 percent ten years ago when ARV
drugs were not available. Many of the HIV-positive mothers are
the wives of migrant workers from outlying provinces, while
commercial sex workers (CSWs) and IDUs comprise only six to
seven percent of the total. When queried about future plans,
Dr. Nhung described a volunteer peer support group for pregnant
woman who presented too late to begin effective PMTCT treatment,
and a People Living with HIV/AIDS (PLWHA) program for
HIV-positive mothers

HIV-infected Migrants and Trafficking Victims
---------------------------------------------
4. (SBU) At a working lunch, StaffDel met with International
Organization for Migration (IOM) personnel Andrew Bruce, Chief
of Mission; David Trees, Project Development Officer; Andrew
Billo, Program Officer; Goran Grujovic, Chief Migration Health
Physician; and Patrick Corcoran, Head of HCMC Office. IOM seeks
increased collaboration between agencies dealing with
trafficking and those dealing with HIV, to better identify and
assist HIV-infected migrants and trafficking victims.

The HCMC Model: One Stop Counsel, Test, and Treat
--------------------------------------------- -----
5. (SBU) In the stifling heat - air conditioning is banned for
fear of circulating tuberculosis bacteria - of a clean but
spartan facility in HCMC's economically depressed port district,
Dr. Nguyen Vu Thanh of the District 4 CCSC described five
PEPFAR-supported activities: community outreach, PMTCT, VCT,
OPC, and reintegration of rehab center returnees. Sixteen PEs
contact 700 to 800 IDUs and CSWs per month, up from some 350 per
month in 2005; about 1500 of these per year are first-time
contacts. In 2006 less than half of the women who came to the
CCSC for pregnancy testing consented to an HIV test; this year

HO CHI MIN 00001107 002.2 OF 002


effective counseling raised that figure to almost 90 percent.
Since 2006, nearly 100 percent of VCT clients have returned for
HIV test results (40 to 50 percent of which are positive.)
Approximately 40 percent of IDU rehabilitation center returnees
to District 4 receive services at the CCSC, including job
counseling, drug relapse prevention, care and treatment
services, and ARV therapy. Vu Thanh said she would use
additional resources for a sexually transmitted infection (STI)
clinic, and equipment and training to improve diagnosis and
management of extra-pulmonary TB.

Fighting Discrimination
-----------------------
6. (SBU) The last stop was at the PEPFAR-funded HIV/AIDS
Legal Clinic, the first of its kind in Vietnam, set up by the
Health Policy Initiative (HPI) in January 2007. HPI advisers
Tran Tien Duc and David Stevens, and Chairman of the HCMC
Lawyers' Association Ms. Dong Thi Anh introduced the clinic's
two lawyers and four PLWHA counselors. These staff members have
advised some 300 individuals regarding access to treatment,
access to schooling for children affected by HIV/AIDS, basic
HIV/AIDS information, and referral to other services. The
majority (approximately 200) of cases concern the lack of HIV
treatment at IDU rehabilitation centers. The clinic has yet to
bring a discrimination case to the courts under the new HIV/AIDS
law, instead mediating between the relevant HCMC agency and the
affected individual. The clinic plans to replicate its model in
six other provinces.

7. (SBU) Comment: Staff member Smith appreciated the frank
assessments and the detailed statistics presented at the sites,
noting that both are necessary components of an accurate
evaluation. Smith and Simon saw significant progress in
prevention of mother to child transmission, care and treatment
of the HIV-affected, and community outreach, but treatment of
incarcerated and released-but-relapsed IDUs is a growing
problem. Its progressive nature and greater latitude for
innovation allow HCMC to lead the way in developing new programs
in Vietnam's battle with HIV/AIDS, allowing replication of
successful variants nation-wide. End comment.

8. (U) This cable was cleared by StaffDel Smith and coordinated
with Embassy Hanoi.
FAIRFAX

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