Relying on foreign donations for 70 percent of anti-HIV/AIDS costs, Vietnam needs to fill the void as its new ‘middle income’ status inspires aid cuts
Hillary Clinton, US former secretary of state, visits the Ngoc Lam Pagoda, which receives funding from the US President's Emergency Plan for AIDS Relief (PEPFAR), in Hanoi, Vietnam, in 2010. More than 70 percent of the country’s HIV/AIDS response comes from international donors, who plan to reduce or phase out projects due to the country’s new middle-income status and their own financial woes brought on by the global financial crisis. PHOTO: BLOOMBERG
Nguyen Thi Thanh Nga knows well how difficult it is for a family with an HIV/AIDS patient.
The 40-year-old day laborer in Ho Chi Minh City is fighting her own HIV infection and rearing two young children after her husband, who gave her the virus, died of AIDS several years ago.
Nga, who is also chairman of a club that supports children with HIV, said the difficulties are multiplied for children orphaned by AIDS.
“They have to live with their relatives. But their uncle or aunt has to raise their own children... There will be a lot of difficulties,” she said.
Nga is seriously concerned about international donors’ plans to cut funding for the prevention and treatment of HIV/AIDS in Vietnam over the past years.
“I don’t know how we’ll help the children if things get worse,” she said.
More than 70 percent of the country’s HIV/AIDS response comes from international donors, who plan to reduce or phase out projects due to the country’s new middle-income status and their own financial woes brought on by the global financial crisis.
Since the first case was detected in Vietnam in 1990, HIV infections have increased rapidly until recent years when the rate was curbed by the work of local agencies and international organizations.
According to a report released at a conference last week in Ba Ria-Vung Tau Province, HIV infection remains a concern nationwide with an average of 30 new cases reported every day.
There are almost 213,400 people living with HIV nationwide, apart from more than 63,300 AIDS patients. So far, the incurable virus has claimed the lives of more than 65,000 people in Vietnam.
In the first five months of this year, more than 4,300 people have tested positive for HIV, according to the report.
Vietnam began using life-prolonging antiretroviral therapy (ART) for HIV/AIDS patients nationwide in 2007 for free, with 74,000 patients that have so far benefited.
According to the Vietnam Administration of HIV/AIDS Control, the fatalities to AIDS have significantly reduced since 2007 thanks to the therapy and other efforts.
Since 2007, 1,000-1,500 people have died of AIDS annually, while annual fatalities had been 7,000-8,000 in years previous.
In 2012, Vietnam spent VND2.2 trillion (US$104.3 million) on the treatment of HIV/AIDS patients, of which less than 10 percent on ARV. The rest of the spending on ARV has been donated by international donors.
Since 2004, the US President’s Emergency Plan for AIDS Relief (PEPFAR), the largest contributor to Vietnam’s HIV prevention and treatment, had donated almost $600 million.
In recent years, PEPFAR has decreased funding to Vietnam from $98 million in 2010 to $69 million in 2012.
However, according to a 2011 report by the US Agency for International Development (USAID), PEPFAR funding could plunge to an estimated $43 million by 2015.
Meanwhile, the Global Fund to Fight AIDS, Tuberculosis and Malaria - an international financing institution that invests in fighting HIV/AIDS - originally signed a $125 million grant for HIV/AIDS funding in Vietnam from 2011 to 2015, but only $66 million has been committed in the first three years.
The remaining funds are not guaranteed since the Global Fund works on the concept of performance-based funding.
Among the current grants, in January 2013 Vietnam and the Global Fund signed on an incremental amount of $76 million for HIV prevention and treatment from 2013-2015.
Ibon Villelabeitia of the Global Fund said that in 2011, the fund adopted a strategy to give priority to countries who most urgently need funding for health: low-income countries with high rates of AIDS, TB or malaria.
“Vietnam is now classified as a ‘lower-middle-income’ country. That means it is still eligible for funding, but probably not at the same proportion of available funding as before,” he told Vietweek.
Under the Global Fund's new funding model, Vietnam's new grant proposals will need to demonstrate counterpart financing and improved governmental response to all three diseases, as well as its coordination and joint planning with other donors like PEPFAR, he said.
In 2012, Vietnamese lawmakers passed their first National Target Program on HIV/AIDS Prevention and Control, increasing the budget for HIV services by 20 percent compared to 2011, UNAIDS officials said.
Meanwhile, Dang Don Tuan, a spokesman for the Vietnam Administration of HIV/AIDS Control (VAAC), said Prime Minister Nguyen Tan Dung has instructed the health ministry to draft a plan on HIV response in the context of international donation cuts.
By 2015, international donations for Vietnam’s HIV/AIDS programs will be reduced by 70 percent of the current grants, Tuan said.
“However, we will continue to make good on international commitments, including eliminating AIDS in 2020 and maintaining our current HIV response activities even if there will be no international donations,” he told Vietweek.
Vietnam spends around $16 million a year on ARV and the burden will be shifted to health insurance companies to cope with international donation cuts, he said.
“Some other activities will include more social efforts, like methadone clinics to help stop the spread of disease... The users will have to pay partially or fully,” he said.
However, Nguyen Trong An, deputy director of the Child Care and Protection Department at the Ministry of Labor, War Invalids and Social Affairs, said the cuts would make things difficult and priorities would have to be arranged.
He said relevant spending will have to focus on groups with the most urgent demand.
“It will be difficult for the state budget. Thus, we will focus on three of many groups of children most prone to HIV,” he told Vietweek.
Chu Quoc An, VAAC’s deputy director, warned of a resurgence of HIV/AIDS if adequate measures are not taken to cope with the funding shortage.
“I think it is very difficult to eliminate AIDS worldwide because the infection is still complicated. The most effective measure is creating a vaccine, which has no optimistic prospect so far.
“But if we do not continue relevant activities and improve the involvement of local authorities and residents, the rapid spread of HIV/AIDS will resume shortly.”
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By Khanh An, Thanh Nien News (The story can be found in the September 27th issue of our print edition Vietweek)