Tăng tỷ lệ lây nhiễm qua đường tình dục - Thách thức phòng chống HIV/AIDS | VTV24

Key Concepts

• HIV/AIDS Prevention and Control: National efforts and strategies to combat HIV/AIDS.
• Stigma and Discrimination: The societal barriers faced by individuals living with or at risk of HIV.
• ARV Treatment: Antiretroviral therapy for managing HIV infection.
• Viral Load Suppression: The goal of ARV treatment to reduce the amount of HIV in the blood to undetectable levels.
• PrEP (Pre-Exposure Prophylaxis): Medication taken by HIV-negative individuals to prevent HIV infection.
• Sexual Transmission: The primary mode of HIV transmission in Vietnam.
• MSM (Men who have sex with men): A key population group with a high HIV infection rate.
• International Funding: Reliance on external financial support for HIV/AIDS programs.
• Health Insurance: The role of health insurance in ensuring continuous ARV treatment.
• Community Engagement: The importance of community involvement in HIV prevention and support.

National Action Month for HIV/AIDS Prevention and Control

The theme for this year's National Action Month for HIV/AIDS Prevention and Control is "Unity is Strength, Together to End AIDS." This campaign aims to mobilize societal participation to eliminate stigma and ensure equitable access to HIV prevention and control services.

Progress and Challenges in Vietnam

Key Achievements:

• Extensive Testing: Over 2 million HIV tests are conducted annually, identifying more than 10,000 positive cases.
• Treatment Coverage:
  • Approximately 87% of people living with HIV know their status.
  • 79% of those who know their status are receiving ARV treatment.
  • 96% of those on ARV treatment have a viral load below the suppression threshold.
• Regional Comparison: These results are higher than the Asia-Pacific average and approach global benchmarks, demonstrating the effectiveness of Vietnam's HIV/AIDS control program.

Emerging Challenges:

• Increasing New Infections: Despite progress, the number of newly detected HIV infections continues to rise. In the first nine months of this year, nearly 7,000 new HIV infections were reported nationwide.
• Shift in Transmission Routes: Since 2010, there has been a significant shift from blood-borne transmission to sexual transmission as the primary mode of HIV infection.
• High-Risk Group: Men who have sex with men (MSM) currently represent the group with the highest HIV infection rate.

Financial Resource Dependency and PrEP Shortages

A major challenge facing HIV/AIDS prevention efforts is the heavy reliance on international projects for nearly 50% of financial resources, particularly for the PrEP program.

• PrEP Scarcity: For over six months, the availability of free PrEP medication has become scarce due to the depletion of donor funding. This shortage poses significant difficulties for prevention efforts in the country.
• Impact on Clinics: A clinic that previously provided care and PrEP to over 700 at-risk clients now serves only a few dozen. In Hanoi, only 3 out of 20 HIV clinics have access to free PrEP funded by international programs.
• Community Concerns: Community members face difficulties in finding affordable and genuine PrEP medication, with concerns about counterfeit or substandard drugs circulating in the market.
• Accessibility Issues: Government health services operate during administrative hours, making it difficult for individuals to access PrEP medication outside of these times.
• Cost of PrEP: While clients can purchase PrEP services, the cost varies significantly, ranging from 300,000 to 500,000 VND per month for a treatment course. This is a substantial financial burden for students and individuals with low to moderate incomes.
• Projected Increase in Infections: Without free PrEP support for economically disadvantaged individuals, there is a strong likelihood of a significant increase in infections in the coming years.

Shifting Perceptions and Reliance on PrEP

• Trust and PrEP: Within the LGBT community, the use of condoms is sometimes perceived as reducing intimacy and trust. Conversely, knowing that a partner is on PrEP signifies a commitment to HIV prevention, fostering a sense of trust and connection.
• Condom Use Decline: Despite the risk of HIV transmission due to PrEP shortages, few individuals in the LGBT community use condoms during sexual activity, as it is seen as undermining trust.

Government Response to PrEP Shortages

The Department of Preventive Medicine has planned to procure additional medication to continue the PrEP distribution program to HIV prevention clinics nationwide.

• Policy Changes: Changes in PEPFAR (U.S. President's Emergency Plan for AIDS Relief) policies at the beginning of 2025 have disrupted the supply of PrEP.
• Procurement Efforts: The department is actively purchasing medication from existing global sources to cover areas currently experiencing shortages due to PEPFAR funding gaps.
• Timeline for New Supply: The new supply of medication is anticipated to be available in early next year.

PrEP Program Scale and Targets

• Free Provision: Since 2019, PrEP has been provided free of charge through 200 facilities with various service delivery models.
• Usage Statistics (2020-2024): Over 110,100 individuals have used PrEP at least once, with a retention rate of over 70% for treatment duration of three months or more.
• National Strategy Goal: Vietnam's national strategy aims to have 40% of gay men on PrEP by 2030.

WHO Concerns and the Risk of Complacency

The World Health Organization (WHO) representative in Vietnam views the PrEP shortage as a significant risk that could lead to an increase in HIV infections.

• Complacency Risk: Beyond the medication shortage, there is a greater underlying concern about complacency following significant advancements in HIV/AIDS control.
• Reduced Funding Impact: The sudden reduction in international funding has led to PrEP shortages in many areas, which is a serious concern.
• Increased New Infections: If high-risk groups lack access to preventive measures, a rise in new infections is highly probable.
• Decreased Community Attention: As HIV cases decrease and significant achievements are made, community attention and concern may wane, leading to a lapse in prevention efforts. This requires vigilance.
• Regional Examples: The recent surge in new infections in countries like the Philippines in the past 12 months serves as a warning of what can happen if robust HIV prevention programs are not maintained consistently.

ARV Treatment and Health Insurance

A key priority for Vietnam is not only reducing HIV transmission but also encouraging people living with HIV to enroll in health insurance for uninterrupted free ARV treatment. However, achieving this goal is challenging.

• Patient Case Study: A patient diagnosed with HIV over 10 years ago initially could not afford ARV treatment, leading to severe health deterioration. After the local government facilitated health insurance enrollment, his treatment costs were fully covered.
• Economic Benefits of Insurance: Health insurance significantly reduces the economic burden, as ARV medication can be expensive. Before 2003, the monthly cost for medication was around one million VND.
• Health Insurance Coverage in Bac Ninh: The Bac Ninh Center for Disease Control is monitoring nearly 1,200 people living with HIV, with approximately 90% enrolled in health insurance.
• Barriers to Insurance: Some individuals hesitate to use health insurance due to fear of their HIV status being revealed to family, friends, or acquaintances.
• Future Implications: If patients do not use health insurance, they rely on donated medication. As donated drug supplies are expected to decrease, this poses a risk to both patients' economic well-being and the consistent availability of treatment, as HIV requires lifelong management.
• ARV Medication Access Issues: A young man from Thai Nguyen must regularly travel to Bach Mai Hospital in Hanoi to collect his ARV medication. The supply at these facilities is largely donor-funded, leading to occasional shortages. Patients may receive weekly allotments or have to purchase medication out-of-pocket.
• Stigma and Travel: The patient chooses to travel to Hanoi for medication despite the cost and inconvenience, fearing that collecting medication locally would reveal his identity to friends and relatives.
• Risks of Out-of-Pocket Purchases: Individuals purchasing medication outside of official channels risk obtaining products with unclear origins or questionable quality. They also lack access to medical consultations, examinations, and adherence support from healthcare professionals, which are crucial for effective HIV management. Therefore, HIV management requires strict oversight.
• Local Efforts and Stigma: Local authorities are working to increase health insurance enrollment among people living with HIV through home visits and free insurance purchases. However, stigma remains a significant barrier, causing reluctance among individuals to participate.

Conclusion: Ending AIDS by 2030

Ending AIDS by 2030 is an ambitious goal that Vietnam has committed to. To achieve this, sustainable financial resources are essential, alongside societal support in eliminating stigma. Each individual must also take responsibility for protecting themselves and the community through safe prevention methods, especially as sexual transmission is the primary risk factor. In the fight against HIV/AIDS, the responsibility of each person is the strength of the entire community.