PEPFAR SPENDING IN HCMC MONEY WELL-SPENT

UNCLAS SECTION 01 OF 02 HO CHI MINH CITY 001107 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/BCLTV, EAP/RSP, OES/IHA AND S/GAC STATE PASS TO HHS FOR OGHA E.O. 12958: N/A TAGS: ECON KHIV TBIO PREL PGOV SOCI OTRA OVIP VM SUBJECT: PEPFAR SPENDING IN HCMC MONEY WELL-SPENT HO CHI MIN 00001107 001.2 OF 002 ¶1. (SBU) SUMMARY: U.S. Senate Committee on Foreign Relations staff members Shannon Smith and Jennifer Simon concluded their President's Emergency Plan for AIDs Relief (PEPFAR) assessment visit to Vietnam with a stop in Ho Chi Minh City (HCMC) on October 11-12. HCMC officials, medical staff, and NGO partners leading the city's fight against HIV/AIDS reported significant progress in prevention of mother to child transmission (PMTCT), care and treatment of the HIV-affected, and community outreach, while treatment of incarcerated and released-but-relapsed injection drug users (IDUs) remains problematic. Overall, the staffers assessed that PEPFAR spending in HCMC is money well-spent, and the well-reasoned, capacity-building nature of future projects proposed by HCMC HIV health workers (e.g. sexually transmitted infection (STI) clinic and TB diagnosis capability) suggests forthcoming allocations will not be misspent. End Summary. View from the Top -------------- ¶2. (SBU) Vice Chairman of the HCMC AIDS Committee Dr. Le Truong Giang outlined PEPFAR-supported accomplishments, as well as challenges and future priorities in the fight against HIV in HCMC. Giang noted that model programs, such as Community Care and Support Centers (CCSC) that provide a range of services (e.g. Out Patient Clinics (OPC),Voluntary Counseling and Testing (VCT) and Peer Education (PE)) at one location, were developed in HCMC and then spread to other provinces. About 20,000 patients are currently receiving some form of care and treatment, including 7,000 on anti-retroviral (ARV) therapy - up from 100 in 2005 when PEPFAR funding began in Vietnam. PMTCT programs now operate in all of HCMC's 24 districts, benefiting 130,000 pregnant women yearly, many of whom are from outlying provinces without PMTCT programs. One growing challenge is the successful reintegration into society of the 10,000 IDUs released to date from drug rehabilitation centers (a number projected to grow to 20,000 by 2009),many of whom relapse. Although the GVN is still formulating a strategy to mitigate the high relapse rate, following MOH approval, the Committee plans three PEPFAR-supported methadone clinics to treat relapsed returnees. In response to StaffDel questions regarding what proportion of those in need are covered by existing programs, Giang estimated that coverage rates for PMTCT were 95 percent, nearly 100 percent for care and treatment, but much lower for the HIV-infected in prisons and rehabilitation centers. (Comment: Local CDC staff present thought these estimates high. End comment.) Fewer Mothers Infecting Children -------------- ¶3. (SBU) Director Dr. Vu Thi Nhung of Hung Vung Hospital, HCMC's principal ObGyn facility described the hospital's PMTCT program, after which the StaffDel toured the facility. The percentage of HIV positive pregnant women peaked at 1.0 percent in 2005, but has held steady at 0.8 percent (121 of 14,892 cases) since 2006. The current mother-to-child transmission rate is 6.5 percent, down from an estimated high of 35 percent ten years ago when ARV drugs were not available. Many of the HIV-positive mothers are the wives of migrant workers from outlying provinces, while commercial sex workers (CSWs) and IDUs comprise only six to seven percent of the total. When queried about future plans, Dr. Nhung described a volunteer peer support group for pregnant woman who presented too late to begin effective PMTCT treatment, and a People Living with HIV/AIDS (PLWHA) program for HIV-positive mothers HIV-infected Migrants and Trafficking Victims -------------- ¶4. (SBU) At a working lunch, StaffDel met with International Organization for Migration (IOM) personnel Andrew Bruce, Chief of Mission; David Trees, Project Development Officer; Andrew Billo, Program Officer; Goran Grujovic, Chief Migration Health Physician; and Patrick Corcoran, Head of HCMC Office. IOM seeks increased collaboration between agencies dealing with trafficking and those dealing with HIV, to better identify and assist HIV-infected migrants and trafficking victims. The HCMC Model: One Stop Counsel, Test, and Treat -------------- -------------- ¶5. (SBU) In the stifling heat - air conditioning is banned for fear of circulating tuberculosis bacteria - of a clean but spartan facility in HCMC's economically depressed port district, Dr. Nguyen Vu Thanh of the District 4 CCSC described five PEPFAR-supported activities: community outreach, PMTCT, VCT, OPC, and reintegration of rehab center returnees. Sixteen PEs contact 700 to 800 IDUs and CSWs per month, up from some 350 per month in 2005; about 1500 of these per year are first-time contacts. In 2006 less than half of the women who came to the CCSC for pregnancy testing consented to an HIV test; this year HO CHI MIN 00001107 002.2 OF 002 effective counseling raised that figure to almost 90 percent. Since 2006, nearly 100 percent of VCT clients have returned for HIV test results (40 to 50 percent of which are positive.) Approximately 40 percent of IDU rehabilitation center returnees to District 4 receive services at the CCSC, including job counseling, drug relapse prevention, care and treatment services, and ARV therapy. Vu Thanh said she would use additional resources for a sexually transmitted infection (STI) clinic, and equipment and training to improve diagnosis and management of extra-pulmonary TB. Fighting Discrimination -------------- ¶6. (SBU) The last stop was at the PEPFAR-funded HIV/AIDS Legal Clinic, the first of its kind in Vietnam, set up by the Health Policy Initiative (HPI) in January 2007. HPI advisers Tran Tien Duc and David Stevens, and Chairman of the HCMC Lawyers' Association Ms. Dong Thi Anh introduced the clinic's two lawyers and four PLWHA counselors. These staff members have advised some 300 individuals regarding access to treatment, access to schooling for children affected by HIV/AIDS, basic HIV/AIDS information, and referral to other services. The majority (approximately 200) of cases concern the lack of HIV treatment at IDU rehabilitation centers. The clinic has yet to bring a discrimination case to the courts under the new HIV/AIDS law, instead mediating between the relevant HCMC agency and the affected individual. The clinic plans to replicate its model in six other provinces. ¶7. (SBU) Comment: Staff member Smith appreciated the frank assessments and the detailed statistics presented at the sites, noting that both are necessary components of an accurate evaluation. Smith and Simon saw significant progress in prevention of mother to child transmission, care and treatment of the HIV-affected, and community outreach, but treatment of incarcerated and released-but-relapsed IDUs is a growing problem. Its progressive nature and greater latitude for innovation allow HCMC to lead the way in developing new programs in Vietnam's battle with HIV/AIDS, allowing replication of successful variants nation-wide. End comment. ¶8. (U) This cable was cleared by StaffDel Smith and coordinated with Embassy Hanoi. FAIRFAX