Ben Schnayerson
Foreign Service

AIDS spreads as Vietnam targets 'social evils'

Regime arrests prostitutes, drug addicts

HO CHI MINH CITY, Vietnam — As part of a government campaign to stamp out the "social evils" that spread AIDS, a prostitute named Trang was sent last year to a state facility for sex workers and intravenous drug users.

But like so many of the Communist government's misplaced efforts to control HIV/AIDS, this one didn't work.

The rehabilitation center did little to reform Trang — who at the time she was arrested did not have HIV — or about 250 other women being held there, she said. Classes about AIDS focused solely on the anti-social nature of prostitution. Vocational training consisted of making tablecloths nine hours a day.

After three months, the 27-year-old Trang — who wouldn't give her complete name for fear of being picked up again — was released and returned to the streets after failing to find a job making tablecloths.

"I don't have a good education," she says, "so there is no other place for me to work."

In 1990, there was only one known case of HIV in this country of 78 million.

Now, the government estimates there are 107,000 cases — local AIDS workers say the figure is at least 200,000 — and concedes that the number will double by 2005.

The government contends that the chief source of the epidemic is heterosexual sex and points to the nation's estimated 40,000 prostitutes. But AIDS workers say that up to 70 percent of those infected are drug users, addicted to readily available heroin and methamphetamines.

Regardless of the source of the epidemic, AIDS workers say Hanoi's policy of arresting sex workers and drug users under the guise of social rehabilitation only makes the problem worse.

Drug users and prostitutes "are more at risk because (it drives) everything underground," said Laurent Zessler, the United Nations AIDS (UNAIDS) program adviser in Vietnam. "(The government) associates AIDS with social evils. We call it a health issue."

Zessler and other nongovernmental agency officials have urged the government to integrate the state rehabilitation centers into a broader campaign that includes AIDS education, condom distribution, needle exchange and other forms of prevention. So far, their recommendations have been to little avail.

Vietnam spends just $3 million a year on AIDS programs and has about 100 health centers handling HIV/AIDS patients. Even the state rehabilitation centers receive a "meager amount" of funding, according to Thomas Kane, director of Family Health International, a North Carolina-based organization that works with AIDS victims in Vietnam.

Chris Harick, special program director in Vietnam for the Christian relief agency World Vision, said the government must move beyond its "social evils" campaign and focus on all high-risk groups.

Harick is particularly concerned about migrant workers and truck drivers who have sex with prostitutes and then pass the disease to their wives.

"There is this idea that it is mainly spread through intravenous drug users and prostitutes instead of married couples," said Harick.

According to a survey by Family Health International (FHI), 39 percent of truck drivers in the port city of Can Tho and 20 percent of migrant workers in the port city of Hai Phuong said they had slept with a prostitute in the past year.

"Rural people travel to urban areas to get money," said Vu Ngoc Bao of Population Council, a nonprofit group. "They lack knowledge of HIV/AIDS and then adopt the city lifestyle."

Experts say the government also must manufacture more condoms and cheap generic drugs. The high cost of AIDS treatment has prompted many poor people to turn to herbal medicines that have no known effectiveness.

But there are signs of change. From 1997 to 1999, Hanoi spent nothing on condom distribution, according to UNAIDS. But in 1999, the state produced 104 million condoms; most of them were marketed to married couples.

The nonprofit DKT International, targeting locations where prostitutes and their customers meet — discos, karaoke bars, massage parlors and hotels — sold 43 million of their Trust and OK brands of condoms last year at a subsidized rate. DKT expects to sell 50 million this year.

"We know people are going to have sex, and it is going to be risky sex," said Larry Holtzman, director of DKT International in Vietnam.

In recent months, the government has made hints that it is rethinking its "social ills" campaign.

Le Thuy Lan Thao, an official of the government AIDS office in Ho Chi Minh City, conceded that the state could not guarantee that lives will change after a three-month stint in a rehabilitation center.

"We don't follow them and do not know if (the prostitutes) stay at their work or if (the intravenous drug users) stop using drugs. But a lot come back to the centers again."

The government is also beginning to allow independent and private agencies to work at the rehabilitation centers and with local officials.

In the central province of Binh Dinh, FHI employees have organized cultural events and given speeches about HIV/AIDS, according to Kane. The Population Council, FHI, World Vision and other international organizations have been distributing information pamphlets and condoms through taxi drivers, shoeshine boys and barbers, with the help of local officials.

Still, Trang and many other Vietnamese continue to put their lives at risk.

"If a man asks to have sex without a condom, I usually refuse," she said. "But sometimes, we have sex without a condom."