On Friday, May 6, U.S. Deputy Secretary of State Robert Zoellick announced that Vietnam will receive $25 million from the U.S. in HIV/AIDS related assistance under The President's Emergency Plan for AIDS Relief (PEPFAR).1 At least part of the funding will go towards implementing prevention programming, particularly crucial in Vietnam where the epidemic is teetering between remaining concentrated among high-risk groups and becoming widespread among the broader population.
Vietnam is the only country outside of Africa and the Caribbean to receive PEPFAR funding. In his recent trip to Hanoi, Zoellick attributed the selection of Vietnam to the country's successful HIV-prevention efforts and said, "I think we can not only cooperate with but also learn from you."2
Experts have held up the policies on prevention in Vietnam as an exemplary model, especially for other countries whose epidemics are on the verge of becoming generalized. The World Health Organization (WHO) has identified the Vietnamese National AIDS Strategy to 2010 with visions to 2020 as "one of the best national HIV/AIDS strategies in Asia."3 According to the WHO, the Vietnamese Strategy incorporates best practices from around the globe, including harm reduction programs for sex workers and injection drug users, who are at high risk for HIV infection and currently make up the epicenter of the Vietnamese pandemic. For prevention among the general population, the WHO recommends prioritizing interventions that reach young people, including sexuality education programs.4 Such an approach, however, stands in stark contrast with the plan for prevention under PEPFAR which does not support harm reduction or comprehensive education programs.
In fact, restrictions on PEPFAR funding prohibit support of basic harm reduction programming. For example, needle exchange programs are a "proven and essential intervention for reducing HIV prevalence (without increasing drug use)," but U.S. law prohibits federal funding for needle exchange programs.5 In addition, organizations receiving PEPFAR funding are required by law to explicitly oppose prostitution, "a requirement that could disqualify some organizations providing important HIV prevention and health services to sex workers from receiving funds."6
In addition to failing to address the needs of the people currently suffering most from HIV/AIDS in Vietnam, PEPFAR fails to support comprehensive prevention among the general population that could stop the epidemic from spreading beyond concentrated populations. PEPFAR does not fund condom education or distribution for the general public, instead it allows for such interventions only for certain designated high-risk groups. Under PEPFAR, the U.S. government's foremost intervention comes in the form of abstinence-only-until-marriage programs targeting young people. In addition to concerns about the efficacy of these programs, advocates worry that a proliferation of abstinence-only-until-marriage programs in Vietnam will perpetuate common misconceptions about the virus and people who become infected that motivate fear, stigma, and discrimination. Overcoming stigma associated with HIV/AIDS has been a major challenge in Vietnam and remains imperative to protecting the safety and dignity of people living with AIDS as well as encouraging testing and treatment.
- "U.S. Official Announces $25M in 2005 PEPFAR Funding for Vietnam," Kaiser Daily HIV/AIDS Report, 9 May 2005, accessed 11 May 2005.
- "Vietnam's HIV/AIDS Strategy Dubbed Best in Asia," Viet Nam News Agency, 1 April 2005, accessed 11 May 2005.
- Leonard S. Rubenstein and Eric A. Friedman, "Human Rights and the President's AIDS Initiative," American Bar Association Section of Individual Rights and Responsibilities Human Rights Magazine, Fall 2004, accessed 11 March 2005.