SPECIAL REPORT Breaking the silence on AIDS in Vietnam

Posted: 12 October 2004

Like other countries in Asia, Vietnam is threatened with an AIDS epidemic. Already the disease is spreading from the cities into the countryside. And as elsewhere in the region women, the stewards of the rural environment, are most at risk. But young people are now joining a national campaign to spread the preventive message, as Don Hinrichsen reports.

Nguyen Phuy (on far right), AIDS sufferer, Hanoi. Photo: Don Hinrichsen
Nguyen Phuy (on far right), AIDS sufferer, Hanoi. Photo: Don Hinrichsen
Nguyen Phuy (on far right) in meeting with For a Bright Future - a group of HIV positive young people in Hanoi.© Don Hinrichsen
Nguyen Thuy Phuy, a thoughtful young woman with deep, sad eyes, sits in a secluded office on the second floor of Hanoi's Youth House. She is just 29 years old and has been HIV positive for five years. "I became infected from sharing needles," she explains in a barely audible voice. "I was a heroine addict, with nothing to lose, no past and no future."

When her mother found her unconscious from an overdose one evening, the family took her to a rehabilitation centre. Several weeks later, the doctor informed Phuy that she had tested positive for the HIV virus that causes AIDS. "I was shocked and frightened," admits Phuy. "I didn't know what AIDS was, except that you die from it. I didn't know anything about treatment or support groups or how to cope with my status until I came here to the Youth House."

Support group

Still, Phuy considers herself lucky. "Two months after I received the news of my HIV positive status, I told my family. They were completely supportive and did not disown me," confesses Phuy. Her mother informed her about the Youth House, a breezy compound of buildings run by Vietnam's Youth Union, designed to cater to the reproductive and sexual health needs of young people.

Phuy is now part of a support group called "For a Bright Future". They meet every week at the Youth House to discuss problems and concerns, get advice and help if needed, participate in activities and share experiences. "I get advice on how to stay healthy through exercise, special diets and help with drug treatments," she points out. "This has become my second home. I can confide in people and I feel safe here."

The HIV/AIDS rate in Vietnam is still less than 1 per cent of the total population, but studies carried out by the Ministry of Health and UN agencies indicate that the disease, once confined to big cities, is spreading rapidly throughout the country, reaching every province. As of 2003, the Ministry reported that over 81,000 people had been diagnosed HIV positive, with 12,684 developing AIDS and over 7,000 registered deaths. However, by the end of 2003 the number of people estimated to be HIV positive was put at 215,000, or 0.5 per cent of adults. "We are on the threshold of a major epidemic, unless we act now," states Mr. Nguyen Dinh Loan, Director of the Reproductive Health Department in the Ministry of Health.

High risk As elsewhere in Asia, women are more susceptible to the disease then men. Adolescent girls, in particular, are among the highest risk groups, other than drug users or sex workers, because often they lack the information and means to protect themselves. Since women are bearing the brunt of the pandemic, families suffer more and in some cases, community development stalls.

In Vietnam, rural women are also the stewards of their immediate environment. If the pandemic gets out of control - which happens when 1 per cent or more of the adult population is infected - this could have repercussions on rural economies as there would be fewer women and men to manage resources and take care of the environment.

Nguyen Van NamNguyen van Nam, aged 8, in the final stages of AIDS, sits between his great grand mother on left and grandmother on right. Both parents and his sister have already died from AIDS.© Don HinrichsenAIDS soresNam's body is covered with open sores and rashes as a result of AIDS. The highly affective AIDS drug, AZT, is not available to most AIDS sufferers in Vietnam. © Don Hinrichsen

The tragic consequences of the disease are showing up in remote communities, far from city centers. Duy Trung village is located some 40 kms inland from town of Tam Ky in the central part of Vietnam. In a noisy neighbourhood dominated by the constant clatter of weaving machines, Nguyen Van Nam sits uneasily between his grandmother and great-grandmother. Nam is unlikely to celebrate his 9th birthday. He was born HIV positive and at eight years of age has developed full-blown AIDS, his body covered with open sores and rashes. He has already lost his mother, father and sister to AIDS. A neighbor, Mrs. Nguyen Thi Phuoc, a retired nurse, took care of both children after their mother died in 2001. When Nam's nine-year-old sister died in 2003, his grandmother came up from Ho Chi Minh City to look after him.
Limited drugs

"Once the neighbours discovered that the family had AIDS, both children had to drop out of school," explains Mrs. Phuoc. "I taught their daughter to read and write and showed Nam's mother how to take care of the children. When she died, I stepped in to care for both of them. Now only Nam is left and he is very weak. But at least his grandmother and great-grandmother are here for his final days."

Thanks to Phuoc's efforts to educate the neighbours about HIV/AIDS, and with assistance from the local communal health centre, the little community where Nam will spend his last days is more understanding and sympathetic to the boy's plight. Though no children come to play with him, the neighbours do not shun the family. They donate food and run errands. The local health centre provides drugs every week to help Nam fight off opportunistic infections, but the highly effective drug cocktail, known as AZT, is not available to most AIDS sufferers in Vietnam.

Government officials admit that the disease is no longer confined mostly to injecting drug users and sex workers. "We are seeing a disturbing increase in reproductive tract infections, including sexually transmitted diseases and HIV, among young people and adolescents," says Mr. Loan. Since there are 24 million adolescents and young people in Vietnam between the ages of 10 and 24, comprising a full third of the population, "there is an urgent need to address this situation," he states.

National campaign

Officials agree that prevention is key. With support from the international donor community and UN agencies, the government has launched a nation-wide campaign to raise awareness of the disease and its consequences for the country, if left unchecked.

Hanoi Reproductive Health Theatre Troupe. Photo: Don Hinrichsen
Hanoi Reproductive Health Theatre Troupe. Photo: Don Hinrichsen
Two members of the Hanoi Reproductive Health Theatre Troupe perform at skit on how to prevent HIV/AIDS for a group of young people at the Youth House, managed by the Vietnam Youth Union.© Don Hinrichsen
The United Nations Population Fund (UNFPA) devotes a full 10 per cent of its country programme assistance (about $3.5 million) to HIV/AIDS prevention and treatment activities. UNFPA's HIV/AIDS programme is integrated into all activities. "Specifically, the Fund has provided the government with 70 million condoms and has been instrumental in developing a national strategy on social marketing for condoms in collaboration with the Vietnam Commission for Population, Family and Children," points out Dr. Phan Thi Le Mai, UNFPA National Project Officer in Hanoi. "We have also supported information campaigns and services aimed at youth through the RHIYA project - Reproductive Health Initiative for Youth in Asia - of which the Youth House is a part, and have assisted the Ministry of Education and Training to develop adolescent reproductive health curriculum for use in secondary schools throughout the country."

Educating the public about the transmission routes of the HIV virus is a central component of the government's strategy. Another aspect is reducing the stigma associated with HIV infection. Nguyen Thuy Phuy and her friends at the Youth House know about stigma. "One of my HIV positive friends was kicked out of his boarding house when the landlady learned he was HIV positive," she says. Another member of Phuy's group was thrown out of the house when her father learned that she was HIV positive.

"We have all suffered on account of our HIV status, but we are learning to cope and to stay engaged," continues Phuy. "We are also educating our peers on HIV/AIDS. The one message I give out is this: Don't engage in risky behavior, like drugs or unprotected sex. The key is knowledge. Once people are aware and know about AIDS we can stop this disease from spreading."

Related link: AIDS epidemic outpacing response