Ending AIDS - Viet Nam’s Progress and Opportunities

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Pratibha MehtaPratibha Mehta: "local action and focused interventions needed"As published in Viet Week on 30 November 2012.

World AIDS Day was first observed in 1988 to mobilize the world against a rapidly spreading virus without effective treatment or cure. Twenty-four yearslater, the largest-ever global disease response has achieved significant results.

According to a new report from UNAIDS, more than eight million people living with HIV are being treated with antiretroviral therapy, there were more than 500,000 fewer AIDS-related deaths in 2011 than in 2005, and 25 countries have seen a 50% or greater drop in new HIV infections since 2001.

In Viet Nam, there has been great progress. According to the latest data from the Ministry of Health, 60,935 adults and children are now on antiretroviral treatment - 54% of all in need – a 22-fold increase since 2005. There is evidence that the number of new infections has decreased in many provinces.  Last week, His Excellency Deputy Prime Minister Nguyen Xuan Phuc launched a new national HIV strategy with ambitious targets to greatly reduce HIV infections and provide many more people with life-saving treatment.

The United Nations congratulates Viet Nam for its progress and its vision for an even brighter future. But a shadow darkens the road ahead – a shadow of ignorance and fear. Many children living with HIV are denied schooling even though they pose absolutely no risk to their teachers and their fellow students.Many adults living with HIV are denied employment and forced out of their homes, even though they pose no risk to their co-workers and their neighbours. And the people most at risk of HIV infection – people who inject drugs, sex workers and men who have sex with men – are often rejected by society for committing so-called “social evils”. When these people are driven to the fringes of society, vital gateways are missed to engage them with the knowledge and tools they need to keep their bodies free of HIV.

Viet Nam’s leaders are leading lights against the shadow. The Deputy Prime Minister recently called on schools to open their doors to HIV-positive children. A law was recently passed by the National Assembly that will end the practice of sending sex workers to “05” compulsory detention centres. And the government recently enacted a new decree that will guide the scale up of methadone maintenance treatment for people addicted to heroin. Every province, every city, every district, every commune and each individual, now has a special opportunity to do their part – to shine their own lights, contributing to ending AIDS.

Local action is now critical as Viet Nam grows more prosperous. In recent years, Viet Nam’s HIV response has benefited from strong international support. And although the United Nations and individual UN Member States remain firmly at Viet Nam’s side, a combination of Viet Nam’s recent economic success and global economic troubles is contributing to a steady decrease in foreign support for HIV efforts. As Viet Nam shares responsibility to meet the costs of its HIV response, international community financing must be predictable. In the medium term, it will be difficult for Viet Nam to fully replace international funding for HIV.  All partners in the response will be therefore challenged to spend resources where they are most needed. This can be achieved by focusing on populations at greatest risk, and on a preventionto treatment approach which is proven to be effective and sustainable.
Within the general population of Viet Nam, very few people are living with HIV –only 0.45% of people between the ages of 15 and 49 – or less than one in 200. By comparison, nearly one in two men who inject drugs are living with HIV in Quang Ninh, Ho Chi Minh City and Hai Phong. HIV prevalence among men who have sex with men in An Giang, Ha Noi and Ho Chi Minh City is 8.5%, or about one in 12. Among sex workersin Ha Noi and Hai Phong, one in fiveare living with HIV.

We know who is at risk, and we know where that risk is greatest. And we know what works and what doesn’t work. Ensuring that drug users have access to clean needles and methadone works. Sending drug users to compulsory detention doesn’t. Ensuring that sex workers have access to condoms and are empowered to demand their use with every client works. Arresting sex workers and forcing them to change their jobs doesn’t. Raising awareness among men who have sex with men and providing them with condoms and lubricant works. Insisting that they pretend they are heterosexual men doesn’t. And we now know that early diagnosis and early initiation of antiretroviral treatment is the best way to preventnew HIV infections.
As we observe World AIDS Day this year, let ususe the courage and compassion within our hearts to reach out and help the people at greatest need – the men, women and children living with HIV, and the people who are at highest risk of infection. Across the country, individuals, families and communities must gather their combined strengthto grasp available opportunities to end AIDS.