UNAIDS speech at the National Congress on 20 Years of HIV/AIDS Prevention and Control in Viet Nam

Your Excellency Madame Vice President Nguyen Thi Doan, Former Deputy Prime Minister Nguyen Khanh, former Chair of the National Committee for AIDS, Drugs and Prostitution Prevention and Control, Professor Nguyen Quoc Trieu, Minister of Health, colleagues and friends,

It is a great honour to join you today and speak on behalf of the international community during this wonderful commemoration of the 20th anniversary of Viet Nam’s response to HIV and AIDS. It is also a great pleasure to be back in Viet Nam, where I worked for the UN on HIV in the mid 1990s. 

Those days were quite a challenge for the national HIV response, which was in its early stages following the diagnosis of the first HIV case in 1990. There was very little donor funding, the Vietnamese economy was changing rapidly and the health system was struggling to adjust.  We were dealing with a totally different landscape to today: few prevention services or programmes, no antiretroviral treatment. There were only a few hundreds people getting tested for HIV each year, and a sentinel surveillance system was not yet in place. But we all knew that the virus was spreading undetected. I used to work with Deputy Prime Minister Nguyen Khanh and Minister Do Nguyen Phuong and Professor Nguyen Chung A and Dr. Bui Hien – supporting the response. Today Viet Nam can be proud that it has an expanded and multi-sectoral response.

The transformations that have occurred since then are nothing short of incredible. This grand and beautiful convention centre is one of many monuments to the economic explosion that has taken place in Viet Nam. There are also the tall buildings on Hanoi’s skyline and the multi-lane highways that link the capital to the rest of the country. Yesterday I had the great pleasure to visit another monument to Viet Nam’s transformation: the Long Bien District Health Centre. This new health facility is a one-stop-shop for comprehensive HIV services, including HIV testing, antiretroviral treatment, distribution of clean needles and condoms, and methadone maintenance therapy to help people who inject heroin overcome their dependency, stay safe from HIV and become more productive members of society. I also had the opportunity yesterday to meet with sex workers, men who have sex with men and former injecting drug users who are now dedicated to helping their friends to avoid HIV infection through peer-to-peer programming. We know when communities own and implement programmes, these are the most effective – and I was so pleased to see this in action yesterday.  People living with HIV, people who use drugs, people who buy or sell sex, men who have sex with men are not our enemies or criminals – they are the solution to the response. The UN Secretary General said effective programmes do not punish people, they protect them.

Now there are also many partners supporting Viet Nam’s response to the epidemic—from the US President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, DFID and many others. Of course the United Nations is still behind you fully. Partners are impressed by the action, dedication and progress they see.

And when I look around the room now and see the vibrant civil society presence and engagement, it reminds me how far we have come, and how HIV has in many ways itself been a catalyst for change.

Reflecting on the early days and the enormous challenges faced, I am deeply impressed to see how far the response has evolved. Strong and sustained leadership has been fundamental to driving change. On behalf of the international community, I would like to take this opportunity to thank the Deputy Prime Minister and the National Committee on HIV, Drugs and Sex Work Prevention and Control for their drive and dedication in the expansion of a multisectoral HIV response.  The leadership and personal commitment of the Chairman of the National Committee, H.E. Deputy Prime Minister Truong Vinh Trong has brought about significant improvement and change in the response to HIV in Viet Nam. This is both on policy and expansion of best practice programmes such as methaonde, and calling for a review of programmes and approaches to ensure that only the most cost-effective will continue in the future. In addition to the Ministry of Health, MOPS, MOLISA, MOET and others are implementing new and effective programmes in their respective areas. (may need to pause for applause here) The Ministry of Health of course carries a large part of the response and has been rapidly scaling up access to services across the country.

Today, on this important anniversary, it is also important to look forward to the future. The Global Report on AIDS launched last week underlined that we have broken the trajectory of the epidemic through exactly the kind of solid and concerted efforts we see in Viet Nam. But as the Executive Director said at the launch, we are still far from being able to say “mission accomplished”.

Our vision and goal is: Zero new infections. Zero discrimination. Zero AIDS.

There are still major challenges to overcome. Nearly half of all people living with HIV in Viet Nam in need of treatment still go without it. Only one in four pregnant women gets an HIV test and only one in three HIV-positive mothers gets treatment to reduce the risk of transmitting HIV to her child. HIV continues to spread among people who inject drugs, sex workers, the clients of sex workers, men who have sex with men, and their intimate partners—and yet, access to treatment and prevention services for these key affected populations, and targeted spending for these populations, is often still inadequate.

More broadly across Asia, we are seeing that punitive laws, policies and practices are hampering the AIDS response – criminalization of same sex relations, criminalization of sex work, forced ‘rehabilitation’ and even the death penalty for people who use drugs. Many countries in the region have laws which obstruct the rights of people living with HIV. This prevents the AIDS response from realizing its full potential. In most of these areas Viet Nam is well ahead of other countries but for others Viet Nam needs to make policy changes to harmonize approaches between ministries based on human rights principles and best practices.

In these times of economic austerity, fragile funding is also a reality for all countries in the region. Viet Nam’s remarkable economic progress also means that donors are reducing their support in the expectation that Viet Nam is building a sufficient resource base to fund the response itself.
In short, the challenge will be to continue increasing access to services, particularly for key affected populations, as donor funding decreases. 
The big question is: How can we do that?

I think part of the answer can be found in the story of the woman who was Viet Nam’s first confirmed HIV case. Remarkably, this woman is still alive, despite the fact that she did not have easy access to treatment for many years. Her strength is a reflection of the strength of the Vietnamese people. 
It is also important to note that this woman is not living openly regarding her condition. In fact, she has changed her name four times over the past 20 years in order to hide her HIV status. This is a reflection of the high level of stigma and discrimination surrounding HIV in Viet Nam. People living with the virus hide their status for fear of being rejected by society and fired from their jobs. People at risk of infection dare not take an HIV test or suggest wearing condoms with their spouses because they fear being identified as practicing the so-called ‘social evils’. So in spite of all the achievements over the past 20 years, stigma and discrimination still allows the virus to hide and spread – we have to move out of the shadows and into the new era of an increasingly enlightened HIV response.

I will end my brief remarks with an appeal to the leaders and all of us assembled in this room. The national law on HIV is a strong framework for action.  Through your public words and actions, and through the strengths of the institutions you lead – Your Excellencies can help Viet Nam break through old taboos and create an environment where key populations at higher risk of infection can access HIV prevention services and people living with HIV can live free of stigma and discrimination. This is the key to achieving universal access to comprehensive HIV services and the Millennium Development Goal of halting and reversing the HIV epidemic by 2015.

Thank you and chuc suc khoe.