This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 001311 
 
SIPDIS 
 
STATE FOR S/GAC; STATE PASS CDC 
 
E.O. 12958: N/A 
TAGS: PGOV PREL EAID PHUM SOCI SNAR TBIO VM HIV AIDS
SUBJECT: THE AMBASSADOR'S DECEMBER 15-16 VISIT TO HCMC AND BINH DUONG 
PROVINCE:  THE FIGHT AGAINST HIV/AIDS 
 
¶1. (SBU) Summary: The Ambassador's December 15 and 16 visits to 
one of HCMC's 21 drug rehabilitation centers and a local HIV 
testing and ARV treatment center highlighted the challenges 
facing the city in planning for the upcoming release of some of 
the centers' 30,000 residents, many of whom are HIV positive. 
Despite two years of vocational training, many rehabilitation 
center residents appear to lack the skills needed to compete in 
the general marketplace.  Although they technically qualify for 
discharge after four years of treatment, city officials will not 
let them go without a guarantee of a stable post-release 
environment.  As an expedient, they plan to house and employ 
some rehabilitation center graduates in a government-owned 
industrial park.  The city's HIV/AIDS community outreach and 
testing programs also need strengthening and do not appear ready 
to cope with the challenge of integrating large numbers of HIV 
positive, former drug users into the community.  The Ambassador 
pushed for intensified HIV/AIDS education for workers in 
meetings with managers of two U.S.-owned companies operating in 
the neighboring province of Binh Duong and with the provincial 
government.  End Summary. 
 
¶2. (U) The Ambassador, accompanied by ConOff and CDCOff, visited 
a PEPFAR-funded antiretroviral clinic located in one of Ho Chi 
Minh City's poorest districts as well one of HCMC's 21 "05/06 
Centers" -- rehabilitation centers for drug users and 
prostitutes -- during a visit to HCMC December 15-16.  The 
Ambassador also traveled to neighboring Binh Duong Province, 
where he raised the need to combat HIV/AIDS in meetings with the 
provincial People's Committee and managers of two American-owned 
factories: Stickley International, Ltd. and Spartronics Vietnam 
Co., Ltd. 
 
ARV Clinic Visit 
---------------- 
 
¶3.  (SBU) Officials from HCMC's District 4 Department of Health 
(DOH) told the Ambassador that the "Public Consulting and 
Assistance Center" -- the district's HIV/AIDS outpatient 
treatment and testing center -- opened in 1998.  It operated 
using funds from the HCMC Provincial AIDS Committee (HCMC PAC) 
until it began receiving PEPFAR funds this year.  Current 
operational and staffing budgets are primarily covered by PEPFAR 
funds provided to supplement the HCMC PAC's health budgets for 
the city's 24 districts.  DOH officials stated they see the U.S. 
support as a starting point and are hoping to receive more funds 
to expand their operations.  (Note: DOH officials said the 
center is receiving approximately $31,500 in PEPFAR funds for 
its current four-month contract.  End Note.)  The Ambassador 
reminded the DOH officials that PEPFAR funds are meant to be 
used to supplement local efforts and to put prevention, 
treatment and care systems in place, not to pay for 100 percent 
of the costs of treating AIDS patients. 
 
¶4.  (SBU) DOH officials said the center has 228 registered 
patients: 45 receiving anti-retrovirals (ARVs), 56 patients 
waiting for ARVs to become available and 130 receiving 
opportunistic infection drugs and other treatment. 
Additionally, the center has approximately 100 voluntary 
counseling and testing (VCT) clients each month, with 40 to 55 
percent testing positive.  Some 51 percent of the clinic's 
HIV-positive VCT patients became infected through intravenous 
drug use; 36 percent claim not to know how they were infected. 
Officials professed that over 90 percent of HIV-positive VCT 
clients return for treatment after diagnosis.  The center has 16 
full-time peer educators in the community encouraging people to 
come to the center to get tested; however, most of the VCT 
clients who come in do so because they are already sick, 
acknowledged DOH officials. 
 
¶5. (SBU) The Ambassador observed, and DOH officials agreed, that 
the center is not drawing enough clients in for voluntary 
counseling and testing, despite the district having an HIV 
prevalence rate double that of the city average.  The officials 
also admitted they have not changed the public's perception that 
the HIV/AIDS epidemic affects only drug users and sex workers. 
DOH officials acknowledged that the district's HIV prevalence 
rate is approximately one percent compared to half a percent for 
the rest of HCMC. 
 
¶6. (U) The DOH officials requested more detailed training on 
treating patients and counseling people with HIV/AIDS and 
suggested that the Center's staff could benefit greatly from 
meetings with colleagues dealing with similar cases.  Both DOH 
and HCMC PAC officials claimed that drug use in HCMC is under 
control because most users have been sent to 
rehabilitation/detention centers. 
 
05/06 Center Unable To Care For HIV-Positive Residents 
--------------------------------------------- --------- 
 
¶7. (SBU) Officials at the Nhi Xuan Education, Vocational 
Training and Job Placement Center told the Ambassador that at 
least 1,500 of the 2,100 residents are almost finished with a 
4-year rehabilitation program.  Leaders of the HCMC Voluntary 
Youth Force (VYF), which runs the facility, said that intake has 
slowed in the past year as most of HCMC's drug users have been 
admitted into the 05/06 centers.   They also admitted that this 
center is full beyond its 2,000-person capacity.  The Center's 
directors told the Ambassador that they need technical HIV/AIDS 
assistance to provide testing and care for the residents.  The 
facility does not have sufficient trained personnel, facilities, 
drugs or funds to care for its HIV-positive population. 
Currently, a resident is tested for HIV only if (1) he/she 
requests it and pays the 90,000 VND fee; (2) has a mandatory 
test due to a suspected AIDS-related illness; or (3) the 
resident's family requests and pays for the test.  If the family 
requests the test, the Center will not disclose to the resident 
the result of the test unless the family instructs it to do so. 
To date, the Center has tested 1,200 inmates and more than 700 
have tested positive.  The Center would like to provide 
wide-scale voluntary counseling and testing but does not have 
the capability. 
 
¶8.  (SBU) Currently, the Center's medical clinic has 100 AIDS 
patients who are too sick to be in the general population but 
are not yet sick enough to send to the hospital.  What drugs 
these patients receive are provided by the GVN or by the 
patients' families.  The Center's medical staff noted that only 
ten percent of patients are receiving the medicine they need. 
The clinic has an additional 69 tuberculosis patients kept in a 
separate ward in three crowded rooms (with a listed maximum 
capacity of 60). 
 
Treatment and Possible Release 
------------------------------ 
 
¶9. (SBU) The 05/06 Center treatment program consists of two 
phases:  two years of rehabilitation and detoxification followed 
by two years of vocational training.  After completion of the 
four-year program, the residents technically are eligible for 
release.  Nhi Xuan officials told the Ambassador that they hope 
to release 99 residents before Christmas, 143 before Tet (end of 
January 2006) and 200 shortly thereafter.  However, to be 
eligible for release, in addition to completing the four-year 
program, the residents also must meet other "conditions," which 
include proof of an outside job or enrollment in an education 
program and consent of the family and the community to accept 
the rehabilitated addict.  Thus far, only 20 residents have met 
the Center's criteria for being allowed to return home.  Center 
officials admitted that sending residents home was not their 
"first preference." 
 
¶10. (SBU) VYF officials said that graduates who do not meet the 
criteria for release into the community will be assigned work in 
the factories at the rehabilitation center or at an adjacent, 
city-owned industrial zone.  Graduates will be given free 
housing "equivalent" to that provided for workers in commercial 
industrial parks.  They also would enjoy "80 percent of the 
freedom" that other industrial zone workers normally enjoy. 
However, graduates would not be allowed to leave the compound at 
night except on weekends and holidays.  The Center would offer 
additional counseling programs to the graduates at night. 
Graduates would be required to pay for their meals, but would be 
housed free-of-charge. 
 
¶11.  (SBU)  During a brief visit to a garment factory located 
next to the Center, the Ambassador was told by the factory owner 
that Center residents working there, on average, only earn half 
the normal salary for a factory worker.  The Center's director 
justified the lower pay, arguing that -- on a per unit basis -- 
the residents' pay was equivalent to workers at other factories; 
residents' productivity is lower because of poor health and 
because, as apprentices, they still needed to hone their skills. 
 The Ambassador noted that issues of the residents' pay at the 
factories and their continued detention past the completion of 
the four-year program would need to be examined in more detail 
as the USG considers establishing a PEPFAR program to address 
the HIV/AIDS needs of 05/06 Center residents.  He also 
encouraged officials to explore the use of methadone 
substitution therapy to complement and support ongoing 
rehabilitation efforts. 
 
¶12. (SBU) A decision on how to handle the bulk of the Nhi Xuan 
Center's 1,500 residents eligible for release would be made only 
after the results of the "pilot release" were assessed, the 
officials told the Ambassador.  Another contact at the VYF 
subsequently told us that it plans to release 1,600 residents 
from the VYF-run centers in HCMC by the end of March 2006, and 
that the city plans to release over 3,000 from all its 05/06 
centers during the same period.  How many of these individuals 
will be free to resume their lives in their communities is still 
unclear. 
 
Binh Duong 
---------- 
 
¶13. (U) Nguyen Hoang Son, Chairman of the Binh Duong People's 
Committee, told the Ambassador that HIV/AIDS is a problem only 
in Vietnam's large cities and thus is not a serious issue for 
his province.  However, the Chairman noted children of all ages 
and in all locations should be educated about HIV and AIDS.  All 
the province's high schools and colleges have HIV prevention 
courses.  The Ambassador suggested that the provincial 
government could require major employers in Binh Duong to 
provide seminars on HIV/AIDS to their employees at least once a 
year. 
¶14. (U) Officials from two American factories in the province, 
Stickley International, Ltd. and Spartronics Vietnam Co., Ltd., 
stated that they currently provide their employees with the 
minimum health care required by the GVN.  The Ambassador urged 
the directors of both factories to create HIV/AIDS awareness 
programs for their workers, particularly as both companies are 
rapidly expanding and are drawing more heavily from the influx 
of migrant workers to the province.  Both directors expressed 
interest in launching such a program in 2006. 
 
¶15. (SBU) Comment:  HCMC is on the horns of a dilemma. A 
substantial portion of the city's 30,000 05/06 residents will be 
eligible for release in the coming year.  City managers are 
concerned over the implications of the release into the 
community of a large cohort of "rehabilitated" drug addicts, at 
least half of whom are believed to be HIV positive.  One 
official explained that community reintegration is particularly 
complicated as many from this cohort are family outcasts, come 
from broken homes, or were migrants to HCMC from other provinces 
and have no local support network.  On the other hand, many 
local officials were uncomfortable with holding an 05/06 
resident beyond the scheduled release date.  Nhi Xuan's plan to 
create a post-release work and living environment for its 
graduates is one example of how city planners are struggling to 
find a solution to this problem. 
 
¶16. (SBU) Comment, continued:  If the Nhi Xuan Center is any 
indication, HCMC is ill-prepared to manage the return of 
thousands of HIV positive, "rehabilitated" drug addicts to the 
community.  Despite up to two years of vocational training, Nhi 
Xuan's residents appeared unable to compete in the marketplace, 
or at the very least, would still require additional on-the-job 
training to be employable.  Similarly, the results at the ARV 
Center demonstrate that community outreach and education efforts 
need to be strengthened to foster community reintegration of 
rehabilitation center residents, reduce the stigma attached to 
HIV/AIDS and encourage HIV testing as a strong prevention and 
control message.  Finally, U.S. companies operating in Vietnam 
should be encouraged to hold seminars and implement workforce 
prevention programs to educate their workforces on HIV/AIDS 
prevention and treatment.  End Comment. 
CHERN