Thursday, July 20, 2006

Combating Avian Influenza and HIV/AIDS: Vietnam’s National Policy

July 19, 2006 4:30 PM-6:00 PM

Dr. Trinh Quan Huan, Vice Minister of Health, Vietnam
Dr. Nguyen Huy Nga, Director General, Vietnam Administration of HIV/AIDS Control
Dr. Nguyen Tran Hein, Director, National Institute of Hygiene and Epidemiology

In January 2006, CSIS traveled to Vietnam for an HIV/AIDS Task Force Mission. There have been 108,789 HIV cases nationwide, and by 2010 a predicted 311500 cases of HIV will have been contracted. In 1990 the first case of HIV was reported and in the last five years there has been a rapid explosion of its prevalence. The HIV distribution is gender skewed; 85% of the cases are contracted by males. Of all cases, 70-80% occurs as a result of injection drug use (IDU). Youths are the largest population hit; it is estimated that 50% of HIV infected people are between the ages of 20-29.

The government has adopted a new progressive law that prohibits discrimination and stigmatization of the virus, and includes harm reduction, therapy, care, and support into the treatment plan. Under the wing of PEPFAR, the Vietnam HIV/AIDS program has a strong national strategy that contains an M&E unit, support at every level of society, and a control center. There are programs for women sex workers, for children living with AIDS, and therapy programs for the many injection drug users. The programs are encouraged by the religious centers; Vietnamese monks in particular are especially supportive of the policies and have encouraged their communities to seek treatment and information for prevention.
Vietnam’s main achievements are its political commitment to addressing the HIV/AIDS issue and implementing a strong program. They have scaled up HIV/AIDS treatment and care; as of now 5000 people have access to treatment and by the end of the year, 7000 will. Funding is still the main challenge of the country, right now only 30% of needed funds are available.

The avian influenza is also a major health risk for the country of Vietnam. The epidemic has come in three waves and all provinces of the country have had outbreaks. There have been 92 human cases overall and 42 deaths. There haven’t been any outbreaks in 2006. In wave one, 44 million poultry died. The epidemic started in the northern region of the country, and then jumped to the southern part of the country, skipping the whole middle section. Each wave followed this pattern and the third wave finally migrated to the middle. Wave three was most deadly, and lasted from December 2004 to November 2005.

There were a few major findings reported, the most important being a strong correlation between the river networks and HPAI (human poultry avian influenza) outbreaks. Secondly, the outbreaks occur in the cold wet season (winter/spring). There is no gender discrepancy but the flu seeks more damage among the under 40 crowd. The flu also works in family clusters, meaning that the virus generally would affect more than one family member in a particular region. There is no evidence of human to human transmission of the virus. Direct contact with the ill/dead poultry seven days prior was the main cause of the disease.

Four main ‘lessons learned’ were reported: First, a high level of political commitment is needed, with strong government leadership present. Second, the establishment of multi-sectoral steering committees is needed, and is central to the communal level. Third, good collaboration is needed between the ministries, the government, and the regional and local governments. Organizations and mass media are crucial as well. The implementation by these groups led to surveillance/early warning systems, virus eradication programs, disposal of contaminated birds, a ban of duck hatching, and poultry vaccinations. Finally, the fourth lesson learned was the benefit of a strong health care system that included surveillance, care and treatment across the country. The recommendations for the future include strengthening surveillance, vaccinating poultry, using tamiflu, accelerating human vaccinations, and enhancing regional and global communication.

by Rebecca Bonardi

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