Cablegate: Substance Abuse Treatment and Hiv/Aids in Hcmc (Update)
This record is a partial extract of the original cable. The full text of the original cable is not available.
UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 000984
SIPDIS
SENSITIVE
E.O. 12958: N/A
TAGS: PGOV PREL SOCI SNAR PHUM VM KHIV CNARC HIV AIDS RELFREE
SUBJECT: SUBSTANCE ABUSE TREATMENT AND HIV/AIDS IN HCMC (UPDATE)
REF: A) HCMC 132; B) HCMC 160; C) HCMC 398
Summary
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1. (SBU) The visit of an INL-led team to HCMC underscored the
need for new approaches in drug rehabilitation and in HCMC's 20
drug rehabilitation centers. HCMC is still struggling to provide
effective substance abuse and medical treatment for the 30,000
injecting drug users and commercial sex workers in its
rehabilitation centers, the primary populations in Vietnam for
acquiring and/or transmitting HIV. Contacts in the HCMC Catholic
Archdiocese report that local corruption, bureaucratic ineptitude
and discrimination against persons with HIV/AIDS are undermining
the Church's efforts to act as an effective NGO partner with the
HCMC government in the battle against HIV/AIDS. End Summary.
REHABILITATION CENTERS AND HIV/AIDS
-----------------------------------
2. (U) The visit of INL/C Gregory Stanton and Fernando Perfas of
Daytop International to HCMC August 17 to 19 highlighted the
challenges confronting HCMC in rehabilitating drug abusers and
combating the closely linked problem of HIV/AIDS. The team came
to HCMC to lay the groundwork for Daytop International, a U.S.-
based NGO, to implement an INL project to train 140 staff of 20
rehabilitation centers throughout Vietnam on a new drug
rehabilitation model. The team was in HCMC to identify which of
its rehab centers will participate in the program, slated to
begin in November 2005. (HCMC has 20 rehabilitation centers --
05/06 centers -- housing 30,000 inmates. The HCMC Department of
Labor, Invalids and Social Affairs (DOLISA) directly manages 12
centers. The HCMC Youth Federation manages the other eight
centers.) During their visit to HCMC, the INL team met with Le
Thanh Tam, Director, HCMC Department of Labor, Invalids and
Social Affairs (DOLISA), Dr. Lan Thao of the HIV/AIDS Committee
in HCMC, staff from 3 rehabilitation centers, and Father Dinh
Thoai, Coordinator for HIV/AIDS programs for the HCMC Catholic
Archdiocese.
3. (SBU) HCMC is still struggling to provide effective substance
abuse and medical treatment for injecting drug users and
commercial sex workers, the most vulnerable populations in
Vietnam for acquiring and/or transmitting HIV. Le Thanh Tam,
Director of HCMC DOLISA stated that 50 to 60 percent of inmates
in the city's rehabilitation centers are known to be HIV
positive. The actual number may be higher since HCMC does not
have compulsory HIV testing. In many centers residents are tested
but do not receive test results; thus, a significant number
return to home communities unaware of their HIV status.
4. (U) Tam said that the HCMC model divides drug rehabilitation
into two phases. Phase one focuses on detoxification, health
improvement and therapy. This phase lasts for two years. At the
end of phase one, the inmates are "encouraged" to enroll in the
second stage of the program, which focuses on education,
vocational training and job placement. The length of the second
stage is between one and three years. According to
rehabilitation center managers, the length of stay is determined
by the inmate's ability to meet risk-mitigating criteria such as
family support, prospective stable employment, and guaranteed
housing in a neighborhood declared as a "drug-free zone." The
Phu Van center officials acknowledged that most inmates are
unable to meet the early release criteria and remain in centers
for the full term. The officials also stated, "It takes a lot of
effort by staff to get the inmates to volunteer to stay. Risks
of early re-entry (to society) must be explained and reiterated
to residents and families." Once the inmates agree to stay, they
must sign a contract, which is submitted to local government
authorities. The HCMC government hopes that the extra three
years in a rehabilitation center will reduce the relapse rate,
which stands at over 90 percent. The first class of five-year
program clients will graduate in November 2005.1
5. (SBU) Le Thanh Tam stated that the HCMC rehabilitation program
faces numerous serious challenges, including low education levels
in the client population. Between 45 and 60 percent of inmates
at different centers have not completed primary education. A
significant number are illiterate, making vocational and
counseling activities difficult to organize. Up to 25 percent of
inmates were abandoned when they were children and have criminal
records. Up to 90 percent of inmates in some centers never had a
stable job or occupation before entering the center.
6. (U) Compounding the challenge of rehabilitation and
reintegration into society, Dr. Thao of the HCMC HIV/AIDS
Committee reported a significant increase in the number of known
people living with HIV/AIDS (PLWHA) in 2005. The increase of
PLWHA is due to a new generation of drug users who are more
sexually active and take drugs in group settings, often sharing
needles. The exact figures are unknown as very few persons use
the city's voluntary testing program, Thao said. Thao noted that
in HCMC there is no aid or other benefits available for those
identified as having HIV, and people fear the stigma of
considerable societal discrimination against PLWHA in Vietnam.
COLLABORATION BETWEEN CHURCH AND STATE ON THE ROCKS
--------------------------------------------- ---------
7. (SBU) Father Phuong Dinh Toai, in charge of HIV/AIDS programs
for the HCMC Archbishop's office, expressed growing frustration
with the inability of the Church to collaborate effectively with
HCMC to care for persons with HIV/AIDS. At a senior level, the
Archdiocese's relationship with the HCMC government is generally
positive. The HCMC government has licensed the Church to operate
a hospice for terminal AIDS patients in the Cu Chi District of
HCMC and invited the church to staff and run the HIV/AIDS
hospital in the city's Trong Diem rehabilitation center. Father
Thoai noted that the city administration also turns a blind eye
to the Church's other initiatives such as opening a shelter for
women and children with HIV/AIDS and running a private health
clinic for HIV/AIDS patients.
8. (SBU) However, the HCMC government has thus far been unable or
unwilling to intervene with other local officials in support of
the Church's activities. For example, although the Church has
complained to the HIV/AIDS Committee and DOLISA about corruption,
malfeasance and incompetence in the Trong Diem center, nothing
has changed. Church volunteers at the center protested the
local administrator's "no dying in the center" policy. According
to Thoai, the center's managers do not want to deal with the
paperwork associated with recording the deaths of patients in
center and press for the patients to be transferred to hospitals
to die.2 The Church has protested that such a policy is inhumane
and impossible to implement in any case. Administrators have
asked Church caregivers to falsify death records in cases where
patients have died at the center. Administrators "counsel" the
Church-supplied staff to tell visitors that they have no
shortages of medicine and equipment, although medical supplies
are in fact inadequate. The Church also has reported situations
when government-assigned staff members beat patients and smuggled
cigarettes and other contraband into the center to sell to the
patients. Other government staff reportedly accepted bribes from
inmates to allow them to escape. As a result, administrators in
Trong Diem have delayed signing new personnel contracts with the
Church and have made working conditions for Church-supplied staff
very difficult, Father Thoai said. Additionally, local officials
only permit the Church staff four days of leave per month, making
life very tough for them.
9. (SBU) The Church also is dissatisfied with the HCMC
Government's response to local police "harassment" against its
unofficial shelter for abandoned women and children with
HIV/AIDS. Father Thoai said he complained to the HIV/AIDS
committee that local police had begun harassing staff, checking
documents, threatening closure and conducting snap inspections,
after they found out the shelter was for persons with HIV/AIDS.
The HCMC HIV/AIDS Committee offered to legalize the center, but
on the condition that the Church cede managerial control to it.
Thus far, the HCMC Cardinal has refused.
10. (SBU) According to Father Thoai, HCMC parish priests and even
other bishops have criticized privately HCMC Cardinal Man for
trying to regularize church HIV/AIDS humanitarian activities and
expand them in cooperation with the state. Thoai stated that the
Cardinal is particularly frustrated that HCMC authorities have
sought to steer potential donors from offering assistance
directly to the Church. In response, the Cardinal plans to
organize his own international charitable conference on HIV/AIDS
in HCMC in late October. Current plans call for the HCMC
Archdiocese to invite sister church organizations such as such as
Caritas Germany, Secours-Catholique of France, Catholic Relief
Services, and MISERO Germany. The Archdiocese would invite local
GVN organizations including the Fatherland Front, HIV/AIDS
Committee, and possibly the HCMC Union of Friendship Associations
to participate.
11. (SBU) Comment: The visit of the INL team and subsequent
discussions with NGO implementers at the rehabilitation centers
underscored the timeliness of the INL project as well as the
challenges before it, particularly in tackling the petty
bureaucracy, occasional corrupt practices and discrimination
against those with HIV/AIDS inside and outside of the centers.
The visit also highlights the utility of having an NGO presence
in the rehabilitation centers to act as an independent source of
information on conditions within the centers. End Comment.
WINNICK
_______________________________
1This is the first information I've had that there is anything
voluntary about the second 1-3 year stage of treatment. The
requirement for residents to return to a "drug-free" zone is also
problematic. If this requirement were applied comprehensively,
no one would be eligible for release.
2Interesting...when we visited Trong Diem, Dr. Giang (HCMC PAC)
told us patients were not allowed to die at the centers because
they had no crematoria to dispose of the bodies.