The health sector in Viet Nam has made remarkable progress in keeping people living with HIV on life-saving antiretroviral treatment, according to a new global report jointly released yesterday by the World Health Organization (WHO), United Nations Children’s Funds (UNICEF) and United Nations Joint Programme on HIV/AIDS (UNAIDS).
"Viet Nam's commitment to combat the HIV epidemic has yielded progress in several measures of prevention, care and treatment, "said Graham Harrison, acting WHO Representative in Viet Nam.
The report shows Viet Nam is a leading country in the provision of sterile needles and syringes to people who inject drugs. The number of methadone clinics increased sharply from four in two provinces in 2009 to 39 in 11 provinces in 2011, providing methadone to more than 6000 people who depend on heroin. Between 2008 and 2010, the proportion of people who inject drugs in Viet Nam who received an HIV test and learned their HIV status increased from 11% to 18%. Over the same time period, increases in serostatus knowledge were also seen among men who have sex with men (16% - 19%), and female sex workers (15% - 34%.)
Also according to the report, Viet Nam has made impressive progress in developing a continuum of HIV care that has improved retention on treatment. Through home-based care, treatment retention increased 30% from 2009 to 2010 in participating districts.
Advances in HIV science and programme innovations over the past year add hope for future progress. In times of economic austerity it will be essential to rapidly apply new science, technologies and approaches to improve the efficiency and effectiveness of HIV programmes in countries.
The report highlights what is already working:
- Improved access to HIV testing and counselling services for pregnant women. According to Ministry of Health data, Viet Nam increased HIV testing coverage among pregnant women from 32% in 2009 to 36% in 2010, providing HIV testing to over 760,000 pregnant women.
- Globally, close to half (48%) of pregnant women in need receive effective medicines to prevent mother-to-child transmission of HIV (PMTCT) in 2010. Similarly, Viet Nam increased provision of such effective medicines to an estimated 49% of women in need, in parallel with increased HIV testing coverage of pregnant women.
- Antiretroviral therapy (ART is available now for 6.65 million people in low- and middle-income countries, accounting for 47% of the 14.2 million people eligible to receive it. The number of people living with HIV in Viet Nam who have been receiving ART was 49,492 by December 2010. Viet Nam currently reached an estimated 52% of people living with HIV in need of treatment.
When people are healthier, they are better able to cope financially. The report acknowledges that investment in HIV services could lead to total global gains of up to US$34 billion by 2020 in increased economic activity and productivity, more than offsetting the costs of ART programmes.
“Guided by strong political commitment and leadership, Viet Nam is firmly progressing towards the global vision of zero new HIV infections, zero stigma and discrimination and zero AIDS-related deaths,” said Eamonn Murphy, UNAIDS Viet Nam Country Director. “By investing wisely on evidence-based, high-impact harm reduction programs that target key populations at higher risk of infection, Viet Nam will be able to increase efficiencies, reduce costs, improve on results and achieve our bold global targets by 2015.”
The report also points to what still needs to be done:
- More than half of the people who need antiretroviral therapy in low- and middle-income countries are still unable to access it. Many of them do not even know that they have HIV.
- Despite the growing body of evidence as to what countries need to focus on to make a real impact on their epidemics, some are still not tailoring their programmes for those who are most at risk and in need. In many cases, groups including people who inject drugs, men who have sex with men, sex workers, prisoners and migrants remain unable to access HIV prevention and treatment services.
Although better services to prevent mother to child transmission of HIV have averted some 350 000 new infections among children, some 3.4 million children are living with HIV - many of whom lack HIV treatment. Only about one in four children in need of HIV treatment in low- and middle-income countries received it in 2010, as compared to 1 in 2 adults.
“While there have been gains in treatment, care and support available to adults, we note that progress for children is slower,” says Lotta Sylwander, UNICEF Viet Nam Representative. “Care and support for children affected by HIV and AIDS remains alarmingly low. Through concerted action and equity-focused strategies, we must make sure that efforts in Viet Nam are working for children as well as adults”.
Sustaining the HIV response through the next 10 years
- Countries are already showing marked efficiency gains in HIV programmes including Viet Nam. Such efficiencies are promoted through Treatment 2.0 - an initiative launched by WHO and UNAIDS in 2010, that is being piloted in Viet Nam to promote simpler, cheaper and easier-to-deliver HIV treatment and diagnostic tools, combined with decentralized services that are supported by communities.
- A WHO, UNAIDS, UNICEF "Elimination Initiative" aims to eliminate new HIV infections among children by 2015 and keep their mothers alive.
- WHO's "Global Health Sector Strategy on HIV/AIDS, 2011-2015", endorsed by the World Health Assembly in May 2011 highlights the importance of continuing efforts to optimize HIV treatment and "combination" prevention - the use of a range of different approaches to reduce people's risk of infection.
The 2011 "Report on the Global HIV/AIDS Response" is the comprehensive report on both the epidemiology and progress rates in access to HIV services globally and in regions and countries. It has been jointly developed by WHO, UNICEF, UNAIDS, in collaboration with national and international partners.