HIV/AIDS in Vietnam

The first case of HIV in Vietnam was diagnosed in 1990 and since then, prevalence has climbed steadily. The estimated national prevalence rate (the percentage of all adults of reproductive age living with HIV) is 0.51 percent,1 which is relatively low for the region. Prevalence rates in Vietnam’s large cities, however, are more than double the national level. The commerce capital, Ho Chi Minh City in the south (formerly Saigon), is home to the country’s largest and fastest growing epidemic.

Vietnam’s HIV/AIDS epidemic is a concentrated one, driven by injection drug use and commercial sex work. HIV prevalence among injecting drug users (IDUs) has been the highest of any group since the epidemic began in Vietnam.2 National prevalence among IDUs is approximately 33 percent. Female sex workers have the next highest prevalence, with an estimated 16 percent of sex workers believed to be HIV positive.3 For both populations, HIV prevalence is highest in Vietnam’s urban hubs—Ho Chi Minh City in the south, Hanoi and Hai Phong in the north, and elsewhere.4

In stark contrast to African epidemics, Vietnam’s epidemic is not as advanced. HIV prevalence is currently far higher among men than women, which is characteristic of the epidemic at its early stages. Eighty-five percent of those people reported to be HIV positive are men; 57 percent are injecting drug users.5 Vietnamese young adults and adolescents bear the brunt of the disease—70 percent of those living with HIV are under 30 years old and most are sexually active.6

Vietnam’s HIV/AIDS epidemic has entered a rapid growth phase with many more people becoming infected than dying each year.7 The sharing of contaminated needles and other equipment among drug users remains a primary route of HIV transmission. However, sexual transmission of HIV—between drug users and their partners, female sex workers (many of whom also inject drugs) and their clients, clients of sex workers and their wives/partners, and men who have sex with men—accounts for an increasing proportion of HIV infection in Vietnam.

HIV/AIDS is highly stigmatized in Vietnam. For those living with HIV/AIDS, the accompanying stigma and discrimination are formidable barriers to seeking needed care, as well as to receiving quality care. Drug use and commercial sex work are illegal in Vietnam. Together with general crime, they spurred a punitive “anti-social evils” campaign carried out by the government for several years that has since ended. As HIV/AIDS was closely associated with two of the three social evils, the disease fell into the path of this anti-crime crusade, deepening the stigma attached to HIV/AIDS. Consequently, reaching these groups with prevention, testing, and treatment services is extremely difficult and at times risky for NGO staff when dealing with local officials and police.

The government’s principal response to drug use and sex work is rooted in the criminal justice system: compulsory rehabilitation in residential detention centers from two to five years. Officially known as “05/06 centers,” these “re-education” facilities for drug users and sex workers are located throughout the country. A sizeable number of AIDS orphans also reside in the 05/06 centers in the absence of a government strategy and program to provide care and support to these children. Often described as prison-like, the 05/06 centers are widely viewed as the incubators of the epidemic where unprotected sex and drug use are the norm. HIV testing is mandatory, yet test results are not often disclosed to the individual nor treated confidentially. Few centers provide detainees with counseling, treatment, skills training, or social support. As a result of this and the lack of rehabilitation services in the community, recidivism rates are high among drug users and many end up back at the 05/06 centers.

The Vietnamese government is open to international NGOs and donors working within the 05/06 centers to provide staff training, improve health services, and assist drug users and sex workers transition back to their communities. Over the years, however, few donors have taken up the government’s standing invitation to work within the 05/06 centers. Meanwhile, there is widespread awareness that these facilities need to be a priority for HIV/AIDS prevention, care and treatment. In 2006, a large number of rehabilitated IDUs and sex workers—an estimated 15,000-18,000 are scheduled for release in Ho Chi Min City alone over the next year—will be released. Most are young, sexually active, and a high proportion are HIV-positive, some sick with AIDS. According to most NGOs, not enough has been done to prepare for this imminent migration of 05/06 center residents back into their communities. Had comprehensive drug and HIV/AIDS prevention and treatment services been offered within the 05/06 centers, even in the last few years, the public health ramifications of this move would almost certainly be less worrisome.