As part of the President’s Emergency Relief Fund (PEPFAR), the Centers for Disease Control and Prevention (CDC) provides funding and technical support to the Government of Vietnam to operate 41 Health Center for Counseling and Community Support (CCSCs) across Vietnam. This helps ensure that most-at-risk-populations are identified and tested for HIV, and if positive, have ready access to the necessary care and treatment.
Ho Chi Minh City (HCMC) VIETNAM – Before Linh joined the Ho Chi Minh City Health Center his life was spiraling out of control -- he used drugs daily, was unemployed and his health was deteriorating rapidly.
But his fortune took a turn when his friends told him about the local CCSC. Reluctant at first, Linh finally took the plunge and signed up for the Methadone Maintenance Treatment (MMT) program. After a challenging period of withdrawal, he stopped using heroin.
As part of the MMT program Linh was also tested for HIV, which is commonly spread by injecting drug users who share dirty needles.
The news was devastating: Linh had tested HIV positive.
But he was in the right place to start a new, healthier chapter in his life -- he was linked up with a package of other services offered at the clinic, which included HIV care and treatment, as well as the methadone treatment.
Linh's story is just one of many that local health officials and CDC delegates have gathered to hear about today at the HCMC health clinic.
Linh tells us about being diagnosed with HIV, and put on to the anti-retroviral treatment (ART) program to manage his condition, and how this essential U.S. government backed service has turned his life around.
Linh's eyes reflect a story of pain and determination as he talks to us through a translator.
A toy wooden ship sits on a shelf and paintings of fishing boats hang on the walls to remind us that the city’s bustling waterfront is just blocks away.
“After joining the methadone program I stopped using heroin, and got a steady job,” he says. “I also started on the ART program here – so thanks to that my life is so much better now.”
Linh's life is now back on track, and he is helping others kick their heroin addiction too.
“Now I work as a Peer Outreach Worker,” he says. “It’s a program backed by the CDC and the Government of Vietnam that supports people like me who are struggling to stay clean and sober.”
With a transient population and easy access to drugs, port districts are often hotbeds for groups most at risk of from HIV infection, like injecting drug users. These people often share their needles, picking up the disease from previously infected individuals.
Sex workers and men-who-have-sex-with-men are classified as the other two most-at-risk groups from HIV infection in Vietnam, and are typically infected through sexual intercourse.
These three most-at-risk groups are being actively targeted by health workers as part of the national HIV strategy.
Linh sips at a bottle of water as the conversation moves away from personal stories of overcoming addiction and coming to terms with being infected with a life-long disease, to the bigger picture of how these clinics can support people in these situations.
With a enthusiastic sparkle in her eyes, the CCSC Director gives us a brief history of the CCSC program and its attempt to lower HIV infection rates in HCMC through an innovative approach that combines prevention, care, and treatment.
It's a tale of ups and downs, setbacks and successes.
She explains that in the first few years of operations, from 2005-2006, over 1,500 clients registered for the CCSC program's care and treatment program -- an impressive number.
But at that time only three outpatient clinics existed in HCMC, and resources were at a stretching point to test and treat all these new clients.
In 2007 the number climbed to 21 clinics, and the burden on local staff and the facility’s overloaded capacity was reduced significantly.
This increase in the number of clinics “…represents the willingness of the Government of Vietnam to respond to the epidemic, and the raised awareness that these services were now easily accessible, and funding was available for life saving drugs,” says a CDC Vietnam rep at the meeting.
Vietnam is, however, now shifting into a middle income status, and international donors are reducing their funding across the country. This means the Vietnamese government will have to step in and counter funding reductions in these critical HIV and MMT programs and look at creative solutions to provide quality care and treatment with less resources.
The Vietnamese government is working with the CDC and international partners to ensure the programs in HCMC are sustainable into the future.
This will be challenging as programs are expensive to run and need to continue at current, or increased, rates to deliver a package of services that maintain the healthcare level of HIV positive patients.
Despite the recent drop in funding, the CCSC center that we've gathered at has seen great success over the years, and relapse rates remain low for HIV positive and injecting-drug-user clients once they start the ART and MMT programs.
There is also clear evidence that once clients get onto ART and MMT treatment, their job prospects increase significantly.
Before clients commenced the MMT program about 70% of them were out of work. One year after joining the program these stats are flipped on their head, with 77% of clients going on to find work.
More good news, clients see their physical health improve with many patients reporting healthy weight gain.
Linh and the CCSC centre's health workers say CDC-supported health programs like this one are invaluable -- they provide a vital service to those most at risk of HIV and other infectious diseases like TB. And without this support from the Vietnamese government and CDC, these people might very well fade into the background, sick and dying without these life-saving programs.
Blowing through the open window a breeze puffs up the toy ship's sails -- a sign of this program sailing into uncharted waters with the scaling down of international donors' operations and the transition to the Vietnamese government.
Irrespective of these changes Linh right now seems to be in a good place.
“I’m really happy,” he says. “And this is from the heart – as I get to help people in the same situation as me.”
“I’m happy when I help people quit substance abuse, and join the MMT program – join the ART program – and I want to do good things, as I’ve been given a second chance, and I want others to have the same opportunity too.”