THE AMBASSADOR'S DECEMBER 15-16 VISIT TO HCMC AND BINH DUONG

UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 001311

SIPDIS

STATE FOR S/GAC; STATE PASS CDC

E.O. 12958: N/A
TAGS: PGOV PREL EAID PHUM SOCI SNAR TBIO VM HIV AIDS
SUBJECT: THE AMBASSADOR'S DECEMBER 15-16 VISIT TO HCMC AND BINH DUONG
PROVINCE: THE FIGHT AGAINST HIV/AIDS


1. (SBU) Summary: The Ambassador's December 15 and 16 visits to
one of HCMC's 21 drug rehabilitation centers and a local HIV
testing and ARV treatment center highlighted the challenges
facing the city in planning for the upcoming release of some of
the centers' 30,000 residents, many of whom are HIV positive.
Despite two years of vocational training, many rehabilitation
center residents appear to lack the skills needed to compete in
the general marketplace. Although they technically qualify for
discharge after four years of treatment, city officials will not
let them go without a guarantee of a stable post-release
environment. As an expedient, they plan to house and employ
some rehabilitation center graduates in a government-owned
industrial park. The city's HIV/AIDS community outreach and
testing programs also need strengthening and do not appear ready
to cope with the challenge of integrating large numbers of HIV
positive, former drug users into the community. The Ambassador
pushed for intensified HIV/AIDS education for workers in
meetings with managers of two U.S.-owned companies operating in
the neighboring province of Binh Duong and with the provincial
government. End Summary.


2. (U) The Ambassador, accompanied by ConOff and CDCOff, visited
a PEPFAR-funded antiretroviral clinic located in one of Ho Chi
Minh City's poorest districts as well one of HCMC's 21 "05/06
Centers" -- rehabilitation centers for drug users and
prostitutes -- during a visit to HCMC December 15-16. The
Ambassador also traveled to neighboring Binh Duong Province,
where he raised the need to combat HIV/AIDS in meetings with the
provincial People's Committee and managers of two American-owned
factories: Stickley International, Ltd. and Spartronics Vietnam
Co., Ltd.

ARV Clinic Visit
--------------


3. (SBU) Officials from HCMC's District 4 Department of Health
(DOH) told the Ambassador that the "Public Consulting and
Assistance Center" -- the district's HIV/AIDS outpatient
treatment and testing center -- opened in 1998. It operated
using funds from the HCMC Provincial AIDS Committee (HCMC PAC)
until it began receiving PEPFAR funds this year. Current
operational and staffing budgets are primarily covered by PEPFAR
funds provided to supplement the HCMC PAC's health budgets for
the city's 24 districts. DOH officials stated they see the U.S.
support as a starting point and are hoping to receive more funds
to expand their operations. (Note: DOH officials said the
center is receiving approximately $31,500 in PEPFAR funds for
its current four-month contract. End Note.) The Ambassador
reminded the DOH officials that PEPFAR funds are meant to be
used to supplement local efforts and to put prevention,
treatment and care systems in place, not to pay for 100 percent
of the costs of treating AIDS patients.


4. (SBU) DOH officials said the center has 228 registered
patients: 45 receiving anti-retrovirals (ARVs),56 patients
waiting for ARVs to become available and 130 receiving
opportunistic infection drugs and other treatment.
Additionally, the center has approximately 100 voluntary
counseling and testing (VCT) clients each month, with 40 to 55
percent testing positive. Some 51 percent of the clinic's
HIV-positive VCT patients became infected through intravenous
drug use; 36 percent claim not to know how they were infected.
Officials professed that over 90 percent of HIV-positive VCT
clients return for treatment after diagnosis. The center has 16
full-time peer educators in the community encouraging people to
come to the center to get tested; however, most of the VCT
clients who come in do so because they are already sick,
acknowledged DOH officials.


5. (SBU) The Ambassador observed, and DOH officials agreed, that
the center is not drawing enough clients in for voluntary
counseling and testing, despite the district having an HIV
prevalence rate double that of the city average. The officials
also admitted they have not changed the public's perception that
the HIV/AIDS epidemic affects only drug users and sex workers.
DOH officials acknowledged that the district's HIV prevalence
rate is approximately one percent compared to half a percent for
the rest of HCMC.


6. (U) The DOH officials requested more detailed training on
treating patients and counseling people with HIV/AIDS and
suggested that the Center's staff could benefit greatly from
meetings with colleagues dealing with similar cases. Both DOH
and HCMC PAC officials claimed that drug use in HCMC is under
control because most users have been sent to
rehabilitation/detention centers.

05/06 Center Unable To Care For HIV-Positive Residents
-------------- --------------


7. (SBU) Officials at the Nhi Xuan Education, Vocational
Training and Job Placement Center told the Ambassador that at
least 1,500 of the 2,100 residents are almost finished with a
4-year rehabilitation program. Leaders of the HCMC Voluntary
Youth Force (VYF),which runs the facility, said that intake has
slowed in the past year as most of HCMC's drug users have been
admitted into the 05/06 centers. They also admitted that this
center is full beyond its 2,000-person capacity. The Center's
directors told the Ambassador that they need technical HIV/AIDS
assistance to provide testing and care for the residents. The
facility does not have sufficient trained personnel, facilities,
drugs or funds to care for its HIV-positive population.
Currently, a resident is tested for HIV only if (1) he/she
requests it and pays the 90,000 VND fee; (2) has a mandatory
test due to a suspected AIDS-related illness; or (3) the
resident's family requests and pays for the test. If the family
requests the test, the Center will not disclose to the resident
the result of the test unless the family instructs it to do so.
To date, the Center has tested 1,200 inmates and more than 700
have tested positive. The Center would like to provide
wide-scale voluntary counseling and testing but does not have
the capability.


8. (SBU) Currently, the Center's medical clinic has 100 AIDS
patients who are too sick to be in the general population but
are not yet sick enough to send to the hospital. What drugs
these patients receive are provided by the GVN or by the
patients' families. The Center's medical staff noted that only
ten percent of patients are receiving the medicine they need.
The clinic has an additional 69 tuberculosis patients kept in a
separate ward in three crowded rooms (with a listed maximum
capacity of 60).

Treatment and Possible Release
--------------


9. (SBU) The 05/06 Center treatment program consists of two
phases: two years of rehabilitation and detoxification followed
by two years of vocational training. After completion of the
four-year program, the residents technically are eligible for
release. Nhi Xuan officials told the Ambassador that they hope
to release 99 residents before Christmas, 143 before Tet (end of
January 2006) and 200 shortly thereafter. However, to be
eligible for release, in addition to completing the four-year
program, the residents also must meet other "conditions," which
include proof of an outside job or enrollment in an education
program and consent of the family and the community to accept
the rehabilitated addict. Thus far, only 20 residents have met
the Center's criteria for being allowed to return home. Center
officials admitted that sending residents home was not their
"first preference."


10. (SBU) VYF officials said that graduates who do not meet the
criteria for release into the community will be assigned work in
the factories at the rehabilitation center or at an adjacent,
city-owned industrial zone. Graduates will be given free
housing "equivalent" to that provided for workers in commercial
industrial parks. They also would enjoy "80 percent of the
freedom" that other industrial zone workers normally enjoy.
However, graduates would not be allowed to leave the compound at
night except on weekends and holidays. The Center would offer
additional counseling programs to the graduates at night.
Graduates would be required to pay for their meals, but would be
housed free-of-charge.


11. (SBU) During a brief visit to a garment factory located
next to the Center, the Ambassador was told by the factory owner
that Center residents working there, on average, only earn half
the normal salary for a factory worker. The Center's director
justified the lower pay, arguing that -- on a per unit basis --
the residents' pay was equivalent to workers at other factories;
residents' productivity is lower because of poor health and
because, as apprentices, they still needed to hone their skills.
The Ambassador noted that issues of the residents' pay at the
factories and their continued detention past the completion of
the four-year program would need to be examined in more detail
as the USG considers establishing a PEPFAR program to address
the HIV/AIDS needs of 05/06 Center residents. He also
encouraged officials to explore the use of methadone
substitution therapy to complement and support ongoing
rehabilitation efforts.


12. (SBU) A decision on how to handle the bulk of the Nhi Xuan
Center's 1,500 residents eligible for release would be made only
after the results of the "pilot release" were assessed, the
officials told the Ambassador. Another contact at the VYF
subsequently told us that it plans to release 1,600 residents
from the VYF-run centers in HCMC by the end of March 2006, and
that the city plans to release over 3,000 from all its 05/06
centers during the same period. How many of these individuals
will be free to resume their lives in their communities is still
unclear.

Binh Duong
--------------


13. (U) Nguyen Hoang Son, Chairman of the Binh Duong People's
Committee, told the Ambassador that HIV/AIDS is a problem only
in Vietnam's large cities and thus is not a serious issue for
his province. However, the Chairman noted children of all ages
and in all locations should be educated about HIV and AIDS. All
the province's high schools and colleges have HIV prevention
courses. The Ambassador suggested that the provincial
government could require major employers in Binh Duong to
provide seminars on HIV/AIDS to their employees at least once a
year.

14. (U) Officials from two American factories in the province,
Stickley International, Ltd. and Spartronics Vietnam Co., Ltd.,
stated that they currently provide their employees with the
minimum health care required by the GVN. The Ambassador urged
the directors of both factories to create HIV/AIDS awareness
programs for their workers, particularly as both companies are
rapidly expanding and are drawing more heavily from the influx
of migrant workers to the province. Both directors expressed
interest in launching such a program in 2006.


15. (SBU) Comment: HCMC is on the horns of a dilemma. A
substantial portion of the city's 30,000 05/06 residents will be
eligible for release in the coming year. City managers are
concerned over the implications of the release into the
community of a large cohort of "rehabilitated" drug addicts, at
least half of whom are believed to be HIV positive. One
official explained that community reintegration is particularly
complicated as many from this cohort are family outcasts, come
from broken homes, or were migrants to HCMC from other provinces
and have no local support network. On the other hand, many
local officials were uncomfortable with holding an 05/06
resident beyond the scheduled release date. Nhi Xuan's plan to
create a post-release work and living environment for its
graduates is one example of how city planners are struggling to
find a solution to this problem.


16. (SBU) Comment, continued: If the Nhi Xuan Center is any
indication, HCMC is ill-prepared to manage the return of
thousands of HIV positive, "rehabilitated" drug addicts to the
community. Despite up to two years of vocational training, Nhi
Xuan's residents appeared unable to compete in the marketplace,
or at the very least, would still require additional on-the-job
training to be employable. Similarly, the results at the ARV
Center demonstrate that community outreach and education efforts
need to be strengthened to foster community reintegration of
rehabilitation center residents, reduce the stigma attached to
HIV/AIDS and encourage HIV testing as a strong prevention and
control message. Finally, U.S. companies operating in Vietnam
should be encouraged to hold seminars and implement workforce
prevention programs to educate their workforces on HIV/AIDS
prevention and treatment. End Comment.
CHERN