Vietnam’s AIDS quagmire

Hai Duong Province is sparsely populated and quietly nestled about two hours southeast of Hanoi.

The energy infused scooter-filled streets of Vietnam’s capital long since out of sight, disappearing below the horizon of the rear view mirror, giving way to a two lane highway that cuts through open rice fields scattered with the silhouettes of hunched over workers under the blazing sun. There are no cafes, no bia hoi beer joints, only the occasional restaurant among communities spread far and wide.

On the 25th of each month a group of Hai Duong residents convene for a monthly meeting where snacks and beverages are served for men, women and their children of various ages and walks of life. They come together to share their stories and to provide some comfort for those in need of support. Upon first glance, what links the members is not clear, not evident to the eye. The cause that binds them is unseen, but the reason they meet each month is one that has left many of them ostracized from society, cut off from family and friends. When they come here, they are no longer alone. These club members have one thing in common. Each of them is infected with HIV.

All of them are unique, coming from varied backgrounds, levels of education and work. Their stories of how they were infected are all personal, none of them the same, except for the result. There was a time when some worked in factories, farms and schools, once when some were husbands and wives. Testing positive changed all of that.

Arriving for the monthly meeting, each is treated to a free medical check-up, anti-retroviral medicine, and maybe most importantly, to share a few laughs and feel at ease. Of the reported 280,000 living with the virus in Vietnam, statistics show that only 45 percent receive therapy, making free medical access a necessity.

Members are open to talk about the group and how it has helped them endure life after their infections, especially in a country where HIV/AIDS leaves them viewed as lepers driven from their caste. People who due to their own supposed immoral actions are blamed for disgracing not only themselves but also those closest to them.

Launched in 2001, the HIV group known as the Bright Future Club was created to give those with the virus a refuge, a place where they could find comfort to shield them from the intolerances and discrimination of society. What began with gatherings in a small office in the Kinh Mon district is now based in a home and has grown to become the nation’s largest for those with HIV.

Like any association found in Vietnam, the Bright Future Club received official permission to be formed, in its case from women’s 955 Union responding to support women and their children. Today, 42 people volunteer their time at the centre. Group events are organized for members along with information and education sessions for the public. Visitors are often treated to dramatic sketches and games, performed to help the community better understand the virus and the people who live with it.

Mr. Củỏng, a tall, lean and well-dressed man in his 40s, happily attests to the club’s worth, reflecting on the success it has achieved in 10 years of operation. As the club’s leader and an original member, he oversees the day-to-day programs, organizes events, and regularly submits reports to funding officers. What began with 46 members has grown to 116 with an increasingly public face. A reality today that was hard to imagine during the group’s infancy.

“The club attracts more people because of the activities,” said Củỏng through an interpreter. “Historically, there has been a lot of discrimination in the community.”

Before leading the group and before discovering he was infected with HIV, Củỏng was a school teacher with a fiancée. He recalls how in 2005 his family pressured him to urge his fiancée to undergo an HIV test. As a foreigner coming from a family with less wealth, there were concerns she may have carried the virus. To appease everyone Củỏng and his future bride were both tested. Only he was positive. His career was over, the wedding called-off. The irony of his story has not left him bitter, but rather makes him smile, as a constant reminder of how indiscriminate the virus is in a country where AIDS is commonly viewed as the affliction of drug addicts and prostitutes.

His story is familiar among those in Vietnam living with the virus. Word of a positive test spreads quickly here, resulting in lost friends, family and jobs. Although it is against the law, companies continue to administer blood tests for job candidates and employees, leaving many shut out of the labour force and blacklisted wherever they go.

To help remedy the problem of unemployed people with HIV, organizations including the Bright Future Club have created work programs that include tasks such as producing charcoal. However, the jobs provide little hope of securing financial stability and leave people with HIV on the outskirts of society.

Having lost his career in education, Củỏng says what was originally created to give people a chance to survive has shifted its focus to prevention, hoping that through education others will avoid infection.

Although the number of people infected with HIV/AIDS in Vietnam is relatively low compared to its population of 90 million, what may appear to be a controlled issue to some is deceiving in a country that remains culturally conservative, suffering from stereotypes surrounding AIDS that prevent awareness and treatment. Despite the comparisons to neighbouring countries with much higher rates of infection, Vietnam’s numbers are rising, and not just among high-risk groups. The combination of conservative views and a lack of intervention are helping the virus spread among the general population.

Making corporations socially responsible

“The problem with prevention, with workplace programs, is that we don’t have champions in Vietnam. We don’t have individual corporate managers or companies that will stand-up and do really good things on HIV.”

Patrick Burke doesn’t mince his words. For the past 20 years his work has focused solely on HIV prevention in Vietnam, specifically promoting corporate social responsibility (CSR.) The Australian, who calls Hanoi home and speaks the language fluently, agreed to talk about HIV workplace prevention on a Saturday afternoon in-between meetings. His work is non-stop, no matter the day. Devouring his cake he wasted no time getting to the heart of the issue. “The frustration for anybody working in this area is that it would be a lot easier to get a solid response if a few companies had the balls to stand-up and say ‘we’ll do something about this.’ ”

Burke knows the issue of HIV prevention well. Currently coordinating prevention programs for World Bank-sponsored infrastructure projects, he speaks freely on corporate Vietnam’s reluctance to play a prominent role in the health of its workers.

“There is not a single Vietnamese business leader, not a single Vietnamese company that has taken a public stance on [HIV/AIDS],” he says with a disdain that comes from being immersed in the issue for so many years. “It’s ironic that Bill Gates is so universally admired in this county and so many people think he’s such a great businessman. But I wish they would actually remember that he contributes a very large amount of his own personal wealth to HIV/AIDS, Malaria, TB and other diseases as well. Some of these guys who are the owners of these very successful Vietnamese companies, very successful, very wealthy, I just wish they’d take a look at Bill Gates and become more like him.”

The example of The Bill and Melinda Gates Foundation, which to date has contributed more than $600 USD million to the Global AIDS Fund, has not only made the former Microsoft CEO an international social ambassador, but also a shining example of CSR.

“I’ve worked with companies that have done great work and won’t publicize it because they think that their products or services will somehow be associated with HIV/AIDS,” he said, citing one company that despite initiating prevention programs for its more than 3000 workers, it would not distribute condoms simply due to the conservative views of the managing director. A lack of leadership from the top he says “promotes the sorts of behaviours we are trying to prevent.”

Despite looking to people like Gates and former US President Bill Clinton’s Clinton Health Access Initiative, efforts to stimulate a better corporate and government level response to HIV prevention in Vietnam have resulted in what Burke describes as “a series of disappointments,” even with the support of international aid money.

Burke’s latest challenge, implementing an HIV/AIDS prevention program for a World Bank sponsored infrastructure project, is one he hopes will become an example of how taking initiatives benefits everyone involved.

“It’s a bit of a long stretch for some people to think there is a connection to building these infrastructure programs and the spread of HIV,” he said, referring to an earlier road improvement project in the Mekong Delta to illustrate the failure to respond to a situation primed for problems: an all-male workforce living away from home with a large disposable income and easy access to commercial sex and drugs. Making it worse is a lack of condom access, treatment and education. “Many don’t even know that testing facilities exist. So the risk factors, if you add them up, are all pretty high.”

Following the Mekong project the community experienced a “spike” in the number of infections. So far his latest prevention program has resulted in no positive tests. A success that he believes will encourage others to follow. “You do good things with the environment, good things in the community, you build schools, and you know HIV is an easy one, provided you’re prepared to take a stand on it.”

Despite the progress of international organizations in creating awareness, Vietnamese-initiated actions remain a rarity. “There have been a lot of achievements at the local company level, and I can feel proud of the fact that that I’ve created quality programs for workers and managers, put many people with HIV into contact with audiences they never would have met,” he says. “But in creating a sustained response where Vietnamese can take the lead, no.”

Sacrificing health for trade benefits

While people like Patrick Burke work to change the perception of HIV and the safety of the workplace, another issue involving government and big business is threatening the very health of those living with the virus.

Negotiations are currently underway for the Trans Pacific Partnership Agreement (TPP), a new international trade pact among nine Pacific Ocean countries. Made up of Australia, Brunei, Chile, Malaysia, New Zealand, Peru, Singapore, Vietnam, and the United States, Japan, Mexico and Canada are also looking to join. As the US leads the way to unlimited access to large Asian markets, developing country partners are showing a willingness to agree to concessions for a potential infusion of wealth. Left behind in a bid for trade are the citizens, and specifically those with HIV/AIDS. Such is the case when small countries enter into trade pacts with bigger, more powerful ones.

Once ratified, the controversial TPP is set to deny signatory countries’ access to generic anti-retroviral medicines. Developing countries dependent on cheap generic AIDS drugs will be forced to buy expensive, name-brand medicine. The TPP will give large American pharmaceutical companies absolute control over patents, leaving smaller generic companies unable to reproduce easily accessible and affordable medicines for AIDS patients.

Generics have previously been available because patent and copyright laws did not apply to the countries that needed them. The TPP will change that by returning all the bargaining power and patent rights to “big pharma,” setting the stage for drug companies to monopolize the market.

Judit Rius, the US Access Campaign manager for NGO Medecins Sans Frontieres (MSF), says the TPP “is going to affect US-supported initiatives in Vietnam,” suggesting that increased costs would undermine the efforts of major aid organizations ability to deliver medicines. “It’s going to have an effect on all developing countries.” Not only will medicine access become more difficult as prices increase, but because of stricter copyright laws Rius fears that a lack of access to knowledge will delay scientific progress.

So far TPP negotiations have been held behind closed doors with the details of the agreement kept secret. However, a “white paper” released in early September in Chicago shed light on the talks and made it clear that big business, and specifically US firms, would take the priority surrounding access to medicines. The paper cited that stronger intellectual property protection would increase access and innovation of medicines.

Rius says that the measures outlined in the paper would make it difficult for MSF to get medicine to patients early because of the cost. She points to the latest studies that show improved health of HIV carriers if they receive treatment earlier and more aggressively. “We will have to treat more people and we will have to treat them earlier, and that is all threatened if the cost of medication goes up.”

Generic drug companies have long been able to provide lower cost medicines by not having to repeat medical trials needed for initial approval, instead relying on the work of large pharmaceuticals. With the TPP, rather than waiting two years for approval to produce medicine, generics will be forced to wait 5 – 11 years for access to medical trials. The delay will allow large companies to slightly alter patents and find alternative uses for drugs already on the market in order to keep control of the property rights for longer periods.

Opposition to the TPP is being voiced within all the partner countries, including the US where in August 10 members of Congress published an open letter to US trade ambassador Ron Kirk calling for improved access to life-saving medicines. However, criticism of the TPP has done little to slow the talks that are expected to conclude toward the end of 2012.

Local progress pushes ahead

Back in Hai Duong there is little talk of international trade agreements and intellectual property rights. There members of the Bright Future Club focus on their day-to-day health and work to help others avoid their predicament. Despite living through discrimination daily, they know progress has been made.

Củỏng, the club leader, is able to take a moment and reflect on the club’s simple and difficult beginnings. He remembers when the health authority provided little support and the club had no clear idea of activities or even a strong purpose. Today that is no longer the case. He says members are now empowered, and that expectations are much higher.

With an increase of financial support, the club has been able to purchase equipment to hopefully fulfill its plans of building a garment workshop and help curb the 92 percent unemployment rate among those with HIV. Change is also happening within communities, which he credits for improving the health of members and has made him optimistic and happier. Because of increased efforts he believes Vietnamese society is more aware and better understands the virus.

“The most important thing is the knowledge among society,” he attests. “We have to change the mentality to make more meaningful lives for those living with HIV.”

A special report from Andrew King