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RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB
DE RUEHHI #2822/01 3120050
ZNR UUUUU ZZH
R 080050Z NOV 06
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 3941
INFO RUEHHM/AMCONSUL HO CHI MINH 2118
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
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RUEHGZ/AMCONSUL GUANGZHOU 0743
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RUEHGE/AMEMBASSY GEORGETOWN 0007
RUEHPU/AMEMBASSY PORT AU PRINCE 0014
RUEHNR/AMEMBASSY NAIROBI 0024
RUEHTO/AMEMBASSY MAPUTO 0013
RUEHWD/AMEMBASSY WINDHOEK 0011
RUEHUJA/AMEMBASSY ABUJA 0023
RUEHLGB/AMEMBASSY KIGALI 0031
RUEHSA/AMEMBASSY PRETORIA 0056
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RUEHLS/AMEMBASSY LUSAKA 0013
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 06 HANOI 002822 
 
SIPDIS 
 
SIPDIS 
 
STATE FOR O/GAC, EAP/MLS, EAP/EP 
STATE PASS TO USAID FOR ANE AND GH 
STATE PASS TO HHS/OGHA (WSTIEGER, EELVANDER AND ABHAT) 
BANGKOK FOR USAID (TBEANS, LBRADSHAW AND BSLATER) 
 
E.O. 12958: N/A 
TAGS: ELAB PGOV PINR PROP SOCI TBIO KHIV VM
 
SUBJECT: VIETNAM'S FIRST HIV/AIDS LAW: TRANSFORMING NATIONAL 
APPROACHES AND ATTITUDES 
 
 
HANOI 00002822  001.2 OF 006 
 
 
SENSITIVE BUT UNCLASSIFIED 
 
¶1.  (SBU) Summary: On June 29, 2006, the National Assembly of 
Vietnam passed the Law on HIV/AIDS Prevention and Control.  The 
legislation, the first on this subject, goes into effect on January 
1, 2007.  While details are still under discussion, this bold and 
comprehensive new Law demonstrates Vietnam's serious commitment to 
combating the disease and mobilizing all sectors of the country, 
including provincial leadership, community- and faith-based 
organizations, and international groups.  Protection of rights for 
people living with HIV/AIDS (PLWHAs), substitution therapy for drug 
abusers, insurance and anti-retroviral drug benefits are among the 
key issues addressed in the law.  The unusually open debate and 
discussion conducted during the past year on the Law's measures, 
through seminars, media outlets and National Assembly hearings, 
offer a rare opportunity for civil society involvement in the 
lawmaking process, which is usually tightly controlled by the 
Communist Party.  As the fifteenth focus country under the 
President's Emergency Plan for AIDS Relief, Vietnam will continue to 
receive strong USG support and funding as it continues to construct 
laws, regulations and policies dealing with HIV/AIDS.  End Summary. 
 
Vietnam's First HIV/AIDS Law: Key Provisions 
-------------------------------------------- 
 
¶2.  (SBU) On June 29, 2006, the National Assembly of Vietnam passed 
the long-awaited Law on HIV/AIDS Prevention and Control, the first 
of its kind in the country.  Earlier that month, Deputy Prime 
Minister Pham Gia Khiem pledged to "hammer out bolder and more 
effective measures" at the High Level Meeting of the United Nations 
General Assembly on HIV/AIDS.  The comprehensive measure goes into 
effect on January 1, 2007, overriding a myriad of administrative 
ordinances and decrees issued by the Government of Vietnam (GVN) in 
the past decade.  The Law includes a total of six chapters and fifty 
articles that will affect an estimated 280,000 PLWHAs in Vietnam, 
including 10,000 children. The estimated number of reported (or 
known) cases of HIV/AIDS is expected to rise to 310,000 by 2010. 
 
¶3.  (SBU) A recurring theme throughout the Law is the emphasis on 
the rights of PLWHAs and the need to combat stigma and 
discrimination.  According to the Law, PLWHAs have the right to 
refuse medical examination and treatment, but must notify their 
spouse or fiance and health workers directly dealing with their care 
and treatment of their positive status.  Privacy rights are clearly 
outlined, particularly in the workplace with regards to promotion 
and termination; employers cannot require HIV tests.  Testing will 
only be compulsory when a court dictates it.  Even rights to burial 
and cremation (significant in a Taoist-based society) and admittance 
to schools are explicitly mentioned with enforcement provisions. 
 
¶4.  (SBU) Another key focus in the Law is the inclusion of 
prevention measures for high risk groups (sex workers and injecting 
drug users) including the use of condoms, safe-injecting practices, 
 
HANOI 00002822  002.2 OF 006 
 
 
and expanding the treatment of addiction to illegal drugs through 
the use of medication-assisted therapies (e.g., methadone, 
naltrexone, etc).  A key component is mainstream drug substitution 
therapy with a full range of comprehensive addictions counseling and 
supportive interventions.  Provisions on blood transfusions, 
diagnostic bio-products, sterilization, disinfection and benefits of 
volunteers in vaccine trials are also outlined in detail. 
 
¶5.  (SBU) Prevention of mother-to-child transmission is another 
priority, with commitment to assist babies born to HIV mothers with 
substitutions for breast milk.  Medical establishments are clearly 
identified as responsible for HIV/AIDS treatment and implementing 
preventive measures against mother-to-child transmission.  National 
mobilization in fighting AIDS, not restricted to officials and 
organizations only, are touted, urging awareness and action from 
local leaders at the hamlet, village and clan levels. Additional 
emphasis on public awareness, prevention education and general 
messaging on stigma are prominent in the Law.  Free anti-retroviral 
drugs (ARV) will be provided to those exposed by occupational 
accidents or medical procedures, pregnant women, abandoned orphans 
and children under the age of six.  Those who hold medical insurance 
are now covered for HIV/AIDS examinations and treatment. 
 
How the Law Evolved 
------------------- 
 
¶6.  (SBU) National Assembly deputies debated the draft Law in two 
major sessions in February and May 2006.  Intense discussion focused 
on the right of infected patients to privacy and refusal of medical 
treatment.  The debate over who would receive free ARV drugs and who 
would not, through the provision of health insurance, was also a key 
point of debate.  Discussion about building separate schools for 
HIV-positive children was met with vehement opposition from 
representatives in the southern provinces of Ho Chi Minh City and 
Long An.  Some legislators argued that a proposal to have all fees 
for examinations and treatments paid by insurance would be 
discrimination for those who do not have insurance. 
 
¶7.  (SBU) According to the Law's key drafter, Ministry of Health 
(MOH) Deputy Director of Health Legislation Nguyen Huy Quang, 
existing laws in Cambodia, the Philippines, Australia and Japan 
influenced Vietnam's draft.  The main focus of the Law remains on 
the rights of PLWHAs, prevention interventions and the critical need 
to involve all levels of authority, down to the commune-level (even 
though the overall directive comes from the Communist Party's 
central authorities).  Quang also insisted that Vietnam's Law is 
clearer than that of Cambodia and the Philippines on prevention 
interventions and the rights of PLWHAs, although both were used as 
models. Quang acknowledged the real challenge is that "regulations 
do not change people overnight" and that the Law is a work in 
progress, ready for adjustment and revision as needed.  Supporting 
PLWHA clubs and organizations is an important statement the GVN is 
attempting to make to the public about stigma and discrimination, 
 
HANOI 00002822  003.2 OF 006 
 
 
even allowing the establishment of a State-sanctioned national 
association for PLWHA. 
 
¶8.  (SBU) The USG began supporting work on the development of an 
HIV/AIDS Law in Vietnam in 2002 through a USAID grant to the POLICY 
Project, which has since been renamed the Health Policy Initiative 
(HPI).  Funding is now supported by the President's Emergency Fund 
for AIDS Relief (PEPFAR).  The HPI was instrumental in providing 
technical assistance to the GVN drafting team and eventually direct 
support to the National Assembly in revising the draft Law, which 
passed with a number of heavily debated gains for HIV advocates. 
The Mission's interagency PEPFAR team has provided the MOH direct 
feedback on the draft Law, thereby encouraging legislation that 
addresses comprehensive concerns, particularly on stigma and the use 
of methadone in medication-assisted therapy for illicit drug users. 
 
 
¶9.  (SBU) According to HPI Advisor David Stephens, the new Law could 
be stronger but it is a good base to start, particularly because of 
the intensive consultative process that went into drafting the Law, 
which sought opinions from international organizations, the Women's 
and Youth Unions (quasi-governmental mass organizations), provincial 
officials and PLWHAs.  It provided an opportunity for "ownership" of 
the Law by different segments of civil society that are usually not 
afforded such a voice. Frank, vigorous and sometimes contentious 
debates on testing and privacy heralded a rare forum in Vietnam, a 
society where laws are usually drafted behind closed doors. 
 
Vietnam's Long Road: Dealing with HIV/AIDS 
------------------------------------------- 
 
¶10.  (SBU) The first case of AIDS in Vietnam was detected in 1991 
when a 24-year-old woman in Ho Chi Minh City discovered her status 
during a routine blood test required for immigration to Australia. 
By February 1995, 2,280 cases were detected throughout the country. 
Now, the prevalence rate in the general population is estimated at 
0.53 percent, with high-risk groups including sex workers and 
injecting drug users a growing concern, and the epidemic has spread 
to all 64 provinces and major cities in Vietnam.  A Communist Party 
Directive dated March 11, 1995, did little more than note the 
formation of a National AIDS Committee consisting of eighteen 
members of government agencies and mass organizations under the 
chairmanship of the Deputy Prime Minister.  The Directive called for 
a "healthy, faithful life avoiding drugs and prostitution," which 
are "social evils" to be countered with strong police surveillance 
and sentences. 
 
¶11.  (SBU) The Ordinance on the Prevention and Control of HIV/AIDS 
followed in April 1995, containing definitions of HIV and vague 
references to protecting PLWHAs from discrimination, encouraging 
family members of those infected to provide care and moral support, 
but no legal protections.  The ordinance gave doctors the authority 
to test a patient for HIV during a routine medical examination and 
 
HANOI 00002822  004.2 OF 006 
 
 
require the patient to notify the spouse.  Doctors also reserved the 
right to inform other family members, employers and affiliated 
organizations.  People infected with HIV were also prohibited from 
working in "some sectors" which were never clearly defined.  Dr. 
Stephens of HPI calls the 1995 Ordinance a "measure without teeth" 
as it failed to provide transparent legal guidelines and address the 
protection of the rights of PLWHAs, confidentiality and privacy 
issues.  Since 2003, HPI has been working hard to provide input to 
shape key portions of the Law through the Institute of Health Policy 
under the direction of the Ministry of Health. 
 
¶12.  (SBU) Like many countries, Vietnam was initially unprepared to 
deal with the onslaught of AIDS.  By 2004, the GVN had constructed a 
National Strategic Plan on HIV/AIDS Prevention (2004-2010), 
including a supplementary Vision to 2020.  For the first time, the 
GVN laid out guidelines and measures for a national response to 
combat the disease through a multi-pronged approach enlisting the 
Ministries of Education and Training; Culture and Information; 
Public Security; Labor; Invalids and Social Affairs; Health; 
Finance; and even Planning and Investment.  The GVN opened its arms 
to international cooperation and set a goal to reduce the national 
prevalence rate in the general population below 0.3 percent by 2010. 
 Another goal was to ensure that 70 percent of HIV patients receive 
ARV by 2010. The Strategic Plan included specific commitments to 
negotiating the reduction of ARV's prices, establishing satellite 
treatment quarters of regional hospitals and implementing voluntary 
counseling and testing programs in all provinces by 2010. The 
Supplementary Vision to 2020 committed prevention activities for a 
"gradual reduction in the absolute number of people infected" by the 
year 2020. 
 
¶13.  (SBU) In June 2004, Vietnam became the fifteenth PEPFAR focus 
country. Nearly USD 80 million have been allocated under the EP thus 
far and another USD 59 million are slated for FY07. With over thirty 
international and local partners and sub-grantees that make up the 
PEPFAR family in Vietnam, a wide-ranging network of programs to 
provide ARV medicines, HIV care, prevention and treatment have been 
in place for the past two years with plans for expansion in FY07 to 
additional partners and provinces with focused programs. 
 
A Concrete Pledge and Moving Forward 
------------------------------------ 
 
¶14.  (SBU) Vietnam made a critical decision to take its commitments 
to a deeper level in December 2005 when the Central Committee of the 
Communist Party Secretariat instructed local Party committees to 
tackle HIV/AIDS as an "urgent and long-term duty."  The directive 
cited local prevention plans to combat prostitution and drug abuse, 
along with public efforts directed at youth, sex workers and 
homosexuals.  The Party Central Committee's Commissions for Science 
and Education, and Ideology and Culture, and the United Nations 
Development Program (UNDP) also jointly agreed to implement a 
three-year plan with USD 2 million from UNDP and the Swedish 
 
HANOI 00002822  005.2 OF 006 
 
 
International Development Cooperation Agency (SIDA) and USD 250,000 
from the GVN in the three pilot provinces of Lang Son, Khanh Hoa and 
An Giang.  The project objective was to establish guidelines and 
policies to create a legal basis for multi-sector HIV/AIDS 
prevention and gender equality.  Under the project, HIV/AIDS would 
be included in socio-economic development plans, and a new method 
for contact with HIV/AIDS patients would be applied in the pilot 
provinces. 
 
¶15.  (SBU) In November 2005, Vice President Truong My Hoa 
highlighted the impact of stigma on PLWHAs at a meeting organized by 
UNDP and SIDA with 50 members of the Bright Futures Group, a PLWHA 
network organization founded in 2003 with over 500 members currently 
nationwide. The Vice President stated that the government would 
"reaffirm the highest political commitment of the Party, State and 
Vietnamese people in reducing stigma and discrimination."  Another 
mark of progress was the inclusion of PLWHA groups and international 
organizations in the discussion to develop a national law on 
HIV/AIDS, an unusual nod towards civil society involvement.  Coupled 
with the HIV/AIDS Law is the draft Law on Associations currently, 
which has long been under debate in Vietnam and seeks to establish 
regulations for Vietnamese and foreign organizations to convene, 
including groups to promote HIV/AIDS networks. The latest version of 
the Law on Associations was pulled from the National Assembly's 2006 
work plan; when it will be considered is unclear. 
 
Steps Toward Implementation and Beyond 
-------------------------------------- 
 
¶16.  (SBU) Since the issuance of the HIV/AIDS Law in June 2006, the 
GVN has been busy working out the details on implementation in 
January, 2007.  The MOH held a series of seminars in August in 
northern, central and southern regions to explain the Law to 
provincial leaders, lawyers, media representatives, PLWHAs and 
community groups.  HPI continues its work with MOH on the Law's 
implementing decrees and regulations, debating how detailed they 
should be and the need to build in flexibility to deal with a 
changing environment.  PEPFAR Vietnam's FY07 draft budget supports 
plans for HPI to continue to work with the GVN, local PLWHA groups 
and individuals to examine and assist with the implementation of the 
HIV/AIDS Law at the provincial level. 
 
¶17.  (SBU) Mobilizing the state-owned media in a strong public 
affairs campaign is also an essential component of the Law's 
implementation.  Deputy Director of the Central Party Committee's 
Commission for Science and Education Pham Manh Hung, held a press 
briefing on September 28 urging the media to report more effectively 
on HIV/AIDS. He emphasized that the disease does not equate to a 
"social evil" and called on provincial and city officials to step up 
local plans to fight stigma.  Human interest pieces in the 
State-controlled Vietnam News Agency and Voice of Vietnam radio 
about discrimination and stigma faced by PLWHAs have significantly 
increased in recent months.  Post's Public Affairs Section has 
 
HANOI 00002822  006.2 OF 006 
 
 
intensified efforts to educate the public about HIV/AIDS and tell 
our story of the President's Emergency Plan through press releases 
and seminars.  Joining forces with an online newspaper, Post also 
successfully organized Vietnam's first, live web chat on HIV/AIDS in 
May with a panel consisting of a PEPFAR team member, PLWHAs and 
health experts.  A letter to the editor submitted by the Ambassador 
that congratulated the media's more balanced focus and attention on 
HIV/AIDS, and PLWHAs in particular, was recently published in the 
Vietnam News. 
 
¶18.  (SBU) One of the most significant by-products of the HIV/AIDS 
lawmaking process has been the engagement of civil society and 
community groups, which continues as plans for implementation of the 
Law unfold.  The Center for Consultation on Legal and Policy on 
Health and HIV/AIDS under the Vietnam Lawyers' Association is 
currently training lawyers and PLWHAs in provinces with the highest 
infection rates.  Faith-based organizations and religious groups are 
also receiving open encouragement from the GVN to join the fight 
against HIV/AIDS.  In April, Buddhist clerics convened in HCMC for a 
conference to share experience in providing support to PLWHAs. 
Through PEPFAR funding, a number of pagodas in Hanoi, Hue and HCMC 
provide face-to-face and telephone consultations for tens of 
thousands of people. Clerics have also held more than thirty 
training courses for monks and nuns, provided free medical checkups 
and treatment to over 8,000 patients, and organized memorial 
services and worship for hundreds of families whose loved ones have 
died from AIDS. 
 
¶19.  (SBU) Before implementation of the Law on January 1, 2007, the 
GVN must release details of the legal measures.  This includes a 
list of occupations requiring HIV testing before recruitment, 
regulations on care and treatment of women during pregnancy 
delivery, regulations on monitoring sexually transmitted diseases 
and the responsibility of medical establishments, procedures for HIV 
testing, and steps for HIV education in schools as MOET develops 
content for teachers' manuals on sex education.  Issues such as 
reproductive technology, standards for voluntary testing centers, as 
well as counseling and prevention among discordant couples (couples 
where one member is HIV-positive while the other is HIV-negative) 
are also areas that will require further attention by policymakers 
in the future. 
 
MARINE