Shut out and undercover

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As Vietnam's schools continue to reject HIV-positive students, one advocate pushes for them to keep their health status secret

A mother and daughter living with HIV/AIDS at an undisclosed school campus in northern Vietnam. An estimated 2,000 children in Vietnam are receiving anti-retroviral treatment which reduces the virus count in the blood to virtually nothing. Despite this fact, they are continually shut out of public schools and local advocates are now urging them to keep their health status secret.

Nguyen Ngoc Thuan spent one month in the first grade before the school sent him home.

"The school principal asked me to keep Thuan at home where I could tutor him myself," the boy's mother, Nguyen Thi Tinh told Thanh Nien Weekly.

Thuan had performed well and exhibited no behavioral problems, his mother said.

But, according to Tinh, in 2004, the principal of Chu Van An primary school in Dong Nai Province's Xuan Hiep Commune sent Thuan home for fear he would bite, scratch or even brush shoulders with another child.

Thuan and his mother are HIV-positive. His father died of AIDS in 1997, just several months after he was born.

"Thuan kept asking me why he could not go to school like his peers," she said. "He desperately wanted to go to school."

It was not until 2007 that Tinh managed to convince a new principal and concerned parents that her child was taking antiretroviral medication and, therefore, posed no threat to the other students.

The school finally agreed to let Thuan return, but only on the condition that Tinh chaperone her son at break time every day.

"At first, he was devastated," Tinh said. "But he came to grips with it. He told me not to come to the school anymore because he could stay alone in his classroom at break time."

It took Thuan nearly a year to convince the school and his peers to lift their veritable quarantine.

"He has been getting excellent grades," Tinh said. "Many parents have told me that their kids like hanging out with Thuan. I'm overjoyed that my son is considered a normal boy."

Not all HIV-infected children in Vietnam are as lucky as Thuan.

Despite strict HIV/AIDS laws and the availability of medicine that render infected children benign to their peers, discrimination abounds.

Thanh Nien Weekly found that those who advocate for the rights of HIV-infected students inside Vietnam are increasingly opting to enroll these children undercover to spare them the battle that Thuan endured.

Ten years ago, Nguyen Thi Minh Phuong founded the Xuan Vinh Group - a volunteer advocacy organization which seeks to consult and support people living with HIV/AIDS.

Today, she seems uninterested in campaigns to educate the parents and schools about transmission and acceptance. Instead, she has found great success in secrets.

Phuong said that the best way to get an infected child into school is to tell no one about his or her health status.

"I have been able to campaign for at least ten [HIV-infected] children to go to school since the beginning of the school year [which started on August 16]," Phuong said. "But that's nothing compared to the total number of children in need."

Laws vs. law enforcement

Sister Leonor Montiel of the Maryknoll Catholic Mission in Cambodia said that the introduction of anti-retroviral therapy (ART) changed her job signiticantly.

The medicines inhibit the replication of the HIV virus inside the body, reducing the virus count in the blood to undetectable levels.

Doctors say that ART renders transmission of the virus virtually impossible.

All of a sudden, Sister Montiel found herself helping HIV-positive adults live instead of die. And their children now had a future.

"ART really changed the context in Cambodia," she said. "Now we have to think about living with the consequences. And we totally didn't expect to be taking care of so many children."

Sister Montiel said that while discrimination and stigmas do exist, long-term community cooperation and education programs have allowed Cambodia to successfully create educational opportunities for this marginalized population.

For nearly 15 years, she has been working with teachers and schools in Cambodia"”where, she said, HIV-positive children and the HIV-negative children orphaned by AIDS have been integrated into regular public schools.

"For those that are in their teenage years, a few have started tech school or university," she said. "Six have just passed an entrance exam for hotel and restaurant training."

While the same medicines are now available to Vietnamese children, their opportunities are far more limited.

The Vietnamese Health Ministry estimates that there are around 254,000 people living with HIV in 2010, including 5,100 children.

According to the Vietnam Administration of AIDS Control, around 2,000 HIV-infected children received ART last year.

The remaining 3,100 represent an estimate of those children that have not yet been identified and tested, wrote Dr. Donn Colby, Medical Director of the Harvard Medical School AIDS Initiative in Vietnam in an e-mail.

Dr. Colby said that International NGOs began donating ART medicines to Vietnam relatively recently.

"They have been available since 2005," he wrote. "But it took a few years for the treatment system to reach nationwide availability and accessibility."

In 2006, The National Assembly [Vietnam's parliament] essentially illegalized discrimination based on HIV/AIDS status. Under current regulations, children cannot be denied access to school if they or any members of their family are living with HIV/AIDS. The laws also bar employers from firing infected employees, or doctors from refusing to treat someone, because of his or her HIV status.

"The government of Vietnam has issued some good policies to prevent the stigmatization and discrimination against people with HIV/AIDS," said Jean Dupraz, the UNICEF deputy representative in Vietnam. "It's true that there are many challenges when putting these policies into practice,"

"The laws are already there. But they can't be implemented, on the local level overnight," said Dang Huynh Mai, vice chair of the Vietnam Child Rights Protection Association.

"It would be too optimistic or even extreme to expect the laws to be in force at every school [just a few years after their passage]," said Mai, who once served as the Deputy Minister of Education from 2001 to 2007. "˜The whole commune knows'

Eight year-old Huynh Yen Dang managed to clear out his whole classroom without lifting a finger.

On Monday (September 21), only four of his classmates showed up to the Trang Tan Khuong primary school in Ho Chi Minh City's Nha Be District.

The parents of the other 31 first-graders kept their kids home, fearing that Dang [whose full name has been changed to protect his identity] would infect them with HIV.

Dang's grandmother said school administrators asked her to keep him at home for three days.

The school principal claimed that they only asked her to keep him at home over the weekend.

One week earlier, parents met with school administrators and local authorities to let them know they refused to let their children attend class unless the school expelled Dang.

"I'm so sad. I just want to go to school," Dang said. The boy's mother died of AIDS several years ago. He now lives with his grandparents and father, who is also HIV-positive, in Nha Be District's Long Thoi Commune.

"I hope that I will be allowed to come back to school soon," he said. "Even though nobody wants to hang out with me there."

Nguyen Truong Giang, vice chair of the Long Thoi Commune People's Committee, where the school is based, said she has been bombarded by calls from disgruntled parents insisting that the local government intervene to protect their children.

"It seems that the whole commune knows [about the HIV status of Dang]," Giang said.

At the latest meeting between the local authorities and parents held Wednesday, members of the Nha Be District administration reiterated that they would do their best to bring Dang back to school.

According to the principal, Dang has returned to class, despite continued protests from some parents.

The secret solution

Phuong said that small battles like Dang's are slowly whittling down HIV discrimination among Vietnamese parents. The stigma, she said, has somewhat abated over the past decade.

But it isn't just parents that keep these kids out of schools, she said.

"In some cases, it was the school management that had tried to deny enrollment to [HIV-infected] kids and then passed the buck onto parents," Phuong said.

She cited the recent example of a principal at a primary school in HCMC's District 11 who refused, last month, to accept a first-grader because of his HIV status.

Phuong instructed the grandmother of that boy to lodge a complaint with the District 11 Education Agency.

She said the principal conceded and asked the grandmother to drop her complaint.

"It seems to me that sometimes school leaders don't fear the laws," she said. "They only fear their superiors."

Mai of the Child Rights Protection Association said she has never heard of such an incident.

"I don't think a school leader would dare to openly refuse a kid because he is HIV-positive," Mai said. "[But] perhaps [such an administrator] could find some other clever way to do so."

For this reason, Phuong said her first tactic when trying to get an HIV-infected kid into school is to keep their health status secret.

"I don't know how other people do it," Phuong said. "But for me, it's always the smartest option."

Mai said she does not totally support the idea of sending HIV-infected children to schools secretly, "but it can be considered a wise decision if the stigma among the locals there is still too entrenched."

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