The U.S. enters the picture

The June 2004 announcement of Vietnam as a PEPFAR focus country was a surprise to many. Virtually overnight, the U.S. became the single largest HIV/AIDS donor in Vietnam, notably in the area of treatment and care. U.S. assistance for voluntary counseling and testing (VCT)—the LifeGap project—has been underway since 2001 through the Centers for Disease Control and Prevention initiative with the Vietnamese Ministry of Health. (Many of the major HIV/AIDS donors and UNAIDS are present in Vietnam—the Global Fund, World Bank, Asia Development Bank, Australian AusAID, British DfID, German KfW and others—funding a vast array of HIV/AIDS activities with the government.) Monetarily speaking, however, U.S. assistance is far above other donors’ annual contributions.

In the summer of 2004, Vietnam received more than $17 million in PEPFAR funds. This was a sizeable sum to dispense within a short timeframe, in a country with few potential local organizations with whom to partner, apart from the government. The PEPFAR designation reportedly was well-received by the government, other donors and the Vietnamese public. Yet PEPFAR’s first year in Vietnam was a difficult one. With limited manpower on the ground and with no clear long-term strategy, PEPFAR was a “chaotic pool of confusion,” according to one seasoned NGO staffer.1 Poor communications between the U.S. and the Vietnamese government—concerning the flow of PEPFAR dollars primarily to NGOs—also made for a rocky start.

Managing the sheer amount of money—which grew to $27 million in FY05—meant that the small PEPFAR team was hustling to engage as many partners as possible, and quickly, in order to produce tangible results for the Office of the Global AIDS Coordinator (OGAC). An early casualty, however, was a cohesive strategy that took stock of what other donors and NGOs were doing with regards to HIV/AIDS in order to target PEPFAR funds efficiently. “Truly effective coordination with the government of Vietnam and the country’s own HIV/AIDS strategy” was also sacrificed, senior staff of one NGO remarked.

Two years later, the situation appears to have stabilized somewhat. A stronger PEPFAR team is in place, NGO roles are becoming clearer and a more comprehensive, long-term strategy is taking shape in concert with Vietnam’s national HIV/AIDS strategy. Nonetheless, a senior NGO staffer reported a “general disconnect between reproductive health and HIV prevention,” commenting that PEPFAR-supported prevention efforts aren’t taking advantage of the existing reproductive health network. Multi-year PEPFAR contracts to partners are uncommon, however, which continues to pose planning problems for NGOs when contracts are for one year. “It is difficult for partners to develop a long-term strategy and to scale operations up (or down),” lamented another NGO leader, “We often don’t learn of what other organizations are doing until months into the awarded contract.”

There is widespread consensus that PEPFAR single-handedly jump-started HIV/AIDS care and treatment in Vietnam. Overall, there is optimism about scaling-up anti-retroviral therapy (ART), yet there is much to be done to operationalize treatment for drug users. The mounting pressure to meet OGAC’s treatment targets—22,000 Vietnamese on ART by the end of 2008—is distorting programs and threatens the quality of treatment services. As of mid-2006, only 1,900 Vietnamese receive ART courtesy of PEPFAR.