HIV/AIDS in VIETNAM. Dung Chi Tham,, M.D. Thuong Vu Nguyen, M.D. Epi Spring Quarter, 2007

Transcription

1 HIV/AIDS in VIETNAM Dung Chi Tham,, M.D. Thuong Vu Nguyen, M.D. Epi Spring Quarter, 2007

2 Contents Country background HIV/AIDS Situation Reported cases Sentinel surveillance HIV/AIDS estimation and projection, National Strategy for HIV/AIDS control and prevention Objective Strategies Solutions

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4 Country background Area Provinces: 64 Districts/precincts ,600 km2 Communes/wards 10,732 Climate North: subtropical South: tropical Annual rainfall 1.8 to 2.4 m Only one official lang.: Vietnamese ÊÚ Ha Tay Hun ÊÚ g Yen ÊÚ ÊÚ Nam Dinh ÊÚ Kien Giang Hai Ph ong ci ty Thua ÊÚ Thien - Hue ÊÚ Da Nang city ÊÚ Khanh Hoa

5 Country background 54 ethnicities Kinh group (86% of pop.) Pop. (est. Jul 07): 85 millions Urban: 26%/ Rural: 74% Male: 49%/Female 51%. Population density inhabitants/km2 Pop. growth rate (2007): 1.004% Population (2006) <15 years old: 27% years old: 58% 50-69: 11% 70+: 4% Sources:

6 Economy GDP (2005): Real growth rate (2006): 8.4%. Per capita income (2005): $638. Inflation rate (2006): 4.1%. $53.1 billions. Public debt: 47.5% of GDP, 2006 Agriculture and forestry 20.9% of GDP, 2005 Services 38.1% of GDP, 2005 Industry and construction 41% of GDP,

7 Health statistics 2007 Life expectancy at birth: Male: years Female: years years Infant mortality rate: 24.4/1,000 Total fertility rate: 1.89 children/woman Mortality/children<5: 26/1,000 Maternal mortality: Child malnutrition: 37% Doctor per 100,000: 50 Health Budget : 130/100,000 live birth. 0.8% GDP

8 Top 10 morbidities (MOH, 2004) Top 10 morbidities (MOH, 2004) 1,500 1, Influenza Malaria Tuberculosis DF/DHF Bacillus Dysentery Ameba Dysentery Mumps Typhoid Fever Viral Hepatitis Measles

9 Top 10 mortalities (MOH, 2004) Top 10 mortalities (MOH, 2004) Tuberculosis HIV/AIDS Malaria Tetanus DF/DHF Viral Hepatitis Meningococcal Meningitis Ameba Dysentery Diphtheria Cholera

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11 HIV/AIDS Epidemiology in VIETNAM

12 Vietnam Preventive Medicine System NIHE 64 PMCs Inst. of Hyg & Epi, Central Highland Centers for Border Health Quarantine Pasteur Institute, Nha Trang Pasteur Institute, HCM City

13 Reported HIV infections in Vietnam , , , , , , , , ,253 16, , , ,000 80,000 60,000 40,000 20,000 0 New cases Cumulative '90 '91 '92 '93 '94 '96 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 Number of HIV cases

14 Reported AIDS, Vietnam ' '00 '01 '02 '03 '04 '05 25,000 20,000 15,000 10,000 5,000 0 New AIDS cases Cumulative Number of AIDS cases

15 Reported AIDS deaths Vietnam ,193 1,385 1,661 1, ,673 1, ,000 12,000 10,000 8,000 6,000 4,000 2,000 0 New AIDS Deaths Cumulative Number of AIDS deaths '00 '01 '02 '03 '04 '05 '06

16 Distribution of reported HIV infections by gender, Vietnam Female Female 14.44% 14.44% Unknown Unknown 2% 2% Male Male 83.11% 83.11%

17 Distribution of reported HIV infections by gender and years, Vietnam % 100% 80% 80% Percentage Percentage 60% 60% 40% 40% 20% 20% 0% 0% Years Years Male Male Female Female Unknown Unknown

18 HIV infections reported by target groups, Vietnam Others Others 19% 19% Unknown Unknown 7% 7% Recruital Recruital 1% 1% IDU IDU 52% 52% Suspected Suspected AIDS AIDS 10% 10% Blood Blood transfusion transfusion 1% 1% TB TB 5% 5% STD STD 2% 2% CSW CSW 3% 3%

19 Distribution of HIV infections by age groups, Vietnam yrs yrs 9% 9% >50 >50 yrs yrs 1% 1% Unknown Unknown 1% 1% <13 <13 yrs yrs 1% 1% yrs yrs 9% 9% yrs yrs 24% 24% yrs yrs 55% 55%

20 Distribution of 2 target age groups by years, Vietnam % 80% Percent 60% 40% 20% 0% Years Other groups

21 Model of HIV development IDU FSW Clients Male at low risk Female at low risk Children

22 HIV Sentinel Surveillance Systems in Vietnam

23 Sentinel surveillance systems History: 1994: 8 provinces 1995: 12 provinces 1996: 21 provinces 2001: 30 provinces 2004: 40 provinces

24 Prevalence of HIV among 3 main High risk groups Vietnam, STIs FSWs IDUs 25.0 Percent '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 Year

25 Prevalence of HIV infection among Recruit-Health Health- check Youth & Pregnant women, Vietnam HIV prevalence (%) '00 '01 '02 '03 '04 '05 Preg. Women Recruit-Health-check Youth

26 Number of people living with HIV/AIDS by sex 500,000 Current No. of HIV infections 450, , , , , , , ,000 50,000 Total Male Tæ ng s è Nam Female N Ye a r

27 New and cumulative of AIDS deaths ,000 90,000 No. of deaths 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Luü tý c h Cumulative New death Sè c a tö vong míi Ye a r

28 STIs 5 border provinces of Vietnam where ADB project Community Action against HIV/AIDS has been covering for 4 years

29 Selected STIs among FSWs in 5 border provinces between 2002 & 2004 % HV Syphilis HSV-2 NG CT NGCT

30 Behavioral surveillance

31 Methods Time: 2000, 2001 Sites: Hanoi, Hai Phong, Da Nang, Ho Chi Minh City, Can Tho Population: High risk populations (IDU, street sex workers, karaoke sex workers, male migrants, male long distance truck drivers Community-based samples Questionnaire demographic information, sex partners and condom use, drug injection and needle and syringe sharing, HIV knowledge and beliefs, and access to interventions including VCT

32 SHARING NEEDLES IDU & SYRINGES, BSS HN HP DN HCM CT Source: Ministry of Health, HN HP DN HCM CT Street SWs

33 NUMBER OF ONE-TIME CLIENTS AMONG SSWs IN THE PAST DAY, BSS 2001 HN HP partners DN partner 2 partners HCMC or more partners CT % 20% 40% 60% 80% 100% Source: Ministry of Health, 2004

34 CONSISTENT CONDOM USE AMONG STREET-BASED FSWs, BSS one-time client 2001 Regular client 2001 Regular partner 2001 HN HP DN HCM CT Source: Ministry of Health, 2004

35 INJECTING DRUG USE AMONG STREET-BASE FSWs, BSS Ever Used Drugs Ever Injected Drugs Hai Phong Hanoi Injected in Past 1 Month Shared in Past Month Source: Ministry of Health, 2004

36 MARRIED AND UNMARRIED MEN HAD SEX WITH SEX WORKERS, BSS 2001 Unmarried migrants Married migrants FLL Unmarried LDTD FLL Married LDTD % 20% 40% 60% 80% 100% No commercial sex Commercial sex with consistent condom use Unprotected commercial sex Source: Ministry of Health, 2004

37 Behavior of PLWHA in 5 border province of VN, (ADB) (%) Before After Regular Sometimes Never Males Females Syringe & needle sharing Condom use

38 Summary Southern VN : highest reported No of HIV compared with other regions HIV epidemic: 2nd phase (UNAIDS, 2001) HIV increasing: high risk groups: IDUs, FSWs,, STD patients, but now tends to slightly decrease HIV predominant in younger age High STIs in FSWs High risk behaviors: FSWs, IDUs,, PLWHA

39 National HIV/AIDS prevention and control program (strategies until 2010)

40 GENERAL OBJECTIVES OF THE NATIONAL STRATEGY ON HIV/AIDS PREVENTION AND CONTROL IN VIETNAM TILL 2010 To control the HIV/AIDS prevalence rate among the general population to below 0.3% by 2010 and with no further increase after 2010; to reduce the adverse impacts of HIV/AIDS on social-economic development

41 main solutions for implementation of the national strategic in hiv/aids prevention for period Society techniques resources

42 1. Leadership of the Party and the State Social Solutions Social Solutions 2. Integrate HIV/AIDS Control into social and ecomomical development plans 3. HIV/AIDS:a multisectoral and comprehensive program 5. BCC 4. Perfect the legal frame, regimes & policies 7. Comprehensive support for PLWHA 6.Harm reduction intervention

43 1.HIV/AIDS Surveillance 7. HIV/AIDS Research 2. Safe Blood Transfusion 6. STIs Control: surveillance, diagnosis and treatment Technical solutions 5. PMCT 4. Access to ARV 3. Prevention: Social & medical services,

44 4. International cooperation on HIV/AIDS Control & Prevention 1. Increase fulltime personnel capabilities. Integrate local & central budgets 3. Increase investment, mobilize resources Administration & resource solutions 2. Encourage research into, production of test kits and drugs for HIV/AIDS

45 9. Increase capabilitis & international cooperation 1. BCC 2. Harm reduction 8. Blood transfusion safety 7. STIs management Action Programs 3. Care for PLWHA 4. HIV/AIDS surveillance & evaluation 6. PMCT 5. Access to HIV/AIDS

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47 8. Members of NCADP 7.VTV, VOV, VNNews Agency 9. Vietnam Father Front 1. Provincial People s Committees, centrally-run cities Directing action programs for HIV/AIDS control & prevention correspond to social & economical development plans Actively invest budgets, human resources, & material foundation Enhace Harm reduction Care and treatment 6. MOPI &MOF Implementation of strategies 2. MOH responsible for guiding the Implementation of the National Strategy 5. MOLISA 4. MOET 3. The Ministry of Cul.& Inf

48 Which one you choose?