HIV/AIDS in Vietnam

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Vietnam faces a concentrated HIV epidemic among high-risk groups, including sex workers, and intravenous drug users. There are cases of HIV/AIDS in all provinces of Vietnam, though low testing rates make it difficult to estimate how prevalent the disease is. The known rates among high-risk groups are high enough that there is a risk of HIV/AIDS rates increasing among the general population as well. People who are HIV+ face intense discrimination in Vietnam, which does not offer legal protections to those living with the condition. Stigma, along with limited funding and human research, make the epidemic difficult to control.

Contents

Reporting

HIV prevalence data in Vietnam is based primarily on HIV/AIDS case reporting and on the HIV Sentinel Surveillance conducted annually in 40 of Vietnam's 64 provinces. The government now reports HIV cases in all provinces, 93 percent of all districts, and 49 percent of all communes, although many high prevalence provinces report cases in 100 percent of communes. Even though Vietnam has implemented HIV/AIDS case reporting, the general lack of HIV testing thus far suggests that the actual number of people living with HIV/AIDS is much higher. [1]

Current state

The first HIV case was detected in 1990. [2] The estimated number of people living with HIV then rose drastically from 3,000 in 1992 [3] to 220,000 in 2007, and is projected to be 280,000 in 2012. Among these, 5,670 are children. [4] According to the IMF, this trend is placing Vietnam at the threshold of moving the disease from the high-risk groups of drug users and sex workers to the general population. [5] Among those who inject drugs, 19% are infected by HIV (up to 30% in some provinces). [6]

Injection of drugs

Injecting drug users (IDU) account for up to 65% of people living with HIV. [7] The HIV prevalence among male IDU is estimated to be 23.1%. [4] Drug injection is reported as the major cause for doubling the number of HIV/AIDS patients from 2000 to 2005. [8]

Although there appears widespread awareness of using sterile needles among IDU (88% reported doing so in the last injection [4] ) sharing needles is common among those who have already contracted HIV/AIDS. In a survey of 20 provinces in Vietnam, 35% of IDU living with HIV shared needles and syringes. [9] Besides, IDU often engage in risky sexual behaviours. 25% of male IDU in Hanoi is reported to buy sex and do not use condoms. Meanwhile, female IDU often sell sex to finance their drug need. [7] This raises the risk of spreading HIV/AIDS to the general population.

Sexual transmission

Another main cause of HIV/AIDS spread is sexual transmission through the sex workers. While 97.1% of female sex workers (FSW) reported using condoms with their most recent clients, [4] the rate is much lower at 41.1% among those who are living with HIV. [9]

Others

While HIV/AIDS remain an epidemic only within the high-risk groups, women in the general population may be more exposed to the risk of contracting HIV than reported. One study estimates that reported HIV transmission among women may reflect as low as 16% of the real number due to the lack of HIV screening. The number of women with HIV infection is estimated to increase from less than 30,000 in 2000 to 90,000 in 2007. [2]

Women may contract HIV/AIDS through partners who are undisclosed IDU. Men having pre-marital or extra-marital sexual relationships with FSW inevitably expose their wives to HIV/AIDS risk. Particularly in provinces with mobile populations, migrant husbands who, being away from home, are likely buy sex and use drugs may contract HIV and transmit to their wives. [2]

With potentially high HIV prevalence among women, perinatal transmission presents another channel of HIV transmission. It is reported that more than 1% of pregnant women in some provinces are found HIV positive. [3]

Challenges

Social stigma against HIV/AIDS patients presents a major obstacle to contain HIV/AIDS. HIV/AIDS patients are treated unequally in the hospitals and denied employment. Children with HIV are not welcomed in school. In 2009, parents in Ho Chi Minh City forced officials to expel children with HIV. [10] Discrimination thus discourages people to go for screening or to take medication in fear of revealing their HIV status.

Funding for HIV/AIDS programmes in Vietnam is another pressing issue limiting the success of the effort to control the disease. Over the past 5 years, the available resource covered merely 50% of the demand. [11] Moreover, since 70% of this amount was received from international institutions while state funding accounted for only 13%, [11] there is no guarantee of future availability.

The final challenge lies in the limited human resources. There is a shortage of helpers in provincial and district areas. Currently, there are approximately 1,300 health workers in preventive medicines nationwide, including anti-HIV work, or 21 on average for each city or district. [12] Dr. Nguyen Thanh Long, Chief of the Health Ministry's HIV/AIDS Control Department, estimated that Vietnam has to increase the number of health workers to 20,000 by 2020 in order to be able to contain and reduce the increasing number of infected cases. [12]

Related Research Articles

<span class="mw-page-title-main">Epidemiology of HIV/AIDS</span> Epidemic of HIV/AIDS

The global epidemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), by 2023, HIV/AIDS had killed approximately 40.4 million people, and approximately 39 million people were infected with HIV globally. Of these, 29.8 million people (75%) are receiving antiretroviral treatment. There were about 630,000 deaths from HIV/AIDS in 2022. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

HIV is recognized as a health concern in Pakistan with the number of cases growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the HIV epidemic to take hold in Pakistan, mainly among injecting drug users (IDU), male, female and transvestite sex workers as well as the repatriated migrant workers. HIV infection can lead to AIDS that may become a major health issue.

Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. The status of the HIV/AIDS epidemic in Angola is expected to change within the near future due to several forms of behavioral, cultural, and economic characteristics within the country such as lack of knowledge and education, low levels of condom use, the frequency of sex and number of sex partners, economic disparities and migration. There is a significant amount of work being done in Angola to combat the epidemic, but most aid is coming from outside of the country.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.

HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.

<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.

The southeast-Asian nation of East Timor has dealt with HIV/AIDS since its first documented case in 2001. It has one of the lowest HIV/AIDS-prevalence rates in the world.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive. Bolivia has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total, with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive. El Salvador therefore is a low-HIV-prevalence country. The virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).

Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year. But, in 2012 and 2013 it increased to about 600 new cases and in 2014 it reached 880 new cases per year. According to UNAIDS 2016 statistics, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

Morocco has been identified as one of the best countries within the MENA region in dealing with the HIV epidemic based on their research capacities, surveillance systems, and evidence-informed and comprehensive responses. While the general public has a fairly low HIV prevalence, the majority of HIV/AIDS cases can be found in three high-risk groups, which is important when deciding how to approach intervention and prevention.

References

  1. ↑ "2008 Country Profile: Vietnam". U.S. Department of State (2008). Accessed September 7, 2008. PD-icon.svg This article incorporates text from this source, which is in the public domain .
  2. 1 2 3 Nguyen (2008). "A hidden HIV epidemic among women in Vietnam". BMC Public Health.
  3. 1 2 "HIV/AIDS in Viet Nam" (PDF). Retrieved 2011-09-10.
  4. 1 2 3 4 "UNAIDS Vietnam". Archived from the original on 2011-07-12. Retrieved 2011-09-10.
  5. ↑ "Vietnam's Health Care System: A Macroeconomic Perspective". IMF. 2008.
  6. ↑ "USAID HIV/AIDS Vietnam". 20 April 2020.
  7. 1 2 Nguyen (2008). "Drugs, Sex and AIDS: Sexual relationships among injecting drug users and their sexual partners in Vietnam". Culture, Health and Sexuality.
  8. ↑ "HIVS and AIDS in Asia" . Retrieved 2011-09-10.
  9. 1 2 DuongV (2009). "HIV Risk Behaviours and Determinants Among People Living with HIV/AIDS in Vietnam". AIDS and Behaviour.
  10. ↑ "Love as harm reduction: fighting AIDS and stigma in Vietnam". Harm Reducation Journal. 2009.
  11. 1 2 "HIV/AIDS fight needs more funding, VietNam Today" . Retrieved 2011-09-10.
  12. 1 2 "Vietnam needs 20,000 health workers for HIV/AIDS fight" . Retrieved 2011-09-10.
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