Inter Press Service - Monday, November 30, 1998
Nguyen Minh

After all, relatively little extensive research has been done on the disease here, and there is a huge disparity between the HIV figures given by state authorities and those compiled by United Nations agencies.

The Vietnam National AIDS Committee recently reported a 26 percent leap in the number of HIV-positive people across the first nine months of 1998. This took the officially acknowledged total to 10,336 HIV cases.

In its latest AIDS surveillance report for November issued ahead of World AIDS Day on Dec 1, the World Health Organisation (WHO) Western Pacific office cited end-September reports by Vietnam saying there were 1,819 AIDS cases and 10,118 HIV cases in this country of 77 million people.

However, the United Nations Children's Fund (UNICEF) here believes the total of HIV cases is actually more than halfway toward the 263,000 infections it has conservatively projected will occur in Vietnam by 2000.

UNICEF volunteers in the field believe the Vietnamese are missing the full extent of the problem because their limited testing facilities concentrate on groups with traditionally high risk of infection, like street sex workers and regular heroin users.

Customers of sex workers and occasional intravenous drug-users likely account for an undocumented, but extensive, spread of HIV not yet apparent due to the years-long incubation period of full- blown AIDS.

WHO's own estimates of HIV prevalence in Vietnamese adults aged 15 to 49 years of age stands at 57,000 or .12 percent, much lower than Cambodia's 1.6 percent or Burma's 1.6 percent -- but growing fast.

The lack of reliable HIV/AIDS data has not been helped by a government cut in funding available to fight the spread of the disease. Citing budget belt-tightening due to Asia's economic crisis, the government cut the money available across 1998 to 4.8 million dollars from last year's 5 million dollars.

The chairman of the National AIDS Committee (NAC), Dang Van Khoat, said this was a disappointment because his panel had fought hard to increase its funding year-by-year since the first paltry grant, of just 1 million dollars, was issued in 1993.

"I'm calling on the government to increase State funding levels much further if HIV and AIDS is to be halted before it infects a much larger proportion of the population," said Khoat.

One of the few benefits communist Vietnam enjoyed from virtually closing itself off to the world -- until its 'doi moi' or reformation policy in the early 1990s -- was a natural barrier to HIV spread into the country. By 1992, just 11 infections had been identified by the NAC.

However, the influx of business-seeking and holidaying foreigners throughout the nineties gave the disease a firm route.

Intravenous heroin use has boomed, especially among the young, and accounts for more than 50 percent of HIV infections in Vietnam, says the NAC. The casual sex industry accounts for just 5 percent, it adds.

This latter figure is one which many voluntary workers take issue with. A volunteer for the Australian Red Cross, which works against AIDS with the Vietnam Red Cross National Society, says the casual sex industry has expanded beyond anyone's expectations since foreigners began receiving regular permission to enter Vietnam.

The volunteer said: "You have to remember this country is still one of the poorest countries in the world with per capita income of not much more than 300 dollars. It's no wonder that so many girls and women have been driven to try and capitalise on the sudden presence of thousands of dollar-heavy foreigners."

"The new sex industry is mainly concentrated in Ho Chi Minh City, the commercial hub where most of the foreigners are and a place which already had a massive tradition of prostitution during the American soldiers' era," she added.

"I've seen pocket surveys showing concentrations of some of the poorest street prostitutes with HIV-positive rates of over 60 percent," she pointed out. Many karaoke bars, virtually all discos and top hotel bars had become pick-up joints in recent years, she added.

Indeed, residents journeying home in the early hours in Ho Chi Minh City are likely to pass at least one street corner occupied by huddles of women on the game. Many are economic migrants, sent to the city by rural families devastated by soaring levels of unemployment and underemployment in the countryside. The most infamous street corner, on Nguyen Thi Minh Khai, is overshadowed by several giant AIDS-awareness billboards.

But Nguyen Huong Ha, a 16-year-old sex worker, said she took little notice of them: "Getting an AIDS test would cost me around 10 dollars and if anyone found out I'd taken it, the stigma would be so strong that I'd never get another customer even if I was clear."

"There's no point talking to me about the future. Mine is a day to day struggle. Because I've got no future I'm not afraid of catching AIDS and, anyway, all my clients prefer intercourse without contraception," she explained.

Rare condom use is another problem anti-AIDS workers face. Traditional family-oriented Vietnamese society perceives condoms on the counter negatively, because of their association with casual premarital sex, prostitution and homosexuality.

Eric Palstra at the Hanoi office of the United Nations Population Fund says pressure on the government to try and help change this popular perception was beginning to pay off.

In the past year, his task force has been working to increase the annual supply of condoms to the Vietnamese market from 90 million to the estimated demand of 200 million.

Last week, the NAC reported that contraception use has been growing by 2 percent annually in the last eight years. It said annual expenditure on condoms could double over the next five years. (END/IPS/ap-he-dv/wc/js/98)
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