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The Threat of HIV/AIDS on Viet Nam's Youth:
Meeting the Challenge of Prevention
A
Report on the 1996 Viet Nam Youth Union Conference
by Dr. John B. Chittick
with additional commentary on the
Government's Approach to the
TeenAIDS Epidemic in 1997
by
Dr. John B. Chittick
Boston, USA © 1997
http://www.hsph.harvard.edu/Organizations/healthnet/HIV/docs/sea-aids/pvsex/pvsex17.txt
Foreword
The author has written two versions of this
report on the Viet Nam Youth Union's HIV/AIDS Conference on
youth vulnerability that was held in Hanoi on September 23 and
24, 1996. The author attended the 1996 gathering in Hanoi as the
invited guest of the sponsors in the capacity of youth AIDS
consultant. An abridged version of the report was edited for
promotional use by the conference co-sponsor, Health and
Education Volunteers of McLean, Virginia. This unexpurgated
version contains an expanded conference report, plus independent
research, and professional observations on the government's new
approach to the growing youth AIDS epidemic. The opinions in
this paper solely reflect the views of the author.
Dr. Chittick's analysis of the current
situation suggests that the risk to country's young people is
real; HIV/AIDS is spreading more rapidly than surveillance
reports acknowledge. Warnings from both domestic and foreign
AIDS professionals are making an impression on influential
government leaders and predictions of a major youth epidemic are
no longer being summarily discounted as exaggerated hype. The
conference deliberations demonstrate that a major shift in
official opinion has been underway since early 1996. Already
new policies have been introduced and more aggressive prevention
programs have been proposed that specifically target vulnerable
teenagers and young adults.
Research confirms that the national
leadership is especially concerned about the socio-economic
impact of a serious epidemic on the developing nation's future,
its labor force and agricultural base, its sexually active young
people of child-bearing age, and importantly, its pool of
military recruits.
To combat youth AIDS more effectively,
members of the party, the national assembly, and the government
are proposing recommendations which include: expanded HIV/AIDS
education and awareness in schools and youth clubs; community
networks of peer
AIDS teachers, greater mass media coverage
of teen's vulnerability to HIV, and a substantial increase in
condom distribution and safer sex instruction for young people.
Some officials have stated also that they support the
controversial concept of clean needle exchange for injecting
drug users.
In light of Vietnamese society's
traditional avoidance of the public mention of sexual issues and
the desire to punish social evils, these policy proposals are
significant. Based on new data, including interviews with top
officials, the report concludes that 1997 could be the pivotal
year for Viet Nam to implement more effective actions.
Previously, Dr. Chittick had spent three
months in 1995 working with government AIDS professionals in Ho
Chi Minh City.
His 1996 book, The Coming Wave of HIV/AIDS
in Vietnam reported on the full range of official AIDS
prevention programs with a focus on youth. With a doctorate (Ed.D.)
from Harvard University in human development and psychology, Dr.
Chittick specializes in TeenAIDS issues and has lectured on the
subject at Harvard.
Viet Nam's 1996 Youth AIDS Conference and
theGovernment's Approach to the TeenAIDS Epidemic in 1997by Dr.
John B. Chittick
"In the fight against AIDS, youth should be
the main shock force and a strategic army determined to win
final victory. Youth should save themselves and society from an
HIV/AIDS catastrophe." Dr. Pham Gia Khiem, Deputy Chairman of
the National AIDS
Prevention Committee, VNYU Conference,
Hanoi, September 23, 1996
Introduction:
On September 23 and 24, 1996, Viet Nam's
top ministry officials, health professionals, and AIDS workers
gathered in Hanoi for the country's first AIDS Conference on
Youth. Co-sponsored by the 21 million member Viet Nam Youth
Union (VNYU) and the American non-government organization (NGO)
Health and Education Volunteers
(HealthEd), the conference promised to be
of great importance because its theme focused solely on the
threat of HIV/AIDS among young Vietnamese. "The fact that the
Youth Union is co-hosting this conference and that the
Vietnamese health care community is represented here at such
senior levels," said Mr. Ca Van Tran, President of HealthEd, "is
a strong signal that [Viet Nam] is ready to take the next step
up in its battle for the well being of its people." Professor
Do Nguyen Phuong, Minister of Health and Permanent Vice Chairman
of the National AIDS Prevention Committee (NAC) called the
meeting, "of great significance... now that Viet Nam has been
selected by the United Nations as one of the priority countries
in its global AIDS prevention strategy." Only a few years
prior, the nation had paid limited attention to outside reports
of an impending epidemic.
However, conclusive evidence now exists
which points to the growing vulnerability of young people to HIV
-- especially in Asia. The Director of UNAIDS, Dr. Peter Piot
recently said, "The largest increases [are] now expected in
China and Vietnam." The threat of an AIDS epidemic in Viet Nam
is no longer a theoretical possibility but is an emerging
reality. Although it is recognized that some officials continue
to doubt foreign and domestic warnings, the government is
welcoming foreign assistance for HIV/AIDS prevention efforts.
Worried by news of growing problems in neighboring countries,
public health advisories are being proffered to alert the
population and avert more serious trouble. The question is no
longer how to stop the epidemic from entering the population but
how to limit its spread among the nation's young people, Viet
Nam's single most important resource.
While outside observers and concerned
Vietnamese medical professionals might believe that Viet Nam's
youth-oriented AIDS conference has been long overdue, it should
be noted that the U.S.government's first national youth
conference on HIV/AIDS was convened only a few months earlier
(in spring 1996) at the White House. Indeed, eleven
international conferences on AIDS have yet to make the spreading
youth pandemic their primary focus. Certainly, the response to
adolescent HIV has been slow in coming globally, and then, only
when the epidemic has grown too apparent to be ignored.
AIDS represents a profound threat to
humankind -- not just medically but psychologically and socially
as well. Almost universally, sex and death are two of our
greatest cultural taboos. Consequently, these critical issues
are often privately addressed and publicly ignored.
We fear HIV because the virus is
transmitted through one of life's most natural and pleasurable
activities -- sexual relations. Although the impulse is a
normal part of human existence and essential for the propagation
of the species, its role in passing HIV onto unsuspecting
partners is insidious -- like the Trojan Horse. When other
social prohibitions are added to the AIDS mix such as: unmarried
teenagers engaging in promiscuous sex; STDs (sexually
transmitted diseases ); homosexuality; unwed pregnancies;
illegal drug use; and prostitution, then HIV/AIDS is seen as not
only harming individuals but is recognized as a major threat to
revered family values and traditional tenets of society. "The
Government considers drug addiction, prostitution and the
HIV/AIDS pandemic as the key social issues threatening national
socio-economic development and national construction," stated
Dr. Pham Gia Khiem, Deputy Minister of Planning and Investment
in Viet Nam.
For parents everywhere, the reality that
adolescent sexual experimentation could lead to the early death
of their children is alarming. Yet many adults act as if
silence is preferable to frank discussion. Thus, the root
causes of youth AIDS remain a difficult subject to broach in
most cultures -- including in Viet Nam. The VNYU has exhibited
civic responsibility in sponsoring this first national
conference by bringing a difficult issue to the forefront of
public attention.
The key issue addressed by various speakers
at the Hanoi conference was HIV's spread into the younger
population. As Master Le Ngoc Yen of NAC put it, "Young people
are active with less experience who are sensitive to new things
and easily attracted by good and bad behaviours, affected by bad
cultural activities such as freer sexual behaviour, drug
addiction, and enjoyment... thus easily falling into social
evils." Placing the blame on adult anti-social behaviors for
the spread of AIDS continued to be a popular notion among many
Vietnamese conferees. Conversely, youth vulnerability was
attributed to a weakened resolve on the part of impressionable
youth.
Considering the troublesome societal and
political problems involved with AIDS prevention efforts in a
culturally-conservative country, the deliberations were as
candid as the key recommendations proved remarkable. The
conference was not the strict ideology-based performance as some
international observers had expected. Instead, real problems
were addressed and new solutions were proposed and discussed. A
renewed sense of resolve about how to handle the AIDS crisis was
evident throughout the official proceedings.
The open exchange of ideas was important
news for Viet Nam's young people and their future.
Background:
In the recent past, many Vietnamese have
assumed that HIV/AIDS was a problem of "bad" people who engaged
in social evils such as injecting drug users (IDUs) and
commercial sex workers (CSWs). To a superficial degree, their
impression was accurate. Similar to Thailand and Myanmar, HIV
first spread among Vietnamese drug users sharing contaminated
syringes. Ms. Chu Thi Xuyen of the VNYU's AIDS Prevention Fund
stated, "The number of young intravenous drug users is
increasing very rapidly, as 70% are under 30 years of age and
many are even adolescents." To pay for their expensive habits,
many people turned to illegal activities such as drug dealing
while, "Poverty and hardship have driven some people to risk
activities like prostitution." Whatever the reasons, there is
no doubt that HIV is beginning to infect members of the younger
generation.
Mrs. Nguyen Thi Than, a member of the
National Assembly admitted, "As we all know, there are now
hundreds of thousands of drug addicts in Vietnam (and the number
of sex workers is similarly high)....Young people account for a
large proportion of the afore-mentioned two groups." And when
these high risk activities are illegal and conducted sub rosa,
it is difficult for the authorities to address the problem, let
alone contain it.
Mrs. Than explained HIV's progression in
Viet Nam as coming in three waves, "We are now at the end of the
first stage of the development and transmission of HIV/AIDS (the
stage of HIV/AIDS transmission through injection) and are
entering the second stage (transmission through sexual
relations). We will be in the third stage when HIV/AIDS spreads
to the general population groups." While some professionals
might not agree on which stage Viet Nam is in currently, most
conferees appeared to accept that their country has already
entered the final stage. Undeniably, AIDS is a threat to the
public, especially young people. But because HIV infection has
been labeled a consequence of social evils, it has been
difficult also for many citizens to see HIV as a human virus
that could potentially infect anyone who engages in high risk
activities.
It is necessary to reiterate that the
public mention of sex is not customary or encouraged in Viet
Nam. Most adults neither accept nor discuss the possibility
that "innocent" young children could be engaged in risky
behaviors known to transmit HIV. Perhaps, it could be argued,
that old-fashioned values have protected today's teens from a
far greater (and earlier) exposure to AIDS. Many parents wish
that the traditional influence of culture and customs would
continue to play this role in the future.
Despite years of international isolation
and no reported HIV/AIDS incidence, Viet Nam was not immune to
the global pandemic. It was simply late in arriving. Since the
first incident of AIDS was reported in late 1990, the official
number of HIV-infected cases in Viet Nam has grown exponentially
to 5,000 cases by the beginning of 1997 (see Appendix A).
Although only a few cases of full-blown AIDS are known to
involve young Vietnamese in their teens, some speakers reported
the average age of HIV infections has been steadily declining.
This shift mirrors global trends suggesting that more than half
of all new infections are occurring among 15 to 24 year olds.
Undeniably, the causes for this change
remain a socially-charged issue.
According to Mrs. Xuyen, "of the number of
HIV cases from 1990 up to now, 60% are young people who are in
the main working age group." Another speaker, Deputy Health
Minister Nguyen Van Thuong stated, "The age of the majority of
HIV infected people are in the 30 - 39 bracket, but this tends
to shift to the 20 - 29 and under 20 age brackets. In general,
they are normally of a young age." For those attending the
conference, it was evident that AIDS has already begun to spread
rapidly into the younger population (see Appendix B) -- within
five years of its first appearance in Viet Nam.
Most official surveys report that the
majority of Vietnamese youth do not engage in sexual intercourse
before marriage. Cultural prohibitions and familial shame are
usually given as the main reasons why young people choose to
abstain. Yet independent questionnaires and anecdotal
information suggest that attitudes are changing and teens are
becoming more sexually active. The Pill is being introduced to
women in Viet Nam and experts predict the incidence of
premarital sexual relations will increase among young females as
a result.
Increasingly, reports from in-country
studies by AIDS workers warn that ordinary Vietnamese youth are
adopting the new lifestyles. Young laborers and university-age
students are enjoying increased sexual experimentation. Phan
Thi Le Mai, National Project Officer of the AIDS project of
UNAIDS/UNICEF, told the conferees, "a social survey showed that
the number of adolescents aged 14-15 with premarital sexual
experience is increasing." This trend among Vietnamese teens
appears to be mimicking the practices of young people worldwide
as once sacrosanct cultural taboos are marginalized by modern,
outside influences.
The danger for unsuspecting and
ill-informed youth lies in having unsafe sex when HIV
transmission routes are neither adequately understood nor made
relevant to their lives. This is true for heterosexual or gay
youth, both boys and girls, whether living in cities or rural
areas. As the pool of sexually-active teenagers becomes
increasingly HIV-contaminated, the likelihood of contracting the
virus grows greater with each new intimate partner. Teenagers
who engage in unprotected sex (and bodily fluids are exchanged)
need to be made aware of the medical consequences of their
actions. The risk is no less problematic for the unsuspecting
virgin who one day chooses a spouse from within the infected
group. For Vietnamese youth in the future, this situation could
be the rule -- not the exception.
Many young males, both students and
workers, say they have their first sexual experiences with CSWs
because their girlfriends are virgins. Vietnamese culture has a
tolerant tradition of quietly accepting the male prerogative to
engage in commercial sex. The practice of young men paying for
sex with prostitutes is often emulated -- not put down by other
youth. It should not be assumed however, that Vietnamese teens
lack moral values because some of them engage in commercial
sex. Rather, many boys think of it as a practical alternative
to premarital sex prohibitions. Among a growing minority of
young women, sex work is seen as a practical employment choice
in an increasingly expensive, more consumer-oriented society.
One conference speaker stated that HIV
poses "a threat to the increasing number of sex workers and
intravenous drug users of whom young people account for 75 -
85%." However, that recognition is only part of the story.
Teenage boys with little education or skills find work as cyclo
drivers or day laborers to pay for living expenses, including
drugs and sex if desired. Newspaper reports talk of girls from
the countryside, serving as household workers for urban
families, who are forced into sex by their employers -- there
are even stories of the kidnapping of young women for the sex
trade. How many of them become infected is not known but
presumably their numbers are high.
Many young military recruits are also
vulnerable to HIV. The head of the Secretariat of the AIDS
Committee for the Ministry of Defense said, "Army men from 18 to
25 years old, occupying 60 - 75% of the total force are in the
group of age which has the high [sic] risks of being infected by
HIV at present and in the coming years." Only one case of HIV
in the army was reported in 1995; less than eight months later,
ten more cases had been discovered. Although relatively small,
these numbers tell the tale of Viet Nam's emerging youth
epidemic.
Reports are increasing of greater youth
prostitution as the gap widens between Viet Nam's rising working
class and its very poor. The United Nations Children's Fund
(UNICEF) had previously estimated that there were 40,000 child
sex workers throughout Vietnam. Apprehensive about the
inability of the government to provide for homeless street
children, many AIDS workers are noticing that the international
sex trade is making its presence felt as Viet Nam opens its
previously-closed economy to outside investors (similar to the
earlier experiences of Thailand and the Philippines). According
to Pham Van Du, of the Vietnam Tourism Administration, "The
development of the market economy creates wide exchanges and the
increase in the number of local tourists are often accompanied
by prostitution." The opportunity to earn hard American cash
(Viet Nam's official second currency) often attracts susceptible
youth to make contact with international businessmen and
travelers. Mr. Du stated the official concern about the
increasing amount of foreign visitors, "No one knows how many of
them carry the HIV virus." Although it is not easy for party
leaders to discuss, Mrs.
Nguyen Thi Thuong, member of the Central
Committee of Young Women told the conference, "Bars and
cafeterias which in reality are brothels have mushroomed in Ho
Chi Minh city....There are a number of women, mainly young girls
who live on illegal income by selling sex." Also apparent is a
sex trade involving teenage boys although homosexual activity is
rarely discussed in Viet Nam. Throughout the country, CSWs are
known to operate out of establishments catering to both
tourists and Vietnamese men -- often with the tacit approval
of local authorities. The media has reported extensively on the
problem of late. A government-conducted survey, "made in
restaurants and cafes in Ho Chi Minh City showed that about
5,700 waitresses were involved in prostitution....Worst still,
12 percent are only 13 - 16 years old." Commercial sex workers
have lovers and families, facilitating the passage of the virus
into the general population and the younger generation (HIV is
transmitted in the same way to the partners of IDUs).
Prostitution is a major focus of the
country's social evils campaign. At the Thu Duc Women's
Vocational Training Center in an outlying suburb of HCMC, sex
workers who have been arrested for engaging in social evils are
incarcerated for six month sentences. Of the total number of
inmates, "some surveys have identified as many as 10% of the
residents as under the age of 16 years." Most of the young
women say their line of work is crucial to support their
families.
Unfortunately, girls who are involved in
the sex trade are at even greater risk of contracting HIV/STDs
due to their physiological immaturity and repeated acts of
unprotected sexual intercourse with numerous clients.
Throughout Viet Nam today, young CSWs are highly visible to the
casual observer in cities, resorts, and along the highways.
Viet Nam's leadership has yet to come to
grips with its thriving sex business and the money it generates
for the economy. Despite the fact that prostitution is
technically illegal and police campaigns against social evils
are popular with the government and the public, it appears that
some people in authority prefer to maintain the status quo. In
the recent past, a number of foreign reports have commented on
the possibility of high level involvement with prostitution.
However, such complicity is not official but rather is a
practice sanctioned by a few, well-placed officials interested
in personal, financial rewards. In fact, General Secretary of
the Communist Party Do Muoi acknowledged a serious problem when
he said, "Corruption and smuggling keep developing seriously,
causing high indignation among the people and greatly eroding
their confidence in the Party and the State." Certainly, any
collaboration with the sex trade could not be conducive to an
effective AIDS prevention campaign. To some conferees, any
compromise of social policy is short-sighted because it is the
sex trade that is fueling the explosive growth of HIV/AIDS.
Unless the situation can be brought under control -- and soon,
Viet Nam will pay a heavy price one day. Youth in particular
will bear the brunt of the errors of their elders.
Because most Vietnamese had assumed they
were not vulnerable to a threat that seemingly targeted only
social undesirables, the misconception did much to delay early
prevention efforts aimed at susceptible youth. Yet teens are
becoming HIV-positive due to risk behaviors they have in common
-- not because of their personal identification with "suspect"
groups. Some experts are predicting that a new global wave of
HIV/AIDS has begun to infect a significant number of sexually
active youth who frequently have unsafe sex with multiple
partners. Consequently, this emerging pandemic among the
younger generation, referred to by some as TeenAIDS, would be
more noticeable by the turn of the century.
Parental and societal denials about youth
engaging in sex and drug use present serious problems for the
government, its medical experts, and youth educators. In the
face of public apathy and with little visible evidence of a
widespread youth epidemic, why then would Hanoi want to promote
a high profile conference on the HIV/AIDS threat to the
country's young people? Undoubtedly, international warnings of
a major catastrophe are making an impression. As detailed by
various speakers, Viet Nam's leadership understands well the
lessons of history and the need for total preparedness to defend
their nation from foreign invasion -- in this case from the
global AIDS pandemic.
In numerous speeches, the threat was
described using potent metaphors of conflict and national
survival. Ms. Xuyen stated, "At present, the HIV/AIDS epidemic
is considered an enemy causing a new world war. What is
different is that in this war the enemy is attacking us without
gunshots and silently exterminating us leaving behind serious
consequences whose long-term effects will be even worse than
those of war." Statements of this kind are not made lightly in
a country that has suffered nearly three million deaths as the
result of armed conflict and wartime famine in this century
alone.
Because of Viet Nam's liberalized "economic
renovation" plan called doi moi, its society is no longer
isolated from international interaction or immune to universal
health concerns as it was from 1975 to 1986. During that
period, AIDS was thought to be a problem of foreigners. But
this perception has changed. As a result of official foresight
and planning, Viet Nam can take pride in the fact that it was
one of only a handful of countries that set up its national
prevention programs (between 1987 - 1990) before a single case
of AIDS had been reported (in December, 1990). The government's
actions undoubtedly limited a wider spread of HIV/AIDS. Yet,
the news is not all positive -- follow-up prevention measures
have left much to be desired.
Similar to other governments worldwide, the
leadership in Hanoi chose initially to frame its stop-AIDS
campaign in stark, uncompromising terms. Specific groups were
targeted which were stereotyped as the gateways for the
transmission of HIV/AIDS into the society at large. Only a
modicum of prevention information was geared to teens, in or out
of school. Much manpower and resources were expended in
punitive efforts aimed at eradicating social evils, with the
main emphasis on the arrest and detention of CSWs and IDUs. But
as one Vietnamese delegate admitted: "We have fought very hard
against social evils but risk [of HIV/AIDS is] still growing."
Consequently, valuable time was lost in the first few years of
the epidemic.
Research suggests that teenagers need to
witness the reality of AIDS before they could accept their own
vulnerability and take the necessary precautions to protect
themselves. After all, adolescence is the formative stage for
growing independent from adult control and restrictions. Taking
risks such as experimenting sexually and using drugs could be
considered a normal, albeit unwise, manifestation of feelings of
youthful invincibility. In this regard, modern Vietnamese teens
should not be considered different from their counterparts
internationally. Yet a problem of perception exists. In a
1995 survey of HCMC youth, the great majority (82.6 percent)
agreed that AIDS was a real problem, but only 61.7 percent
believed AIDS could be considered a "personal threat."
According to Ms. Xuyen, "Every year... millions of adolescents
begin to exercise their reproductive function. They lack
knowledge about reproductive health and have neither life skills
nor skills for safe sex to prevent AIDS." Due to inadequate
AIDS education, many youth have continued to engage in unsafe
behaviors without understanding their vulnerability to HIV. Dr.
Bui Hien of the National AIDS Bureau (NAB) points out, "there is
a gap between knowledge and practice."
This situation is especially true today for
Viet Nam's young people such as students, laborers, military
recruits, street kids, service employees, and young
professionals. On the plus side, some studies have found a high
degree of AIDS knowledge among youth (approximately 90 to 95
percent accuracy ) -- a sign that Vietnamese educators have done
a good job of providing a basic awareness of HIV transmission
routes. Yet the conferees were told that the present campaign
strategy has been of limited effectiveness. Recent research
data suggests that many youth do not equate their own unsafe
practices with those actions of people involved in social
evils. A large part of the problem is due to a common societal
belief that "good" youth become infected unwittingly through
error. They are seen as victims -- not as perpetrators of
social evils.
Due to limited surveillance and testing,
the government greatly under-reports the true number of
HIV-positive individuals.
Consequently, too many Vietnamese youth
still believe that HIV/AIDS remains a problem of "others." Out
of a population of 75 million, 5,000 cases of HIV/AIDS could
seem minuscule to the average person.
Although higher numbers are being mentioned
on occasion in the official media, it appears that most youth
have little reason to accept that AIDS could be a danger to
their health or future livelihood. Yet it is among these youth
that Viet Nam's epidemic will have its severest impact.
There is little doubt among experts that
the actual numbers of reported cases are only, "the tip of the
iceberg," according to Roy Morey, the UN Resident Coordinator
stationedin Hanoi. Recently NAC has made a more concerted
effort to be realistic about its figures.
It currently estimates the 1996 countrywide
figure to be 22,527 cases. Yet in 1995, two different sources
suggested higher numbers. A medical specialist from the AIDS
Committee in HCMC (the epicenter of the national epidemic)
estimated that the total number was closer to 35,000 cases.
Another set of official figures placed the estimated range
between 30,000 and 60,000 for 1995-1996 -- considerably greater
than the 4,300-plus cases reported in conference speeches (see
Appendix C).
The higher numbers were based on both
surveillance data and additional information which NAC supplied
to Professor James Chin of the University of California at
Berkeley. Chin, along with his collaborator Jeffrey Dean,
produced an epimodel that analyzed numerous reports, statistics,
and trends to determine their projections.
However, Chin has cautioned that his
estimates should be considered, "on the conservative side."
The conference report included a sheet with the estimate of
120,000 cases of HIV/AIDS by 2000.
According to one international NGO
representative who accompanied the Vietnamese delegation to the
1996 International AIDS Conference, the government chose not to
release estimates that would be greater than 25,000 - 30,000.
Similar to other countries faced with limited resources,
expanding epidemics, and an inadequate surveillance network, the
official line gave the appearance of minimizing the potential
severity of the problem -- if for no better reason than to buy
time and avoid having to make difficult decisions. However,
knowledgeable AIDS professionals in Vancouver questioned the
logic.
In Hanoi, the American co-sponsor advised
his hosts, "The worldwide problem is so immense that... donors
are looking for evidence that the health care leadership of a
country has a well developed understanding of the threat posed
to its people by HIV/AIDS... it must be prepared to address the
hard questions." According to the bulk of the speeches
presented, Viet Nam is demonstrating that it is aware of the
need to make reliable projections in order to plan wisely and to
receive their share of international assistance.
What is the reality of Viet Nam's
epidemic? If 25,000 to 60,000 cases of HIV/AIDS are
approximate, then a United Nation's Development Programme (UNDP)
1994 projection that predicted 570,000 cases by 1998 would be
at the liberal end of the scale. As originally outlined in a
working paper for the UNDP and World Bank, the estimates are now
discounted by the UNAIDS/UNDP office in Hanoi as inflated
although the nation's press continues to report the number
without correction. The truth, of course, is that the precise
size of Viet Nam's invisible, spreading epidemic is not known.
Although sentinel surveillance is improving
in Viet Nam, the situation remains particularly problematic when
attempting to estimate the number of HIV-positive youth.
Because many teenagers do not see themselves being at risk, few
ever get tested. Yet without better knowledge of the true
extent of teen infection, how could prevention efforts be
effective?
Dr. Tran Hien, director of epidemiology at
Hanoi Medical College and the government's chief estimator, said
his estimates basically agree with Chin's higher numbers
(60,000). Hien personally believes that 300,000 to 350,000
Vietnamese could be expected to have contracted HIV/AIDS by the
year 2000. Without implementing more efficacious actions soon,
the actual figures could yet go higher, perhaps closer to the
high end estimate of 570,000 cases. Among the future cases
would be a large number of youth, especially many young women,
who would have been infected in their teenage years. Whichever
prediction eventually proves more accurate, there is no doubt
that Viet Nam is facing a serious threat to the health and lives
of its youngest generation.
There is a lingering perception among AIDS
observers that the bureaucracy is slow in reacting to the
developing pandemic. As early as 1993, Thailand's most famous
AIDS crusader, Dr. Meechai Viravaidya, came to Hanoi and warned,
"React early, react strong and the problem will be small. But
do like my country, reacting late and weak, and the problem is
so, so big." The Thai government's earlier reluctance to
accept outside warnings predicting a large scale AIDS epidemic
is recognized today as a major mistake. Despite recent
successes in prevention, Thailand is still paying the human,
social, and economic costs of that official myopia and societal
denial. For most Vietnamese conferees, the 1996 VNYU conference
was a positive sign that the government would not repeat their
neighbor's errors. In this light, Vietnamese and international
conferees gathered in the impressive Government Meeting Hall in
Hanoi to discuss realistic ways to confront the crisis.
Conference Agenda:
As the officially-mandated representative
of Vietnam's young people, the VNYU has the major responsibility
to speak out on issues of importance to youth. The Vice
Chairman of NAC, Le Dien Hong acknowledged this relationship
when he stated, "We hope that the Youth Union, which has
rendered great services to the nation in all revolutionary
stages, will show even stronger concern over the problem that
directly impacts the young generation and that it will continue
to make great contributions to the current drive against
AIDS." Since the inception of NAC, the mass youth organization
has been the primary conduit for the dissemination of AIDS
prevention information to millions of young Vietnamese (in lieu
of school-based AIDS instruction and a limited media campaign).
Under the direction of Vu Trong Kim, Permanent Secretary of the
VNYU (and member of the Party Central Committee), the leadership
in Hanoi endorsed the conference concept in conjunction with the
Ho Chi Minh Communist Youth Union, the nation's oldest and most
powerful organization for young people.
Another important factor behind the impetus
for the conference resulted from important discussions held at
the 8th Party Congress in June 1996. Grassroots concern was
reportedly expressed by delegates from many of the local peoples
committees, especially from impacted urban areas. Their role in
protecting workers' interests is paramount within Viet Nam's
political system. Dr. Hong reminded the VNYU conference, "The
People's Committee is fully accountable to the Government
concerning activities and outcomes of HIV/AIDS prevention and
control." The idea for an expanded nationwide meeting began with
Mr.Tran, founder of two American-based NGOs active in Viet Nam
since 1991. Concerned about the spread of AIDS in his native
land, he decided to help as he has done previously with his
group, Viet Nam Assistance for the Handicapped (VNAH). Mr. Tran
worked with representatives of various government ministries on
plans for coordinating and financing the conference. He
envisioned an NGO-supported effort that would link outside
consultants with the country's own experts on the current AIDS
situation as it directly pertained to youth. In introductory
remarks, Tran said: "We hope that it will provide a useful forum
for... bringing together the Vietnamese leadership with a
variety of international experts and funding agencies... [to]
highlight where the programmatic gaps may be made in the
implementation of such initiatives and what further funding
needs may be."
Simultaneously, the VNYU had been pushing
for greater responsibility to establish aggressive AIDS
prevention programs for youth. The union also requested
increased funding from the central government to make their
plans feasible. On both counts the mass organization was
granted more autonomy. However, due to budgetary restrictions
imposed on all sectors of the government, as well as a
recognition of the need for external expertise, the VNYU decided
that foreign support would be essential to an expanded national
effort.
Thus, in spring 1996, VNYU and HealthEd
signed an informal agreement to seek ways in which the two
organizations could cooperate. The first plan was a joint
sponsorship of a youth AIDS conference. It was agreed that the
conference agenda would be controlled primarily by policy-makers
in Hanoi. Without that measure of control, government
cooperation would have been limited.
As often happens with ambitious ideas
dealing with controversial issues (such as the public discussion
of government policies dealing with premarital sex, teen
prostitution, and illegal drug use), bureaucratic complications
had to be overcome before the conference became a reality.
Sixteen different government ministries and mass organizations,
all members of NAC, were invited to participate. The logistics
of securing their combined involvement over the summer were
monumental. Recent changes in government personnel and policies
as a result of the Party Congress further complicated the
organizers' work -- especially with leadership changes made at
the Ministry of Health and subsequently, at NAC.
Additionally, the greatest challenge was to
secure the approval of the Politburo for the VNYU to hold the
gathering. This was eventually received.
Shortly before the start of the conference,
a few foreign AIDS groups began urging that the meeting be
postponed but the co-sponsors persisted in their efforts,
convinced that the time was right. Some international
professionals were concerned that the national conference was
hastily planned by the VNYU in conjunction with an NGO with
limited experience in the AIDS prevention field. One Vietnamese
official associated with NAC later confided that the government
found it more comfortable to work with a Vietnamese-American
organization because "their understanding would be good." This
relationship appeared to be a key consideration in the
government's acceptance of the VNYU's conference co-sponsor.
Ultimately, the conference opened as
scheduled, bringing together high-ranking government officials,
Vietnamese health providers, NGO workers, and outside
specialists in one combined effort. Last minute negotiations
were needed to iron out the speakers' schedule as more
government agencies (than had been expected) wanted to
participate, a good omen. Their interest in speaking on the
topic of youth AIDS was a sign of official recognition of the
importance of the VNYU gathering. With much of the country's
media present to record the event, Viet Nam's first national
gathering on youth AIDS was convened to discuss: "The Threat of
HIV/AIDS on Vietnamese Youth: Meeting the Challenge of
Prevention."
Vietnamese Representatives:
With more than 150 Vietnamese
representatives in attendance, many sectors of the government,
party, and local health institutions actively participated in
the deliberations of the conference. Twenty-six of them made
speeches outlining major proposals designed to combat youth
AIDS. It was acknowledged that the VNYU's experience in
carrying out national goals and its country-wide network could
do the most effective job of targeting youth. In her capacity
as Deputy President of the VNYU's AIDS Prevention Fund, Ms.
Xuyen said, "Over the 65 years of operation, the Youth Union at
all levels has made great efforts in education to effectively
mobilize young people to take part in implementing
socio-political and economic programs for the country.
They have always been among the vanguard in
all difficult and hot areas of the country." In fact, many of
Viet Nam's current leaders began their social and political
activism as members of local youth unions, another important
consideration behind the government's support of a VNYU-sponsored
conference. The organization's network stretches throughout all
provinces of the country, including every rural commune and
city ward. In this regard, Viet Nam is most fortunate to have a
ready structure of committed social activists to fight AIDS -- a
major reason for hope in curbing the country's growing youth
epidemic.
Among the key people at the conference were
the six moderators: Ms. Xuyen; Vu Trong Kim, Permanent Secretary
of the Youth Union Central Committee; Do Nguyen Phuong, Minister
of Health and a Vice Chairman of NAC; professor Le Dien Hong,
also a NAC Vice Chairman; Duong Xuan Nam, an executive committee
member of the Youth Union Central Committee; Tran Dac Loi,
acting Director of the Youth Union's Center for International
Development; and the newly-appointed Standing Vice Chairman of
NAC, Dr. Chung A. A list of the Vietnamese speakers and many of
the official ministry representatives are attached to this
document (see Appendix D).
Expatriate Representatives:
Accompanying Tran were three board members
of his organizations (HealthEd and VNAH): Shep Lowman, retired
American diplomat, as well as Thang Do and Dr. Do Tuan Duc,
advisors. Also on HealthEd's team were Dr. Duong Nguyen,
associated with John Hopkins and a Colonel in the U.S. Army
specializing in tropical medicines and Dr. Richard Moore, Vice
President of John Snow, Inc.
(JSI), a major funder of the conference.
Dr. Moore was accompanied by Jenny Dahlstein from JSI's Boston
headquarters.
Joining the group was Dr. John Chittick, an
educational specialist who has lectured on youth AIDS at Harvard
University and who had recently completed a comprehensive book
on the HIV/AIDS situation in Viet Nam. Paul White, senior
representative of the U.S.
Agency for International Development (USAID)
at the American Embassy in Tokyo, came to lend his official
support to the efforts.
White predicted that USAID would be more
involved in helping Viet Nam in the future as official relations
continue to improve between the two countries. Attorney Julie
Hamblin, a legal consultant to UNDP with experience in human
rights issues, also joined the team from Sydney.
Roy Morey, the UN's Resident Coordinator in
Hanoi and UNDP representative (one of the six combined UNAIDS
agencies ) delivered a speech that emphasized the global threat
of youth AIDS.
Steve Kraus, the UNAIDS Country Program
Officer, and Jamie Uhrig, UNAIDS/UNDP advisor, also spoke. In
addition, United States Charge d'Affaires Desaix Anderson
(acting Ambassador) gave a welcoming address which acknowledged
the experience of American agencies in AIDS prevention work and
their willingness to assist Viet Nam in its present efforts.
Two other representatives from the embassy, Yvonne Eaton and Ted
Osius also participated.
A number of international NGOs doing work
in HIV/AIDS prevention were also in attendance. James Kurtz,
Country Director for Population and Development International -
Thailand (PDI) was selected to give an address on behalf of the
more than 30 foreign NGOs doing AIDS work in Viet Nam --
including representatives from: Save the Children Fund/UK; CARE
International - Australia; World Vision International; DKT
International; Medicins Sans Frontieres - Belgium; Deutsche
Gesellschaft fur Technische Zusammenarbeit (GTZ); Swedish
International Development Agency (SIDA); Australian Red Cross,
Path Canada, The Population Council, Oxfam - Hong Kong, Cebemo -
Netherlands, Medicins de Monde, and World
Environment and Peace (WEP) among others. It should be noted
that these outside funders have played an increasingly effective
role over the years despite bureaucratic regulations that
restrict some important NGO initiatives.
By most expatriate accounts, however, the
situation is improving as Viet Nam increases its AIDS prevention
efforts and loosens restrictions.
Main Conference Speeches:
The conference opened with an ambitious
agenda for the 200 conferees in attendance. Assisting the
delegates and coordinating official operations were scores of
VNYU volunteers, staff from various ministries, and government
interpreters. The official language was Vietnamese with
simultaneous English translation via headphones.
At first, there was concern among some
international conferees that their hosts would not be
predisposed to an open and possibly controversial discussion of
official policies and cultural taboos. Foreign delegates
specifically wondered how the Vietnamese would react to outside
criticism of the "social evils" component of their AIDS campaign
with its punitive focus on high risk groups. Without an open
debate, many people in the hall wondered if the national
prevention message could be made more inclusive to target all
Vietnamese youth.
By exclusively concentrating attention on
the actions of individuals engaged in social evils, the
authorities have assumed that teenagers would be scared into
being safe. But in surveys and interviews, many young people
said that they do not accept the harsh warnings as being
relevant to themselves or their friends.
By most measures, Viet Nam remains a
conservative culture where people who break custom or law are
often seen as socially undesirable. Individuals who engage in
illegal drug activities are routinely rounded up by the police
and imprisoned in treatment centers (similar to the previously
mentioned camp for CSWs). According to the Vice Director of the
Binh Trieu Drug Treatment Center, approximately 70 percent of
the current inmates are HIV-positive. Of that figure, 80
percent are young men. With more than half of all reported
cases of HIV in the country, the camp serves as the nucleus of
the spreading epidemic.
A recently announced directive requires the
isolation of ill people living with HIV/AIDS (PWAs ) at the
treatment center. Those who show signs of opportunistic
infections are segregated into a special ward where basic
medical care is available. Present regulations also mandate HIV
testing for all interned IDUs. However, prisoners are not
notified of their test results by camp personnel. Thus many
seropositive young men return home to family and friends upon
their release -- without adequate warning of how to protect
themselves or their partners. It is not clear how this
nondisclosure policy benefits AIDS prevention efforts since it
is the unsuspecting partners who then become highly susceptible
to contracting HIV. But for many young Vietnamese who come in
intimate contact with former inmates (and contaminated bodily
fluids are exchanged), there could be little denying that these
youth would be negatively impacted.
In addition to the complicated issue of
social evils, there was concern that the Vietnamese delegates
would prefer to avoid controversial reports of increasing
adolescent sexual experimentation, particularly as it might be
influenced by the government's "Market-Leninist” reform policy
-- better known as doi moi. In private conversations, it was
evident that Viet Nam has been undergoing radical economic
changes which impact heavily on the social and sexual mores of
youth. Vu Trong Thieu of the Ministry of Culture and
Information's AIDS Prevention Committee stated, "It is necessary
to let young people understand the side-effects of a
market-oriented mechanism on all people in the society,
especially young people." A number of the conference speakers
expressed the conviction that the adoption of destructive social
habits and loose personal morals are the main cause of HIV/AIDS
in Viet Nam. In the words of Mrs. Than, "At present, young
people are influenced by modern lifestyles and decadent culture
and films. Young people are converging on urban areas to find
jobs but since they rarely are able [to] find jobs with
sufficient income they easily fall prey into high-risk groups.
At the same time, young people have the least access to HIV/AIDS
information." However, any initial apprehension that the
conference would sidestep these sensitive issues dissipated
quickly as many speakers spoke about the reality of the
country's epidemic. VNYU Permanent Secretary Kim repeated a
powerful analogy to make his point: "If effective preventive
measures are not taken in time, its consequences will lead to a
destruction no less atrocious than that of war." Having set a
somber tone to the conference theme, other speakers talked about
400 people living with AIDS, more than 200 deaths, and
estimates of at least 4,340 reported cases of HIV in 41 of the
country's 53 provinces. From each official speaker could be
heard a sense of alarm and urgency that had not been noticeable
to this observer a year earlier.
In Viet Nam as elsewhere, there has been a
predilection to blame the introduction of AIDS on outsiders.
Professor Hong spoke about the problems caused by migration due
to economic considerations: "[Movement] provides opportunity for
HIV/AIDS to infiltrate into Vietnam which is strongly spreading
in neighbouring Thailand and Cambodia." In the past, this
"foreign" argument regarding the introduction of HIV/AIDS was
used to absolve government planners of responsibility for not
taking controversial or expensive corrective measures. But
lately this rationalization carries less weight as greater
attention is being paid to the seriousness of Viet
Nam's own internal crisis and its
relationship to its neighbors. Today, fewer Vietnamese are apt
to discount reports of the Thai epidemic as being alien to their
own future. The news is especially encouraging among younger
people. A 1995 survey of 334 HCMC young people found that only
15.9 percent of those questioned answered "yes" to the
rhetorical statement: "AIDS is not a Vietnamese problem -- it is
a foreigner's problem" (while 73.9 percent answered "no.")
Certainly, prejudice still exists but denial is less pervasive.
However, there is growing concern about the
number of youth migrating in search of employment, whether
between countries of the Mekong River region or from rural areas
to the cities. One speaker put it succinctly: "Every year, more
than 1,000,000 young people enter the workforce. Apart from
employment provided by the State and their families, a section
has to go and find jobs away from home. Ninety percent of rural
[to] urban labour migrants are young people who pose a threat to
the increasing number of sex workers and intravenous drug users
of whom young people account for 75-85%." Further
exacerbating the situation are the thousands of young people
crowding into the main urban areas where HIV is already
present. One NAC official said, "Young people from the
countryside flow to major cities to seek jobs, and many do not
intend to return to their native villages.
Many of them are non-skilled people, with
low education and unstable jobs and easily susceptible to bad
practices such as drug abuse, prostitution, robbery, gambling
and violence." Most conference speakers were candid when
speaking about the culturally difficult topic of youth
sexuality. Mrs. Thuong admitted, "Pre-marital sexual traditions
are unacceptable by the ethical traditions of Vietnam, but [are]
an undeniable fact." Collaborating with the University of
Economics, Mrs. Thuong conducted a survey of 300 students in
HCMC that found 34 percent of respondents thought premarital sex
was "acceptable." Although not considered high by most global
standards, the statistic drew audible murmurs from the largely
Vietnamese audience. The conferees appeared to be more
comfortable with NAC survey results that suggested only, "10.3%
of men and 1.4% of women have sexual intercourse before their
marriage." The author's 1995 youth survey found that 57.5
percent of respondents said they did not plan to have sex before
marriage (while only 14.7 percent replied in the affirmative).
During a conference break, a delegate from the central highlands
worried about the declining moral standards of city youth
spreading to his province. He said, "Our children should not
know about those problems." In the past, teens did not need to
know much about the consequences of sexual experimentation
except for unplanned pregnancies. But Vietnamese youth,
especially in rural areas where formal health and sex
instruction is not prevalent, are at a major disadvantage if the
problem of HIV/AIDS is not discussed.
Sex education has been limited because of
Viet Nam's traditional bias against the public mention of
anything sexual (HCMC schools were the first to introduce a
truly comprehensive AIDS and sex curriculum in fall 1995 ). In
many other school districts and locales, the subject is rarely
discussed. Although this situation may seem similar to other
countries, in Viet Nam much of the opposition to "sex ed" comes
from administrators and teachers of whom many are reportedly too
embarrassed to discuss intimate sexual matters with youth. Ms.
Xuyen noted the problem and said, "Education on healthy and safe
sex for youth has not been included." Also confronting the
cultural dilemma head on, Mrs. Than recommended, "Sex education
is one of the subjects to be introduced into school curricula.
It will contribute to HIV/AIDS prevention among youth....The
Youth Union should formulate suitable sex education programmes
to popularize sex knowledge to different groups of young
people." Learning more about sex appears to be a popular
concept with young people as well.
In the 1995 survey, 82.1 percent of youth
answered "yes" to the question: "Should AIDS education include
information about ways in which people can have safer sex?"
Arguments for teaching reality-based sex education were repeated
by various speakers. This push for school-based instruction
appeared to be coordinated. One NGO representative commented,
"if so, it [sex ed] must now have official backing" of the top
leadership. The VNYU conference was selected as the most
appropriate vehicle for promoting the message to a skeptical
public.
Professor Phuong stressed the epidemic's
diffusion "among ordinary people who have direct or indirect
relations with the high risk groups." It became evident as the
conference proceeded that the national prevention message would
no longer be based solely on "who you are" (groups) but rather,
on "what you do" (behaviors). The significance of this shift
away from the traditional focus and towards a more
health-oriented approach was not lost on the conferees. The
change also suggested the possibility that punitive policing
actions would be relegated to less prominent roles in future
AIDS campaigns -- especially after the public spectacle of
organized street burnings of "anti-social" music tapes, CDs, and
other materials suspected of endangering public morals
(preceding the 8th Party Congress in early 1996). However, few
observers discount the power and influence of conservative
elements in the government to resist progressive changes even if
the actions were known to be beneficial to stop-AIDS
initiatives.
Professor Phuong's point of greater
inclusivity is crucial to a more effective prevention campaign.
By making the AIDS prevention message more youth-oriented,
teenagers should be able to recognize more clearly their
vulnerability to HIV/AIDS. Once it is understood that HIV is
transmitted by behaviors, not group identity, teenagers could
better make the connection that promiscuous, unprotected sex is
unwise for anyone. As the UNDP's Kraus put it: "It is at that
level that infection is transmitted, and at that level that
prevention takes place." Xuyen stated, "the number of youth
having safe sex is very low in urban areas -- 41% of men and 21%
of women (data of the National AIDS Committee in 1996). The
figures are much lower in rural areas. Pre-marital sex is
increasing." Other research suggests that abortions
(sanctioned as a population control tool) are on the rise. It
was reported that HIV infection among women, especially younger
females, is spreading rapidly. While the number of HIV-positive
women in Viet Nam appears to be relatively small (approximately
15 percent of the total presently), the anticipated cases of
seropositive women are expected to reach parity with men within
the next decade. Much of this trend is attributed to the
succeeding stages of Viet Nam's epidemic which first infected
IDUs (mostly men), followed by CSWs (mostly women), and now into
the general public.
Dr. Phuong made two key recommendations,
one for the foreign delegates and one for his fellow
Vietnamese. First, international funding agencies should "step
up their cooperation and assistance" to the VNYU -- an official
signal to NGOs and multilateral organizations that the
government would like the Youth Union to be the vehicle for the
nation's new emphasis on teenAIDS prevention. Second, Phuong
stated that Vietnamese families of PWAs as well as local
communities and youth especially, must accept more
responsibility caring for ill PWAs. His admonition was a
comment on the traditional importance of familial loyalty in
Vietnamese culture. It also acted to reassure people that they
should not fear the casual transmission of HIV/AIDS.
Yet when a top NAC official promised
medical help for PWAs, the clear perception was that care would
be minimal out of economic necessity.
Vice Chair Hong said, "The AIDS committee
will focus on... providing counseling for HIV carriers and AIDS
victims in the community as well as concentration camps"
(although a poor choice of translation, the connotation,
nevertheless, remains one of very limited medical assistance).
One of the most interesting speakers proved
to be Dr. Chung A who referred to the prepared remarks only in
passing, preferring to speak about why he recently chose to
accept the government's highest AIDS prevention position:
Standing Vice Chair of NAC. A research scientist and medical
doctor by training, he spoke of moving NAC towards more
progressive action -- including the implementation of better
behavioral intervention strategies based on methodological and
scientific research designs. Dr. A emphasized his commitment to
improving training programs for peer educators. He stated that
NAC would closely scrutinize prevention materials to ensure that
the information is medically-accurate, youth-relevant, and
socially responsible. Speaking directly to an audience mainly
comprised of government employees, Dr. A stressed the view that
each sector should institute their own AIDS programs. He
strongly endorsed local capacity building by granting greater
autonomy. This view was seconded by Hong, another Vice Chairman
who said NAC was committed to, "Building an anti-AIDS network at
all rural communes and villages and urban wards." To
reiterate, socialist Viet Nam is fortunate to have the
pre-existing structure in place for implementing better AIDS
prevention efforts at the grassroots level.
Dr. A made it clear there was a strong
medical necessity to include safer sex instruction as part of
the abstinence message preferred by Vietnamese adults. A number
of international observers suggested that his appointment was a
positive sign that the national leadership wanted the best
technical expertise in the government's primary AIDS prevention
slot. They also hoped that Dr. A would prove to be a
convincing, hands-on agent of change. His leadership is coming
at an opportune time as Hanoi has publicly acknowledged the
potential severity of a growing epidemic. Importantly, Viet Nam
also appears to be willing to allocate greater resources to
youth prevention efforts (funding for NAC has increased from VND
300 million in 1992 to VND 5 billion in 1996 ) -- at a time when
it is most needed.
Other speakers brought up the question of
the socio-economic cost of HIV/AIDS to the nation. Dr. Khiem
reported that VND 50 billion (approximately US $4.5 million) has
been spent to date in 1996 (having received approximately US
$10,000,000 from outside donors in the last three years ).
Khiem warned, "When a person is infected by HIV/AIDS, he or she
is not only addicted [sic] in terms of health and financially,
but also leaves great and unpredictable consequences to
society....An AIDS patient who dies at the age of 25 - 30 causes
society to lose about 20 - 30 working years from that
individual." Currently, the government allocates approximately
four percent of Vietnam's national budget to health care (down
from previous years before market reforms were widely
instituted). Annual budget estimates for HIV/AIDS, however,
have been constantly rising -- what is now $US 5 million
annually could be $US 8 - 10 million in the next decade. If
Thailand's experience could be applicable, then Viet Nam would
be burdened by greater AIDS expenses after 2000. For a
developing nation in the highly competitive Asian-Pacific
region, the scenario could spell economic disaster.
Current estimates of the average daily cost
of providing for a PWA is between VND 200,000 to 300,000 (about
US $18 to $27). This figure represents a minimal standard of
AIDS care. As one of the world's poorest countries where the
average annual income is approximately US $220, Viet Nam's
leadership understands it is presently unequipped to deal with
the consequences of a massive public health catastrophe. Recent
international developments in HIV/AIDS therapies are not
expected to directly benefit Vietnamese patients because the
cost for the medicine remains prohibitively high. As with many
developing nations, Viet Nam could be forced to watch many of
their young people die prematurely while richer countries would
see their PWAs live longer and more productive lives. While the
shift to an expanded market economy promises rewards for the
average Vietnamese, the changes are also exacerbating the AIDS
situation among all sectors of the populace -- with sexually
active and unprotected youth paying the heaviest price.
Despite the dire forecasts, Professor
Thuong conceded, "In Vietnam, there has not been any fundamental
study on the socio-economic influence of AIDS." Clearly, it is
more difficult to plan for an emergency if the ramifications of
a coming crisis like AIDS are not fully known. When the World
Bank and UNDP collaborated on its preliminary report in
1993-1994, their estimates of 570,000 seropositive cases by
1998 were thought to be exaggerated. Thus, their original
economic projections were suspect too (although it is possible
that their analysis could still prove accurate). What is needed
now is a new study of the expected impact of a youth-driven
epidemic based on Chin's and Hien's research and revised
epimodels. A new study would take time, expertise, and of
course, money. Presumably, Hanoi chose to highlight this
problem at the VNYU conference in the hope that international
organizations would be encouraged to underwrite the costs --
primarily because the main focus would be on youth AIDS, of
obvious empathetic concern globally.
On the whole, conference speakers were open
to the discussion of the shortcomings of earlier
government-sponsored, anti-AIDS efforts.
The effectiveness of IEC (information,
education, and communication) was broached and the criticism was
direct. In speeches throughout the first day, most speakers
concurred that the country could no longer treat the growing
threat of HIV/AIDS as routine. Xuyen admitted, "Achievements
of the Youth Union in the past five years are... far from
meeting young people's demand for communication and education on
HIV/AIDS prevention." However, more criticism was directed at
the intersectoral problems between competing ministries -- a
factor that hinders program coordination and often, is endemic
to bureaucracies protecting their own fiefdoms. Yet HIV/AIDS
appears to be finally making its presence felt after years of
spreading silently and generally unnoticed by the public.
Khiem stressed the importance of a targeted
prevention message for all young people, "The Youth Union should
broaden its scope. It is not enough to only educate its members
at schools and army units. What is more difficult is the
education of street youth, rural youth... as well as unemployed
youth and drug addicts." Focusing greater attention on rural
youth was a popular theme throughout the conference. Mrs. Than
urged, "Youth organizations in rural areas need to develop
programmes to help young rural people avoid falling into the
traps of urban social skills." There was a real sense of
empathy for youth in the countryside. Many boys and girls must
leave school at early ages to work in the rice paddies to
support their families. Even if their parents could spare them,
attending public school in Viet Nam costs money now, another
factor in the high number of out-of-school teenagers. Hence,
many young people miss out on the HIV/AIDS prevention message
due to an interrupted education.
In response to a lack of individual and
societal responsibility for AIDS prevention, the Anti-AIDS Fund
Steering Committee (FAPA) of the Youth Union Central Committee
was founded in 1995. Duong Xuan Nam, President, said the
purpose was to have youth volunteers assist PWAs and promote
knowledge and awareness in the community to alleviate needless
fears. Despite stated goals preaching nondiscrimination, the
stigma against anyone or thing related to HIV/AIDS remains
strong in adult society. The problem is so great, Professor
Thuong noted, "HIV/AIDS carriers are deserted by their own
family members," placing additional pressures on the local
peoples committees with already limited means of support. A
Western-style welfare state does not exist in Viet Nam with its
safety nets for the poor or sick. Yet Professor Dong referred
to a survey that found, "A large proportion of people (72.2%)
have non-discriminatory attitude towards people living with
HIV/AIDS." While the findings were an encouraging sign of
evolving sentiment, some international observers mentioned that
altering public prejudices against PWAs is an ambitious goal by
any society's standards.
Another problem in disseminating the AIDS
prevention message to youth is the lack of access to a
consistent message through the mass media (there are few
televisions or radios in poor homes or worksites in rural
areas). Vu Trong Thieu, a representative of the Ministry of
Culture and Information's AIDS Prevention Committee noted, "Most
newspapers, radio and TV programs have recently mentioned AIDS
prevention but have rarely determined youth to be the major
target group of communication campaigns." Thieu's point: if
the public does not recognize that the younger generation is
vulnerable, then the threat remains hidden. Instead of urging
children to take specific precautions and avoid obvious dangers,
many parents have been lulled into a false sense of security by
a complacent media, leaving Viet Nam's youth at greater risk.
However, speakers also praised the VNYU's newspapers for being
aggressive in their reporting of teen AIDS.
One consensus among conferees was that the
youth prevention campaign should increase its focus, "on the
poor, high risk groups who do not have the opportunity to be
reached by general information: non-state workers; porters;
construction workers; street youngsters; and poorly-educated
women who work in hotels, restaurants, private sectors." Peer
teaching (training young people to be AIDS prevention teachers
in service to other youth) was strongly endorsed as the best way
to reach out to a most vulnerable population which lacks
critical information. One speaker said, "Peer education is
needed....They [youth] like to pour out their hearts, to hear
love affairs, sexuality and safe behavior from their peers more
than [from] adults or their parents.
They also prefer to receive information and
skills on anti-AIDS from their peer educators....If one changes
his/her behavior, it will affect the other." The VNYU has
already successfully promoted peer teaching (including for AIDS
prevention) under the guideline: "Youth talks to youth. Youth
provides guidance to youth and peer education." When students in
the previously mentioned University of Economics survey were
asked what they thought of peer education, the study found, "It
is noteworthy that 69.7% of them said they were ready to act as
motivators on HIV/AIDS prevention when invited." In another
youth survey, 86.8 percent of the respondents answered
affirmatively when asked: "Do you believe you have a
responsibility to warn your best friends about the dangers of
AIDS?" Already a number of NGOs in Viet Nam have sponsored
peer programs as have private consultants working outside the
establishment. The author has conducted "PeerCorps" training in
HCMC and found that youth can be effective teachers of the AIDS
message by learning interactive techniques that emphasize
one-on-one communication, medical facts, and non-judgmental peer
support. The peer education proposal resonated well among the
Vietnamese conferees because of the valuable contributions youth
cadres have made in past struggles of national survival.
On the politically-sensitive matter of
social activism, concern was expressed about the independent
agendas of NGO workers and peer educators. Because public
meetings cannot be held in Viet Nam without prior permission,
AIDS advocacy has occasionally resulted in police interrogation
and detention of volunteers. Some authorities believe that
street outreach undermines official efforts aimed at eradicating
social evils. By distributing free condoms to CSWs, the
reasoning goes, commercial sex is encouraged; exchanging
contaminated syringes for clean needles enables IDUs to continue
their habits; and promoting safer sex techniques to teenagers
increases experimentation and risk. Therefore, it was noteworthy
when Master Yen recommended, "These social activists may conduct
their activities on the streets or locations where out-of-school
youth regularly gather." The delegates heard about the
introduction of the first condom cafe ("Thanh Nien") located in
the Youth Culture House in HCMC.
Originally conceived by a young Canadian
woman who was doing volunteer work with street children, the
idea was supported by Mr.
Luan, Vice Director of the Culture House.
Following negotiations on the details of the
culturally-sensitive proposal, the operation was approved by
Dr. Le Truong Giang of the HCMC AIDS Committee and funded by two
NGOs, Cebemo and Medicins de Monde. The cafe finally opened to
youth in March 1996 although distribution of condoms was delayed
until July. Now unmarried young people can go to the resource
center for safer sex counseling and to the cafe for refreshments
and free condoms. According to the manager, Bui Chi Cuong, "At
the beginning, young people hesitated to go into the Cafe.
However, now it seems normal to have a condom on the table and
to talk about it in public." In addition, the conference was
told about the success of the "Evergreen Shop" in Hanoi where
gifts and everyday commodities are sold along with condoms, some
of which are available at no cost. At first glance, these
ventures might not seem extraordinary to foreign observers.
However, even in countries which have lived with HIV/AIDS since
the early 1980s, specialty outlets (whose primary mission is to
promote the sale or dissemination of condoms for HIV and STD
prevention, not family planning) are relatively new and rarely
sponsored by public entities. While some nations might provide
community health clinics that service the safer sex needs of
adolescents, the officially sanctioned distribution of condoms
to unmarried teens still remains a highly controversial practice
in most societies. Indeed, in many places it is illegal. Yet
on this subject, the leadership in Hanoi has chosen to
prioritize medical necessity over cultural sensibilities. Their
approach could be expected to help further AIDS prevention goals
among youth.
Until recently, the government had promoted
condoms solely as a family planning tool for couples to meet the
national goal of not more than two children per family. Now
public billboards are prominently displayed along major
thoroughfares urging all people, including youth, to use "bao
cao su" for the prevention of HIV and STDs. Occasionally,
condoms can be found for sale at the sidewalk stands of HCMC
street vendors, along with cigarettes and lottery tickets --
although a NAC-sponsored survey of 4,200 young people found,
"21.1% of men and 24.3% of women still do not know where to buy
condoms." When asked, many youth reported that they found it
embarrassing to buy condoms from neighborhood pharmacies where
they are known. Consequently, youth-oriented sales venues like
the condom cafe and Evergreen shop should prove popular if
located in more areas.
Proposals for both concepts had initially
met with opposition from the local peoples committees and the
police. But in the conference hall where "Trust" and "OK" brand
condoms were available (donated by DKT, the social marketing
NGO), young, unmarried delegates and conference workers were
taking the free samples. However, accepting condom usage in
theory may be different from actually using them in practice.
As Binh reported, "The percentage of women from 15 to 49 years
who accept contraceptives is 64.97%... the percentage of people
who use condoms -- an effective method for HIV/AIDS prevention,
only accounts for 4.03%." To be effective, condoms must be
made attractive to consumers since pleas by social planners
often fall on deaf ears.
The VNYU was credited with "changing the
image of condoms and raising the number of condoms used from 40
million in 1991 to 97 million in 1995." According to Mr. Binh,
"In 1996, 53 provinces and cities throughout the country
received an amount of more than 7.1 billion dong worth of
condoms....The supply and use of condoms are aimed at young
people, and young couples." For a society with a longstanding
history of discouraging premarital sex, the present emphasis on
protecting unmarried youth is the result of greater fear of
teenAIDS than unwanted pregnancies. Aware of the cultural
conundrum, Binh added, "However, how to control and supervise
this work is still a thorny question." Most sexually active
Vietnamese youth report they do not use condoms regularly (and
for many, not at all).
It should be noted that not all condoms are
made of high quality latex rubber and consequently, a number are
defective and break. Their efficacy is diminished further if
the user does not know the proper way to use or store them. OK
and Trust condom packages include a visual diagram of how it
should be worn on the penis (Appendix F). Based on
international studies conservatively suggesting that 200-to-300
cases of HIV transmissions are prevented for every one million
condoms used, thousands of young people are saved from HIV
infection each year in Vietnam.
While more than one speaker mentioned the
complicated cultural problems posed by issues of sex and drugs,
a number of progressive ideas were put forth by Vietnamese
representatives speaking in their official capacities.
According to Mrs. Nguyen Thi Hang, Vice Minister of Labour, War
Invalids and Social Affairs (MOLISA), "we should attach
importance to social solutions in addition to technical
solutions... such as mobilization of condom use; safe needle and
syringe use; and blood screening." Progress has been made to
ensure safer supplies of blood but it is known that many people
who sell their blood also engage in high risk behaviors.
If the issues raised in the speeches are an
indication of official thinking, then a policy of exchanging
IDUs' contaminated needles for clean ones is under
consideration. Mrs. Than urged, "We must also take urgent
measures to help drug addicts use safe needles and syringes."
One speaker suggested that the United States should be a role
model because of its "policy" promoting free needle exchange
among IDUs. Obviously, incorrect information had been given to
the speaker about a specific American locale or else the issue
had been confused with the medically-regulated use of sterilized
syringes in U.S. health care institutions. But it was further
evidence that the topic of clean needles for IDUs was on the
government's agenda.
On another key issue, a cultural difference
was apparent. The Vietnamese strongly favored the use of
mandatory blood testing as the most logical means of identifying
HIV-positive individuals in the interest of public safety.
Kraus argued against mandatory testing, saying, "People don't
like to be placed in a box...Would you want to be put in a
box?" He emphasized the experience of Western countries which
have found that thepolicy, "drives underground those at highest
risk." Yet a member of NAC said all Vietnamese favor the
practice because it allows the government to keep PWAs under
surveillance.
The concept of human rights for people
living with HIV/AIDS is different in every society.
On the whole, the speakers put many
important recommendations on the table for discussion. What was
important about the suggestions was that the VNYU conference
proved willing, indeed eager, to confront cultural issues raised
by youth vulnerability -- in ways other nations still find
troublesome to address. Yet Mr. Binh was realistic when he
stated the government's quandary, "This also leads us to
question how we can control, and assist the young labour force
in their sexual behaviour. We have to look it straight in the
face and not evade it." Throughout the proceedings,
international observers were supportive and complimentary about
the conference's willingness to tackle tough questions. By the
end of the first day's session, it was evident that many
Vietnamese conferees were more convinced than before that only
radical and immediate changes could save youth from the
quickly-spreading epidemic.
Conference Deliberations (Break-Out
Sessions):
A scheduling change was made on the morning
of the second day by the VNYU and HealthEd. Conversation during
the first day's breaks and the previous night's dinner had been
so animated that the organizers devoted the entire morning to
four separate meetings moderated by Vietnamese facilitators.
International conferees chose the break-out session they wanted
to attend while the VNYU organizers selected one for each
delegate based on their area of responsibility and expertise.
Approximately 20 to 40 people were involved
in the smaller groups. Designed so that individual
participation would be maximized, the sessions provided everyone
an opportunity to present their ideas for a better AIDS
prevention campaign for youth. Following a brief introduction
to the proposition under discussion, cultural differences were
soon apparent in the way conferees presented their opinions.
Vietnamese delegates preferred making short
speeches when addressing their specific concerns while foreign
expatriates favored debating the issues. With the help of the
trained moderators, both sides adapted quickly to each other's
style. The result was a spirited discussion of ideas and a list
of key recommendations (Appendix E).
At the conclusion of the break-out
sessions, the conferees returned to the main hall to hear
summations by the four raporteurs.
Very specific proposals were raised:
sending trained peer corps into the countryside and onto the
streets; putting a greater emphasis on safer sex instruction and
condom use; mandating comprehensive sex education in the schools
(as well as continuing to encourage premarital abstinence and
"loyal love," the preferred euphemism for monogamous relations);
and promoting greater AIDS awareness in the mass media. It was
recognized that Vietnamese youth are tempted by the new
lifestyles and need more guidance from the state (via the VNYU).
Each session discussed the consequences for society when young
people contract HIV and succumb to AIDS-related opportunistic
infections at early ages.
In addition to these reports, the final
afternoon's wrap-up meeting also heard from a few remaining
speakers.
Conclusion:
The two-day conference on AIDS was unique.
As the first government-sponsored forum to specifically target
youth, the meeting investigated novel ways in which the HIV/AIDS
prevention campaign could be strengthened. The collective
impressions of the conferees appeared overwhelmingly positive
although their mood was somber.
For many, it was the first opportunity to
hear a variety of opinions on a topic that had received little
public attention. For the international participants, the
openness with which the government spokesmen criticized existing
program shortcomings in order to improve them was encouraging.
As the conference ended, there seemed to be a greater sense of
self-empowerment and national pride because the conclusions
reached were Vietnamese-generated. If this spirit and
commitment are acted upon posthaste, then 1997 could prove to be
the pivotal year -- with implications of the highest import for
Viet Nam's youth.
The leadership in Hanoi has traditionally
promulgated a series of proclamations in the belief that the
power of central authority could mandate social problems out of
existence. In the past, many national crises have been dealt
with effectively in this manner. But AIDS has proven to be a
formidable challenge due in large measure to HIV's invisible
nature and the public denial surrounding its possible
transmission among young people. Often, the official position
has been appeals to an individual's sense of civic
responsibility or national pride. It was assumed that
information couched in these terms would suffice as HIV/AIDS
prevention in lieu of more controversial, science-based
approaches that directly confronted longstanding cultural
precepts. Although intentions have been good, results have not
been -- as evidenced by the recent reports of the rapidly
expanding epidemic.
The problem is especially obvious when
looking at the figures for HIV/AIDS cases by age of infection.
Evidence clearly points to HIV infecting ever younger segments
of the population. Within the near future, a majority of all
new infections will be among teens and those in their twenties.
The trend will accelerate as outside influences affect
lifestyles. The tourist trade in Viet Nam is considered
essential to prospects for a healthy economy -- although because
of the world pandemic, it might not prove healthy for its young
people. As Hanoi continues to open its borders in the coming
decade, "beside [the] positive aspects, development of tourism
will also pose negative aspects in security, social order such
as prostitution, diseases, environmental pollution and
particularly the HIV/AIDS epidemic." Today Viet Nam recognizes
Thailand's previous successes and mistakes when Thai military
rulers first began pushing for increased tourism and overseas
investment in the years immediately prior to the emergence of
their AIDS epidemic in 1984. However, one major difference
exists between the two: Thailand could say it was not aware of
the threat in the beginning.
The majority of conference speakers made
clear that a more sophisticated approach is requisite to combat
teenAIDS. By acknowledging that Viet Nam's earliest plan (1990
- 1993) had focused too narrowly on increasing AIDS awareness
among youth, NAC's next national push (1994 to present) was
designed to put greater emphasis on changing personal behaviors,
a more ambitious and difficult task. The National Assembly
passed and President Le Duc Anh signed "Article 1" which
succinctly states: "HIV/AIDS prevention is the responsibility of
every individual, every family and of the entire society."
The proclamation is seen by observers as a significant benchmark
in official thinking.
However, moral admonitions and legal
dictums against premarital, promiscuous, and unprotected sex
have not proven convincing to many young Vietnamese. Despite
the failure, a large number of the delegates expressed the
desire to continue to promote a Vietnamese-specific,
morality-based argument -- with a punitive component. Professor
Hong argued, "Inter-sectoral IEC programs on HIV/AIDS prevention
and control must be... integrated with other existing social
programs... [such as] social evil control." Yet at a break-out
session, one participant was more concerned that, "Youth must be
given the ability to say 'no' when necessary." In Viet Nam
there is a compelling need to find adult consensus on AIDS
education aimed at youth. Integrating traditional cultural
values with medically-sound information is imperative if
HIV/AIDS prevention efforts are to be acceptable and have a
reasonable chance of succeeding. Support from parents and the
community is a motivating factor in encouraging youth to make
wise choices regarding lifestyles and intimate behaviors.
Herein lies the dilemma for Viet Nam's AIDS
prevention campaign. On one hand, there is public anger towards
people who flaunt society's rules; thus, penalties are assessed
for engaging in social evils. On the other hand, cultural
shibboleths inhibit the open discussion of safer practices that
could save lives. Instead of helpful advice, too often there is
blame. As a result, the entire nation suffers when anti-AIDS
campaigns fail to do their job. Yet for many Vietnamese,
promoting public morality and family values is integral to
maintaining a strong sense of community. Conference speakers
raised the question whether social evils are being used
primarily to punish unpopular, high risk groups rather than to
prevent high risk behaviors.
Despite the many positive messages
emanating from the conference, it is unlikely that the public
would quickly discard its traditional biases and social fears --
unless it becomes overwhelmingly apparent that HIV/AIDS does not
discriminate and adults see the toll it takes on their
children. In short, the message needs to be: everyone is
potentially vulnerable but only a segment of the population is
at highest risk due to personal choices that they make.
Until recently, Vietnamese PWAs were
essentially hidden from public view. The official reasoning
behind the blackout was the expressed need to protect PWAs'
identities from discrimination and prejudice. As previously
mentioned, human rights issues have not been a significant
factor in Viet Nam's AIDS prevention agenda (it remains a
controversial political issue). So it was noteworthy that the
conference heard from its only HIV-positive speaker, Do Kim Son,
who was described as a, "drug-addict-turned HIV patient [who]
wants to become useful to society." For many of the Vietnamese
conferees, his speech was both electrifying and eye-opening.
Blaming his heroin addiction on contact with "American GIs" at
Long Binh American military base when he was just 16, Son
admitted to continuing to inject drugs after the fall of South
Vietnam in 1975. Making periodic and unsuccessful attempts to
quit, he discovered his seropositive status in 1995. He went
through a suicidal period before he "rallied friends of the same
fate into the 'Peer Group' to share their sorrow, joy, [and]
difficulties in life." Once treated like a pariah by his family
and community, Son has the opportunity now to lead by example.
His advice to youth: "Please lead a healthy life, care for your
health, and stay away from social vices. Do not let yourself be
infected by HIV like us." Even if his message fails to
dissuade all listeners, his personal story is a powerful tool to
convince youth of the reality of HIV/AIDS. The national media
has publicized his story and the public appears to be intensely
interested in hearing more about Son and other Vietnamese PWAs
-- an extraordinary change in attitude in just a few years. But
would this interest continue once the novelty has worn off?
Could Son's story influence behavioral decisions made by teens?
Experiences in other countries suggest that youth respond best
to reality-based prevention information when presented in
person. In the 1995 survey, HCMC young people reported that
they wanted to see and hear from PWAs directly -- by more than a
three-to-one ratio. The HCMC Youth Culture House has invited
speakers on occasion (to packed audiences). Undeniably, a
nationwide HIV-positive speaker's bureau would prove most
effective in reaching unconvinced teens.
If the government decides to legalize the
exchange of safe needles for IDUs, it is not because Viet Nam
wants to encourage harmful drug use. Rather, it is due to the
egregious impact that contaminated syringes have in transmitting
HIV among susceptible teens and young adults. The shift in
official thinking (although not yet implemented as policy) is
important and should not be underestimated when analyzing the
new push to prevent youth AIDS. Still it is of consequence that
these progressive proposals could be running counter to a more
conservative mood that recently appears to be emerging among
some older members of the Politburo over the pace and extent of
its liberal doi moi policy and political reforms. Already, key
changes in leadership posts due to serious illnesses or
political shifts could further alter AIDS prevention efforts
over the next few years. Few observers expect that the national
debate would ever deviate from what is obligatory for Viet Nam's
economic health and national security.
Nguyen Ngoc Bau of the Ministry of Defense
spoke of the intensive anti-AIDS and safer sex training that all
military recruits receive currently. He made an interesting
proposal in support of peer education that has benefits for the
entire population, "Young army men... can transfer this
knowledge to other people in the community including their
friends, relatives and local people. Therefore they are a
target group that needs to be protected, but at the same time
they are effective and reliable soldiers in the AIDS prevention
campaign." Viet Nam would not be alone in using its military
personnel to assist in AIDS prevention efforts. Currently,
American naval observers are involved in HIV surveillance
detection in Viet Nam. When U.S.
Charge D'Affaires Desaix Anderson offered
American help to Viet Nam, he emphasized, "US military research
units have done extensive work on possible vaccines for
HIV/AIDS." In addition, military health care experts from the
two countries met for discussions at the conference although a
planned seminar on the topic of the military and AIDS was
dropped unexpectedly.
The threat of HIV/AIDS to military
preparedness is of real concern to governments
internationally. In Viet Nam, it acts as a powerful incentive
to improve official AIDS prevention efforts targeting youth,
particularly among socially conservative elements in the
leadership. They are cognizant of Viet Nam's past reliance on
the battle-ready strength of its armed forces to protect lives
and ensure survival. Indeed, one of the main reasons why AIDS
could prove devastating to the country's ability to defend
itself is because it has one of the youngest populations in the
world (partially, a legacy of war casualties). More than 50
percent of all Vietnamese are under 21-years old and healthy
young men are expected to serve time. Until recently, Viet Nam
boasted one of the world's largest standing armies.
Since the end of the American war, it has
fought wars in Cambodia and along the Chinese border. For the
nation to feel truly secure, its pool of potential recruits must
be HIV-free and its blood supply must be safe on the
battlefield.
In toto, the list of recommendations was
ambitious. But this question must to be asked: are they
doable? In HCMC, where the municipality's youth union is
recognized as the largest and most active one in Viet Nam, the
director of its Social Division admitted, "It is necessary to
have a contingent of motivators and counselors who provide
counseling about AIDS... [yet] the Youth Union has only 13 teams
and groups out of 3,000 wards and communes throughout the
city." On the national level, another VNYU speaker warned
there were only, "65 Youth clubs on AIDS prevention... [and] 7
pilot models and condom marketing shops and peer education on
AIDS prevention." Obviously, resources are limited and funding
remains a major consideration in implementing the bulk of the
recommendations.
Yet adequate levels of assistance now
could make the difference between a serious epidemic -- and a
major public health catastrophe.
Dr. Chittick suggested that the PeerCorps
concept is the most effective approach economically to slow the
spread of teenAIDS because the VNYU's network of youth
volunteers is already in place. NAC's new chief, Dr. Chung A
has indicated that he favors this approach.
Some in the international donor community
are not comfortable with providing funds to government entities
which promote strict, morality-based ideology over
medically-accepted information to fight HIV/AIDS. Therefore,
outside aid is often made conditional upon compliance with rules
based on attitudes and beliefs derived from other cultures.
Those requirements, of course, are the prerogative of the
individual NGOs and multilateral organizations which formulate
them.
However, requirements for receiving foreign
assistance could prove problematic for a developing nation like
Viet Nam -- especially if it feels pressured to choose between
maintaining its indigenous culture or losing needed aid.
Pressure of this kind appears hypocritical
if the same conditional actions are not in force in the donors'
home countries. For example, many wealthy nations that
contribute funds for AIDS prevention to developing nations: 1)
do not allow clean needle exchange for IDUs; 2) prostitution is
illegal and CSWs are often arrested and incarcerated; 3)
comprehensive sex education with condom availability is not
allowed in public schools; and 4) in some cases, human rights
abuses of PWAs are overlooked or ignored. Indeed, a majority of
UN members do not follow many of UNAIDS' recommended actions
even though a preponderance of medically-sound information
strongly suggests the proposals would help to stem the spread of
global AIDS.
This double standard is unfortunate and
only serves to irritate poorer nations in need of major
assistance. Achieving a consensus of scientific fact and
respect for societal traditions would further youth AIDS
prevention goals globally.
While appreciative of the support of
multilateral donors, Vietnamese government and party officials
have good reason to carefully study the advice of foreign
expatriates before undertaking major social changes. A
reluctance to accept new, potentially disruptive customs is
understandable. Outside professionals should be sensitive to
issues of cultural imperialism as not all modern ways are good
for every country. In fact, it could be argued that many
developing societies are at greater risk of HIV/AIDS currently
because of the adoption of outside mores by their impressionable
youth. Mrs. Than stressed, "Public opinion is against drug
addiction and easy life styles which are unfamiliar to Vietnam's
traditions and customs." Is it any wonder that Vietnamese are
worried when they hear about Western nations' high rates of teen
drug use, school violence, sexual initiation at early ages,
unwanted teen pregnancies, and youth suicide? Or the lack of
respect for traditions, families, and the elderly?It would be
difficult to deny that young Vietnamese are changing their
thinking and lifestyles as the direct result of doi moi bringing
about economic reforms and greater international interaction.
This cultural shift deeply troubles older
Vietnamese. Mrs. Hang, a representative of MOLISA, one of the
more conservative ministries, warned in her speech, "Moral
degradation, family instability and the deterioration of
community health cause general unrest in society." Perhaps
this warning is prescient if the public were to blame a
devastating epidemic on perceived government inaction or the
anti-social actions of unpopular groups. Historically, plagues
have been known to foster social disruption. Already in
Nonthaburi, Thailand and in some central African countries hard
hit by AIDS, there have been reports of civil unrest and
violence among the populace as a result of frustration and fear.
In a tightly-controlled, highly centralized
society like Viet Nam, great concern exists regarding public
discontent -- especially if it could reach a stage of critical
mass, thereby threatening established institutions. Major
social changes brought about by doi moi worry many in the party
hierarchy because of the threat from "peaceful evolution." New
York Times correspondent Henry Kamm recently wrote, " 'Peaceful
evolution' is a catchphrase for what the party fears most: that
the foreign influences to which it had to open the door from
economic necessity will peacefully evolve toward a dilution of
its total power." Already many young people have eagerly
adopted "new fashion" and are showing less respect for
time-honored customs and authority. HCMC's unexpected soccer
riots in 1995 (officially blamed on anti-social youth) was
described by Reuters News Service as "some of the worst civil
violence seen in years." In private discussions older
Vietnamese complain that the lawbreakers were urban youth who
have become "spoiled" with too much money and time on their
hands.
Others worried about an upwardly-mobile
generation of self-absorbed young people with little sense of
history and past struggles. As the sexual revolution
infiltrates Viet Nam with its health consequences, young people
become increasingly vulnerable to HIV. A serious youth epidemic
would put great pressures and demands on adult society and
consequently, the nation's leadership.
Thus, issues raised at the conference
highlighted the Catch-22 dilemma faced by government leaders --
the need to find a balance between science and morality, between
individual empowerment and public order, and between
encouragement and castigation of youthful aspirations. Speeches
by top educators pointed up the cross-currents at work in
designing better prevention campaigns. Tran Xuan Nhi, Deputy
Minister of Education and Training (MOET) stated, "Another
concrete AIDS prevention mention is to praise and present awards
to collectives and individuals who have made outstanding
achievements in the prevention of HIV/AIDS and social vices. At
the same time, duly punish collectives and individuals which are
involved in transmitting HIV and social vices." Can a policy
of this kind be expected to succeed in curbing the youth
epidemic?
According to many Vietnamese at the
conference there appeared to be no inherent conflict in
endorsing a more aggressive AIDS prevention policy by the VNYU
while at the same time insisting that the union help the
authorities enforce social evils laws. A member of the National
Assembly said, "The Youth Union can join efforts with cultural
and security agencies in limiting the impact of decadent films
and cultural works, and prevent drug traffic
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