HIV prevention
December 1, 2011
The An Duong health clinic in the north Vietnamese harbor town of Haiphong is a busy place as early as eight o'clock in the morning.
A crowd of mostly of young men pushes and elbows its way towards a window where nurses serve them a pink fluid in plastic cups. The men are eager to get their dose of methadone.
Every day, some 150 former addicts are treated with the heroin substitute. But as far as many conservatives in the government are concerned, places like this should not even exist.
Getting clean in work camps
Doan Van Kiem, 36-year-old former addict, is now on the methadone program. He rides his motorcycle to the health clinic every morning to wait in line. He hopes to lead a normal life again and work as a bus driver.
He signed up for the methadone program because all his other attempts to get off heroin had failed - even his stay in the 05-06 camp, where drug addicts and prostitutes are locked up and "re-educated" through hard work.
Although the program has been known to achieve results, the success is not always lasting, says Doan Van Kiem. "We all had to get clean in the 05-06 camp and we worked in the fields. When I was released a year later, I didn't even have any cravings for drugs. But then a few friends I had met at the camp convinced me to take a hit again."
Successful pilot project
Some 90 percent of those who get clean in the camp end up relapsing within six weeks of their release. Although the authorities were aware of this, it took them a while to make changes to the program.
Haiphong was the first region to test out a shift in strategy after Dr. Hoang Van Ke, the former deputy of the local people's congress, spoke out in favor of methadone in 2008.
"When we introduced our first methadone program here in Haiphong, only the health ministry and ministry for public security knew anything about it," he explains. He adds that after a year, patients and their families had proof that the program really works.
Combatting AIDS
According to the statistics, intravenous heroin consumption with dirty (used or unsterilized) syringes is the main reason for the spread of HIV in Vietnam, where over 260,000 people are infected. In some regions, 50 percent of HIV/AIDS patients are drug addicts.
Though drug use, prostitution and homosexuality are looked down upon in Vietnam, the government has now turned its attention to the largest groups at risk of HIV and started distributing clean needles and condoms as well as methadone.
Patients at the An Duong clinic also receive medical care and access to antiretroviral drugs. As a result, the number of newly infected HIV patients has been drastically reduced. Thanks to the great success of the program, the government has started opening up to the idea of expanding the project, which is expected to cover 80,000 people by 2015.
Foreign funding
Foreign NGOs, which fund most of Vietnam's HIV/AIDS programs, also have an impact on government policy. The Global Fund to Fight AIDS, Tuberculosis and Malaria, for example, only funds measures that are proven to have positive results and are compatible with human rights.
"Re-education" camps definitely do not fall into this category, says Mauro Guarinieri of the Global Fund. "In most cases, we have to find out what works and what doesn't. And what doesn't are measures that infringe upon human rights. They are both inefficient and expensive." He adds that the criminalization of men who have sex with men and people who use drugs is not only stupid, but completely ineffective.
Mother-child transmission
The greatest challenge now, however, is that the epidemic has spread beyond the traditional risk groups to other populations. Today, women and the children of HIV-infected drug addicts are most at risk. The An Duong health clinic also treats this demographic.
Tran Thi Nguyen is a 38-year-old farmer who is four months pregnant. She was diagnosed with HIV after her first pregnancy check up and thinks her husband who has been a heroin addict for 10 years is responsible. "I demanded that my husband get tested himself when I got my results," she said. "But he still refuses to do so."
Tran is not only worried that her child will be born HIV positive, but that the strong antiretroviral drugs won't agree with her, and that she will no longer be able to work the fields alone. She says she cannot count on her husband for help.
But the doctors have given her a dash of hope - as she started treatment so early on in her pregnancy, the chance of her transmitting the virus to her child is well below 5 percent.
Author: Claudia Witte / sb
Editor: Anne Thomas