Viet Nam consistently shows strong leadership in the response to HIV

Government Web Portal’s Interview with Mr. Eamonn Murphy, Director, UNAIDS Regional Support Team in Asia and the Pacific, on the occasion of his official visit to Viet Nam on 20-21 March 2018. Watch the interview at :http://media.chinhphu.vn/video/viet-nam-the-hien-vai-tro-lanh-dao-manh-me-trong-dap-ung-voi-hiv-aids-9624

 

1. Having worked in the HIV response for so many years, how do you assess Viet Nam’s progress in recent years in responding to HIV?

Viet Nam has consistently showed strong leadership in responding to HIV in the world and the region. In 2014, Viet Nam was the first country in the region to commit to the 90-90-90 targets. In 2016, Deputy Prime Minister Vu Duc Dam championed the UN General Assembly’s High Level Meeting on Ending AIDS with powerful messages, sharing the podium with a woman living with HIV and jointly delivered the message to the whole world of the need to work for and together with community in the response to HIV. By the end of 2017, Viet Nam has achieved impressive progress in the national HIV response. These include the provision of ART to more than 50% of all people living HIV, and enormous efforts to quickly scale up coverage of the methadone program which was providing treatment to more than 50,000 people who depend on heroin. This is a huge strive forward and set a good example for other countries in our region.

 

2. What do you think are Viet Nam’s challenges and also opportunities in Fast – Tracking the national response to HIV including achieving the ambitious 90-90-90 targets? What are the keys to success in addressing those challenges?

Viet Nam is on the right track but also faces many challenges. There are still about 11,000 people acquiring HIV each year. The pattern of the epidemic is changing so we are seeing more men who have sex with men contracting HIV in Viet Nam. Viet Nam is in a transition and integration process both in terms of HIV financing and systems. Stigma and discrimination continue to be a major barrier for people living with HIV to access and uptake HIV services.

However, Viet Nam has strong high level political leadership to respond to HIV. The Central Party Committee’s Resolution No.20 on public health issued in late 2017 has re-confirmed the political commitment to ending AIDS by 2030 and increasing domestic resources for HIV. This is very timely because Viet Nam has been strengthening its economic base as a middle-income country and as a result, the international support for the national response to HIV has declined, so increasing domestic resources for HIV is very important.

Another challenge is looking at what the data is telling us, how is the epidemic shifting and changing, what are the new innovations to introduce for better responding to HIV. Viet Nam is piloting PrEP for men who have sex with men. PrEP is pre-exposure prophylaxis – providing formal treatment to people who do not have HIV but are at higher risk of HIV infection, to protect them from acquiring HIV. This is a significant new tool in HIV prevention. Quickly scale-up PrEP for people at higher risk of HIV infection, while continuing on existing evidence-based interventions including the needle and syringe program, the methadone program and condom program are essential for reducing new HIV infections in Viet Nam.

Ensuring the financial sustainability is also a big challenge which Viet Nam has been modelling for other countries through using social health insurance. But the challenge remains how to quickly expand health insurance coverage and use among people living with HIV.

You mentioned Fast-Track. A big challenge on all fronts is how to make the response moving faster. Ho Chi Minh City is doing really well as the first Fast-Track City in Viet Nam. I hope to also see Ha Noi becoming a Fast-Track City, to lead by example and join the group of Fast Track cities in the region and globally. However, we also don’t want to lose sight of provinces in difficulty and in mountainous areas who have less capacities and need to ensure that these provinces also get attention and support from the central Government and development partners to make further progress.

 

3. Can you elaborate more on some priorities you just mentioned, such as ensuring continued strong leadership and political commitment in responding to HIV, ensuring sufficient domestic resources and smart investment for HIV, ensuring sustainability of both prevention and treatment programs, and scaling up evidence-based innovations? What do you think Viet Nam should do to better perform on those priorities?

It was a great privilege this morning I could meet with the leaders of the National Assembly’s Social Affairs Committee. The Committee is leading the process to review and revise the HIV Law, together with the Ministry of Health and the Government, after 10 years of the Law’s issuance and implementation. It’s critical to ensure leadership not only within the Ministry of Health but also the political leadership and at all levels. Provinces need to keep up their promises by materializing the allocation of provincial budget for HIV and taking initiatives to make health insurance work for people living with HIV and ARV treatment. These are mandated by the Prime Minister’s Decisions on ensuring the financial sustainability of the HIV programme and more recently on using social health insurance to finance ARVs and using local funds to provide financial support for people living with HIV to enrol in social health insurance. Leadership at provincial level is key to expand HIV service coverage including the methadone program, community-based HIV testing program, and also ARV treatment program because half of all people living with HIV in Viet Nam has not yet received treatment. Those are the first two 90 targets: 90% of all people living with HIV know their HIV status, 90% of all people diagnosed with HIV receive ARV treatment. The third 90 target is 90% of people receiving ART treatment have durable viral load suppression. Viet Nam is doing well on the third 90 target but need to scale up regular viral load testing.

 

4. What will be UNAIDS’s support for Viet Nam in the context of on-going transition in the national response to HIV?

As I have mentioned, Viet Nam is now a middle-income country and continues to strengthen its economic base, so donors are reviewing their roles in the country and external support for the national response to HIV is declining. But Viet Nam is step by step increasing domestic investment in the response to HIV. UNAIDS will continue to help ensure the continuity and quality of HIV services while Fast-Tracking service coverage expansion and sustainability. We will continue to work with Government, community and development partners, to make sure investments are in the right places and that the Government will invest sufficiently for treatment but prevention is not lost; to facilitate dialogues between law and policy makers, programme managers, service providers and people living with HIV and other key affected populations; and coordinate partnerships around policy issues related to HIV. We will also continue to support Viet Nam to improve the strategic information on HIV so we know how to best respond to the HIV epidemic today, and look forward to the changes and the needs in the future.

 

5. You used to be Country Director for UNAIDS in Viet Nam and Myanmar and now the Regional Director, can you please share what are the epidemic trend and main issues in the HIV response in Asia and the Pacific?

The biggest concern is about complacency. Many countries think that AIDS is over and HIV is no longer an issue. Yet we are seeing increasing new infections in countries across our region, such as in the Philippines, Malaysia, Pakistan, Papua New Guinea. We saw emerging different patterns of the epidemic. There are new pockets of the HIV epidemic in big countries like India, where new HIV infections are rising in some States which did not have problem with HIV before while other State are doing well. That means no time for complacency. More needs to be done.

Increasing new infections among young people in particular is another concern, among men who have sex with men but also among heterosexual populations. And the mode of communication of young people is by the mobile phone or the internet. Now young people are no longer going to the bar or meeting in certain fixed locations but meeting online, so our programs also need to adapt to the real world of the young people and use innovations to have effective interventions.

I would like to work with Viet Nam so Viet Nam can demonstrate to other countries in the region the innovations and the pragmatic ways Viet Nam has always responded to HIV. That in itself has many lessons for other countries in the region.