The HIV/AIDS epidemic in Nghe An remains complicated.

On the occasion of HIV/AIDS Action MonthNghe An Newspaper had a conversation with Mr. Thai Van Nhan - Deputy Head of HIV/AIDS Prevention Department, Nghe An Provincial Center for Disease Control.

Reporter: It is known that Nghe An is currently the province with the highest number of HIV infected people, ranking 6th in the country. What does this “not so happy” position say?

Mr. Thai Van Nhan:In 1996, Nghe An discovered the first case of HIV/AIDS infection. After 24 years, Nghe An had 21/21 districts, towns and cities with infected people, with 10,094 people infected with HIV reported. Of these, the number of people who died from AIDS was 4,245. With these numbers, Nghe An is the province with the highest number of HIV infected people, ranking 6th in the country.

Screening and testing for early detection of HIV. Photo: Contributor

Looking from this 6th position, we can clearly see positive signals and signs of risk. First of all, from a positive perspective, Nghe An has controlled the HIV pandemic well. Treatment has been implemented in 21/21 districts, cities and towns with 25 care and treatment facilities. Drug distribution activities have been deployed to wards and communes. Mobile activities of counseling, testing, distribution of syringes, condoms... have been deployed synchronously. Thanks to that, we have helped 5,849 people infected with HIV to survive and 4,693 infected people are receiving ARV treatment.

From a risk perspective, we can clearly see that the HIV/AIDS epidemic in Nghe An is still complicated. The province is a key locality for HIV/AIDS in the country. Districts such as Que Phong, Quy Chau, and Tuong Duong have many high-risk subjects. The province is also a key area for drugs, both trafficking and use. From this perspective, Nghe An still needs a lot of effort to reduce the number of new infections, the number of people progressing to AIDS, and the number of people dying from AIDS.

Nghe An is still a key locality in HIV/AIDS in the country. Photo: Contributor

However, the 6th position does not mean anything. The number of people infected with HIV/AIDS that have not been detected in Nghe An is still quite large. Before 2016, each year, the province discovered more than 500 new people infected with HIV/AIDS. In the past 4 years, each year, the province discovered 300 new people infected with HIV/AIDS. In 2020 alone, due to the impact of the Covid-19 epidemic, HIV/AIDS prevention activities were affected, so only about 200 new people infected with HIV/AIDS were discovered. There are still many people infected in the community that have not been detected, for example, in Que Phong district, every month, 4-8 new infected people are discovered. Infected people themselves are hiding their illness or have not taken testing seriously to receive treatment.

PV: In addition to the undiscovered infected people, there will certainly be new infected people. Where does the risk of new infected people coming from?

Mr. Thai Van Nhan:Nghe An is a key area for drugs, both trafficking and use. Studies on HIV-infected people in the province show that more than 80% of the infections are due to the situation of injecting drugs and sharing needles. Thus, in theory, the risk of new infections due to the situation of injecting drugs and sharing needles is still the top risk.

Since 2015, in Nghe An, the trend of HIV infection from drug injection is decreasing and the trend of infection through sexual intercourse, especially homosexual intercourse, is increasing. According to calculations by experts in Nghe An, there are nearly 10,000 people having sex with men - more than the number of drug injection users managed in the province.

Examination, consultation, and medication for HIV patients at Que Phong Medical Center. Photo: Thanh Chung

The reason why homosexual sex has a high risk of infection is because this is not a natural relationship, so it is easy for scratches and infections to occur. Currently, homosexual sex is not accepted by society, so it is very difficult to approach these subjects.

To reach men who have sex with men, for a long time, HIV/AIDS prevention workers have had to go through public MSM (men who have sex with men) groups. These people will conduct propaganda in their own secret groups and societies. Nghe An currently has one public MSM group with about 1,000 people.

According to statistics, in the province there are currently about 200 men who have sex with men undergoing preventive treatment, and over 80 men who have sex with men infected with HIV are undergoing ARV treatment. If we do not have a solution to effectively promote HIV prevention, the risk of HIV infection is very high.

Men who have sex with men tend to “hide” so it is very difficult to infiltrate and propagate, requiring tact. In 2016, a central art troupe coordinated with the project organization and the Nghe An Department of Health to organize an exchange night at a university in the province with about 500 students participating. At the exchange night, this art troupe performed plays with MSM content. Many students burst into tears. When it came to the exchange part, the host asked students with homosexual tendencies to participate in confession, and more than 10 hands were raised, standing on stage to share about their “true gender”.

Community outreach workers in Quy Chau district conduct outreach and contact to bring high-risk subjects for testing. Photo: Contributor

There is another risk of infection, which is having sex after using crystal meth or synthetic drugs. As we know, crystal meth or synthetic drugs cause strong hallucinations and are often used in groups.

PV: Besides these risks, what other difficulties does HIV/AIDS prevention work in Nghe An face?

Mr. Thai Van Nhan:There are many difficulties in HIV/AIDS prevention in Nghe An. Firstly, currently, the budget for prevention activities is very weak and lacking. In the province, all sponsored project programs have been cut and reduced. At the district level, the budget is very limited, even communication must be integrated, the efficiency is not high. Even in the National Action Month for HIV/AIDS Prevention and Control in 2020, some places only allocated funds to make a few banners and slogans.

Second, in recent times, HIV/AIDS prevention and control has received attention, support, and good coordination from many levels and sectors. However, on the contrary, there are also sectors and sectors that have not really taken part. Many officials do not have full awareness of the HIV/AIDS pandemic, as well as Methadone and ARV treatment activities...

Approaching HIV-AIDS prevention propaganda for high-risk groups. Photo: Thanh Chung

Third, in the past, HIV/AIDS prevention activities were supported by a team of collaborators (funded by the provincial and project budgets). However, now this team no longer exists, which more or less affects HIV/AIDS prevention activities.

On the part of the family, the infected person and society, there are still more or less prejudices. Most of the infected people are infected secondary to drug injection or prostitution. The mistakes of the infected person create bad images, causing them to be shunned, discriminated against, and the infected person also discriminates against himself. Due to self-stigma, some infected people live in isolation, are difficult to approach, and move frequently, making it difficult to manage.

Currently, the ARV treatment program for infected people is covered by health insurance, but because of self-stigma, many infected people do not participate in treatment for fear of revealing their personal information, so they go to some outside clinics for treatment. Because of treatment outside, they are not monitored, managed, cared for, counseled, and supported in a timely manner, so they stop treatment or take medication irregularly, losing the effectiveness of treatment.

The ARV treatment program for infected people is covered by health insurance, but because of self-stigma, many infected people do not participate in treatment for fear of revealing their personal information. Photo: Thanh Chung

Not long ago, there was a case of a young unmarried man who had a traffic accident and had to be hospitalized. At the hospital, he had a blood test, and the results showed that he was HIV positive. This young man registered and received ARV treatment right at the hospital. But for some reason, after only a few days of returning home, local leaders came to visit and encourage him; while neighbors whispered and looked at him with prejudice. The young man hanged himself... This is a sad story about discrimination, self-discrimination, revealing personal information, and incompetent handling of patients in Nghe An.

PV: Vietnam in general and Nghe An in particular are setting a big goal of ending the AIDS epidemic by 2030. To achieve this goal, in your opinion, what key tasks should we focus on?

Mr. Thai Van Nhan:Recently, the Prime Minister issued Decision No. 1246/QD-TTg dated August 14, 2020 approving the National Strategy to End the AIDS Epidemic by 2030. The National Strategy has proposed specific solutions and tasks to achieve the goal. For Nghe An, the Provincial People's Committee needs to soon approve the plan to implement the National Strategy, with specific resource allocation.

Nghe An needs to continue to thoroughly grasp and strictly implement Directive 54 of the Central Party Secretariat; Law on HIV/AIDS Prevention and Control; Decree 108/2007/ND-CP regulating the implementation of the Law on HIV/AIDS Prevention and Control. In particular, Party committees at all levels, authorities, departments, branches, unions, social organizations, and community-based organizations need to actively implement; consider HIV/AIDS prevention and control tasks as both urgent and long-term in the action plans of their localities and units.

It is necessary to further promote propaganda work, raise awareness and knowledge for people about HIV/AIDS. Photo: Thanh Chung

Regarding specific solutions, we need to focus on further promoting propaganda, raising awareness and knowledge for people about HIV/AIDS. Focus on propaganda for HIV/AIDS prevention for teenagers, students... It is necessary to increase testing activities, find people infected with HIV who have not been detected, and bring them into management, treatment and prevention. When treated, the possibility of infecting others is very difficult. To do this, the entire political and social system at the grassroots level must actively participate in finding and mobilizing high-risk subjects to get tested.

We also need to implement some intervention and prevention measures such as the needle and condom program. Currently, this program is being supported by the Global Fund (each year, the province receives an average of over 500,000 needles and syringes). Nghe An needs to consider the time when the Global Fund no longer supports it... Particularly with the risk of HIV infection from homosexual sex, we need to call for more funding sources to support outreach activities, testing, and support for collaborators in MSM groups.

PV: Thank you.about this exchange!