America wages new war in Vietnam - on AIDS

By BEN STOCKING (AP)
29/11/2009

TINH BIEN, Vietnam — When her husband fell ill with AIDS, doctors at the hospital turned him away, fearing they would catch the virus.

"They told him, 'There's nothing we can do for you. Just go home and wait to die,'" said Do Thi Phuong. So when she too got AIDS, she didn't seek help, fearing that she would also be shunned. Instead, like her husband, she went home to die.

Then she heard about a little AIDS clinic in the Mekong Delta, in a place where the Americans used to train South Vietnamese soldiers during the Vietnam War.

Now, on a regimen of AIDS drugs provided by the U.S., she is getting her strength back.

The clinic at Tinh Bien is one of 55 across Vietnam funded by the President's Emergency Plan for AIDS Relief, known as PEPFAR, the initiative that President George W. Bush made a centerpiece of his administration.

As memories of the eight-year war fade, the America that older Vietnamese remember, of bombers, guns and Agent Orange, is now represented to many by places such as Tinh Bien, where 340 HIV patients are getting treatment.

The U.S. has spent more than $300 million fighting AIDS in Vietnam, and is now providing AIDS drugs to more than two-thirds of the 32,000 Vietnamese receiving treatment. At $85 million this year alone, PEPFAR accounts for 80 percent of U.S. humanitarian spending in the country.

The funding pays for treatment, support for patients' families, prevention programs and dispelling the AIDS stigma, which is entrenched in Vietnam.

Just how entrenched was demonstrated recently when a group of HIV-positive schoolchildren living at a PEPFAR-supported compound near Ho Chi Minh City were enrolled at a neighborhood school. They were expelled the next day because parents of other students objected.

"The other kids refused to play with me," said Huyen, 13, who wouldn't give her last name. "They pointed at me and said, 'She has AIDS.'"

Phuong feared the stigma too. She said that for a long time she didn't dare tell anyone she had HIV.

"In the countryside, the only thing people know about AIDS is that it's the 'Disease of the Century.' They're afraid they'll get infected, so they shun you," she said.

Then she saw a report on TV that life-extending AIDs drugs were available in Vietnam. But the doctors she asked didn't know where to find them.

Finally, outreach workers learned from a friend of hers that she was ill and invited her to the Tinh Bien clinic.
"The doctors and staff here treat me like I'm just another patient," said Phuong, 30.

At the Mai Hoa Center, home to the children who were turned away from school, a memorial display at the center holds rows of urns with remains of former residents.

Until the U.S. began providing AIDS drugs, "We used to have one or two funerals a day. Now we only have one a month," said Tran Van Nhan, a center volunteer.

PEPFAR has been criticized for its paperwork, which is regarded as onerous, and for the U.S. ban on spending the money to dispense clean needles and syringes, on the grounds that they might foster drug abuse. Infected needles are the main transmitter of HIV nationally in Vietnam.

Under the Obama administration, PEPFAR is reconsidering this approach, according to Steve Mills, who directs the Vietnam operations of Family Health International. The North Carolina-based nonprofit organization runs the Tinh Bien clinic and other programs in Vietnam and Cambodia, funded through USAID, the U.S. Agency for International Development.

Some question why Vietnam, whose 0.51 percent AIDS prevalence falls short of a generalized epidemic, was chosen. Most of the 15 PEPFAR countries are in Africa, and Vietnam is the only Asian one.
But for Mills, working in Vietnam is special.

"I'm continually amazed that the places we are working in used to be battlegrounds," he said.
Mills has lived in Hanoi for five years and has adopted a Vietnamese boy.

"As an American who remembers the war, I'm awed that Vietnamese are so welcoming of us, and I'm happy we're back now supporting the development of their health system," he said.

Tinh Bien is in An Giang, a poor province where some women supplement their income as prostitutes in the casinos and brothels just across the frontier in Cambodia. That makes commercial sex, rather than needles, the main transmitter of AIDS in the province.

"These drugs are making a very big difference," said Mai Hoang Anh, the top AIDS official in An Giang province.

"They allow people to stay active for many years, just like Magic Johnson," the American basketball ace who announced 18 years ago that he had AIDS and is still looking healthy at age 50.

On a recent day, Chau Thi Anh Loan, 23, sat on a bench outside the clinic, holding a one-month-old baby bundled in a green blanket. She caught the virus from her husband, a heroin user who shared needles with friends and is now dead.

Staffers at Tinh Bien make sure she takes her medicine on schedule and feeds her baby with formula milk.
"This will prevent me from passing HIV to my son," said Loan, who received medicine that helps prevent mother-to-child transmission. "The doctors tell me he's healthy."