Uncharted Waters - The Impact of U.S. Policy in Vietnam

December 1, 2006

By Wendy Turnbull

Vietnam—a vibrant country of 84 million people—is experiencing rapid economic growth and unprecedented societal change ushered in by globalization. This is posing interesting possibilities and challenges for U.S. assistance and policy. In June 2004, the Bush Administration named Vietnam the fifteenth “focus” country under the President’s Emergency Plan for AIDS Relief (PEPFAR). Vietnam is the sole PEPFAR focus country in Asia, with twelve in Africa and two in Latin America and the Caribbean.1 The HIV/AIDS epidemic here differs greatly from that of its African counterparts: HIV/AIDS prevalence is quite low and is concentrated among populations which engage in high risk behaviors. The disease has been driven principally by injection drug use, though the rate of infection from sexual transmission is increasing rapidly.

Politically, Vietnam remains a strong Communist state determined to be in charge of its well-developed national HIV/AIDS strategy. Ensuring that donor efforts fall into line with the country’s strategy and priorities is a work in progress for the government. U.S. influence in Hanoi has been limited since relations were normalized a decade ago, yet this is changing where U.S. assistance is involved. Increased donor support for HIV/AIDS—especially from the U.S.—is credited with creating a more visible, vocal and independent non-governmental organization (NGO) sector. Nonetheless, most NGO and donor staff contend that PEPFAR is distorting the HIV/AIDS agenda by focusing so heavily on treatment in a country with relatively low prevalence.

Among the PEPFAR focus countries, Vietnam stands out in one important regard: it has a well-established health care system, capable of reaching down into the provincial and town levels. Two recent health scares in the Asian region—SARS and Avian Flu—did not become major public health crises in Vietnam, partly because the government moved decisively and a vast health infrastructure was in place. A similar political and public health response to HIV/AIDS is only now beginning to mobilize, just as the epidemic is expanding beyond high-risk groups. However, according to one NGO staffer, “There is still a huge amount of work to be done to enable the health system to deal with HIV/AIDS” in the years ahead.

The arrival of PEPFAR happens to coincide with this critical juncture in Vietnam’s epidemic. Yet funding earmarks and policy constraints imposed by Congress and the Office of the Global AIDS Coordinator (OGAC) have emerged as obstacles to crafting a focused and cohesive U.S. strategy in Vietnam. To be sure, Vietnam’s own policy environment—riddled with vague and conflicting approaches to injecting drug use, commercial sex, and HIV/AIDS—has presented challenges for PEPFAR as well as other donor efforts. At publication time, however, recent developments on both fronts demonstrate that the HIV/AIDS environment is extraordinarily dynamic, with policies and programs simultaneously experiencing change.