HIV/AIDS Prevalence on the Rise in Vietnam
Originally published by Reuters Health, January 7, 2002
HANOI (Reuters Health) — While the rate of HIV infection has begun to drop in neighboring Cambodia, Vietnamese public health officials are warning that the country's number of AIDS cases is escalating at an alarming rate.
"Vietnam is facing a rapidly growing HIV epidemic," said Dr. Laurent Zessler, the UNAIDS representative in Hanoi for 4 years. Dr. Zessler expressed confidence in the accuracy of the most recent surveillance numbers, which indicate a current HIV prevalence between 0.22% to 0.29%, and rising. The Vietnamese Ministry of Health (MOH) puts the number of currently infected at about 122,000, out of a population of over 76 million.
"In India and China we have issues with the numbers, but here in Vietnam we don't," Dr. Zessler told Reuters Health. He noted that annual surveys focus on all the highest risk groups, including prostitutes, injection drug users, TB patients, pregnant women and military personnel. The MOH numbers issued in 2001 indicate an increased prevalence in all these categories.
Almost 25% of injection drug users—the population that is driving the Vietnamese epidemic—are now HIV-positive, up from just over 17% in 1994. Injection drug users, numbering over 21,000, represent 65% of all reported HIV and AIDS cases in Viet Nam.
More than 4% of female sex workers were HIV-positive in 2001, up from just 0.6% in 1994. Among those diagnosed with other sexually transmitted diseases, almost 1.4% were infected—up from 0.3% in 1994. HIV infection among TB patients has more than tripled between 1994 and 2001 to 1.71%, while the number of HIV-infected pregnant women has increased 10-fold to 0.2%.
"The conditions are here for this epidemic to become extremely serious," Dr. Zessler cautioned. "We feel the government is not acknowledging the full magnitude of the problem."
"HIV/AIDS has not been integrated fully into the secondary school education system," he said. "Teachers are trained, and talk for a certain number of hours to their students about HIV, but we consider it to be too tame and too shy. And you must remember that this is a very young population," he noted. According to UNAIDS statistics, almost 34% of the country is under the age of 14 years. "So we have to move faster to reach them."
The World Health Organization's Hanoi representative Dominique Ricard agrees that the time to act is now. "HIV prevalence in Vietnam is still relatively low, so it's a very good time to do something," Ricard told Reuters Health. To alter WHO's projection that AIDS deaths will rise among 15 to 49 year olds, from 4000 to 11,000 by 2005, he said intervention efforts must be quickly directed towards the country's estimated 300,000 female sex workers.
"We should promote 100% condom use among sex workers," he advised, referring to a program promoting easy access to condoms for sex workers—an initiative that has met with much success in Thailand and Cambodia.
However, Dr. Zessler said the country simply has not put such a policy in place and that the social marketing and distribution of condoms remains very weak. He noted that while Vietnam has two functioning condom factories, they are not running at full capacity. He added that what is produced is made available only at family planning and health clinics—not at non-traditional outlets such as bars, clubs, karaoke bars, and brothels, where they would reach a wider group of people.
"Contrary to Thailand, here in Vietnam we have the problem of a centralized government that has not been willing to provide wide access to condoms, particularly among commercial sex workers," Dr. Zessler said. "It's really a political and organizational issue. We have the condoms here—they are quite cheap. But the decision has not been made to make them more available."
